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Su J, Shen H, Peng L, Hu D. Few-Shot Domain-Adaptive Anomaly Detection for Cross-Site Brain Images. IEEE TRANSACTIONS ON PATTERN ANALYSIS AND MACHINE INTELLIGENCE 2024; 46:1819-1835. [PMID: 34748478 DOI: 10.1109/tpami.2021.3125686] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Early screening is essential for effective intervention and treatment of individuals with mental disorders. Functional magnetic resonance imaging (fMRI) is a noninvasive tool for depicting neural activity and has demonstrated strong potential as a technique for identifying mental disorders. Due to the difficulty in data collection and diagnosis, imaging data from patients are rare at a single site, whereas abundant healthy control data are available from public datasets. However, joint use of these data from multiple sites for classification model training is hindered by cross-domain distribution discrepancy and diverse label spaces. Herein, we propose few-shot domain-adaptive anomaly detection (FAAD) to achieve cross-site anomaly detection of brain images based on only a few labeled samples. We introduce domain adaptation to mitigate cross-domain distribution discrepancy and jointly align the general and conditional feature distributions of imaging data across multiple sites. We utilize fMRI data of healthy subjects in the Human Connectome Project (HCP) as the source domain and fMRI images from six independent sites, including patients with mental disorders and demographically matched healthy controls, as target domains. Experiments showed the superiority of the proposed method compared with binary classification, traditional anomaly detection methods, and several recognized domain adaptation methods.
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Liang L, Li S, Huang Y, Zhou J, Xiong D, Li S, Li H, Zhu B, Li X, Ning Y, Hou X, Wu F, Wu K. Relationships among the gut microbiome, brain networks, and symptom severity in schizophrenia patients: A mediation analysis. Neuroimage Clin 2024; 41:103567. [PMID: 38271852 PMCID: PMC10835015 DOI: 10.1016/j.nicl.2024.103567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024]
Abstract
The microbiome-gut-brain axis (MGBA) plays a critical role in schizophrenia (SZ). However, the underlying mechanisms of the interactions among the gut microbiome, brain networks, and symptom severity in SZ patients remain largely unknown. Fecal samples, structural and functional magnetic resonance imaging (MRI) data, and Positive and Negative Syndrome Scale (PANSS) scores were collected from 38 SZ patients and 38 normal controls, respectively. The data of 16S rRNA gene sequencing were used to analyze the abundance of gut microbiome and the analysis of human brain networks was applied to compute the nodal properties of 90 brain regions. A total of 1,691,280 mediation models were constructed based on 261 gut bacterial, 810 nodal properties, and 4 PANSS scores in SZ patients. A strong correlation between the gut microbiome and brain networks (r = 0.89, false discovery rate (FDR) -corrected p < 0.05) was identified. Importantly, the PANSS scores were linearly correlated with both the gut microbiome (r = 0.5, FDR-corrected p < 0.05) and brain networks (r = 0.59, FDR-corrected p < 0.05). The abundance of genus Sellimonas significantly affected the PANSS negative scores of SZ patients via the betweenness centrality of white matter networks in the inferior frontal gyrus and amygdala. Moreover, 19 significant mediation models demonstrated that the nodal properties of 7 brain regions, predominately from the systems of visual, language, and control of action, showed significant mediating effects on the PANSS scores with the gut microbiome as mediators. Together, our findings indicated the tripartite relationships among the gut microbiome, brain networks, and PANSS scores and suggested their potential role in the neuropathology of SZ.
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Affiliation(s)
- Liqin Liang
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou International Campus, Guangzhou 511442, China
| | - Shijia Li
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou International Campus, Guangzhou 511442, China; Swammerdam Institute for Life Sciences (SILS), University of Amsterdam, Amsterdam, The Netherlands
| | - Yuanyuan Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China
| | - Jing Zhou
- School of Material Science and Engineering, South China University of Technology, Guangzhou 510006, China; National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China
| | - Dongsheng Xiong
- School of Material Science and Engineering, South China University of Technology, Guangzhou 510006, China; National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China
| | - Shaochuan Li
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, China; Realmeta Technology (Guangzhou) Co., Ltd, Guangzhou 510535, China
| | - Hehua Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China
| | - Baoyuan Zhu
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou International Campus, Guangzhou 511442, China
| | - Xiaobo Li
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
| | - Yuping Ning
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China
| | - Xiaohui Hou
- Guangdong Provincial Key Laboratory of Physical Activity and Health Promotion, Guangzhou Sport University, Guangzhou 510500, China.
| | - Fengchun Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China.
| | - Kai Wu
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou International Campus, Guangzhou 511442, China; National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China; Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan.
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Cao X, Li Q, Liu S, Li Z, Wang Y, Cheng L, Yang C, Xu Y. Enhanced Resting-State Functional Connectivity of the Nucleus Accumbens in First-Episode, Medication-Naïve Patients With Early Onset Schizophrenia. Front Neurosci 2022; 16:844519. [PMID: 35401094 PMCID: PMC8990232 DOI: 10.3389/fnins.2022.844519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/01/2022] [Indexed: 01/10/2023] Open
Abstract
There is abundant evidence that early onset schizophrenia (EOS) is associated with abnormalities in widespread regions, including the cortical, striatal, and limbic areas. As a main component of the ventral striatum, the nucleus accumbens (NAc) is implicated in the pathology of schizophrenia. However, functional connection patterns of NAc in patients with schizophrenia, especially EOS, are seldom explored. A total of 78 first-episode, medication-naïve patients with EOS and 90 healthy controls were recruited in the present study, and resting-state, seed-based functional connectivity (FC) analyses were performed to investigate temporal correlations between NAc and the rest of the brain in the two groups. Additionally, correlation analyses were done between regions showing group differences in NAc functional integration and clinical features of EOS. Group comparison found enhanced FC of the NAc in the EOS group relative to the HCs with increased FC in the right superior temporal gyrus and left superior parietal gyrus with the left NAc region of interest (ROI) and elevated FC in left middle occipital gyrus with the right NAc ROI. No significant associations were found between FC strength and symptom severity as well as the age of the patients. Our findings reveal abnormally enhanced FC of the NAc with regions located in the temporal, parietal, and occipital areas, which were implicated in auditory/visual processing, sensorimotor integration, and cognitive functions. The results suggest disturbed relationships between regions subserving reward, salience processing, and regions subserving sensory processing as well as cognitive functions, which may deepen our understanding of the role of NAc in the pathology of EOS.
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Affiliation(s)
- Xiaohua Cao
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Qiang Li
- Shanxi Provincial Corps Hospital of Chinese People’s Armed Police Force, Taiyuan, China
| | - Sha Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Zexuan Li
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yanfang Wang
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Long Cheng
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Chengxiang Yang
- Department of Psychiatry, Shanxi Bethune Hospital, Taiyuan, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
- Department of Mental Health, Shanxi Medical University, Taiyuan, China
- Shanxi Provincial Key Laboratory of Brain Science and Neuropsychiatric Diseases, Taiyuan, China
- *Correspondence: Yong Xu, ;
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Klein HS, Vanneste S, Pinkham AE. The limited effect of neural stimulation on visual attention and social cognition in individuals with schizophrenia. Neuropsychologia 2021; 157:107880. [PMID: 33961863 DOI: 10.1016/j.neuropsychologia.2021.107880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/15/2021] [Accepted: 04/29/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Research demonstrates a relationship between faulty visual attention and poorer social cognition in schizophrenia. One potential explanatory model suggests abnormal neuromodulation in specific neural networks may result in reduced attention to socially important cues, leading to poorer understanding of another's emotional state or intentions. OBJECTIVE The current study experimentally manipulated neural networks using tDCS to examine this potential causal mechanism. The primary aim was to determine whether stimulation to the right temporoparietal junction (rTPJ) improves visual attention, and secondary aims were to determine whether 1) stimulation improves social cognitive performance and 2) visual attention moderates this improved performance. METHOD Using a double-blind crossover design, 69 individuals with schizophrenia underwent both active and sham stimulation to either the rTPJ of the ventral attention network (n = 36) or the dorsomedial prefrontal cortex of the social brain network (dmPFC; n = 33). Following stimulation, participants completed tasks assessing emotion recognition and mentalizing. Concurrent eye tracking assessed visual attention, measuring proportion of time spent attending to areas of interest. RESULTS For emotion recognition, stimulation failed to impact either visual attention or social cognitive task accuracy. Similarly, neurostimulation failed to affect visual attention on the mentalizing task. However, exploratory analyses demonstrated that mentalizing accuracy significantly improved after stimulation to the active comparator, dmPFC, with no improvement after stimulation to rTPJ. CONCLUSION Results demonstrate limited effect of a single stimulation session on visual attention and emotion recognition accuracy but provide initial support for an alternate neural mechanism for mentalizing, highlighting the importance of executive functions over visual attention.
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Affiliation(s)
- Hans S Klein
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA.
| | - Sven Vanneste
- Trinity College Institute for Neuroscience, Trinity College Dublin, Ireland
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX,, USA
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5
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Mow JL, Gandhi A, Fulford D. Imaging the "social brain" in schizophrenia: A systematic review of neuroimaging studies of social reward and punishment. Neurosci Biobehav Rev 2020; 118:704-722. [PMID: 32841653 DOI: 10.1016/j.neubiorev.2020.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/20/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
Decreased social functioning and high levels of loneliness and social isolation are common in schizophrenia spectrum disorders (SSD), contributing to reduced quality of life. One key contributor to social impairment is low social motivation, which may stem from aberrant neural processing of socially rewarding or punishing stimuli. To summarize research on the neurobiology of social motivation in SSD, we performed a systematic literature review of neuroimaging studies involving the presentation of social stimuli intended to elicit feelings of reward and/or punishment. Across 11 studies meeting criteria, people with SSD demonstrated weaker modulation of brain activity in regions within a proposed social interaction network, including prefrontal, cingulate, and striatal regions, as well as the amygdala and insula. Firm conclusions regarding neural differences in SSD in these regions, as well as connections within networks, are limited due to conceptual and methodological inconsistencies across the available studies. We conclude by making recommendations for the study of social reward and punishment processing in SSD in future research.
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Affiliation(s)
- Jessica L Mow
- Department of Psychological & Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA, 02215, United States.
| | - Arti Gandhi
- Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, United States
| | - Daniel Fulford
- Department of Psychological & Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA, 02215, United States; Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, United States
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Kitoko GMB, Maurage P, Ma Miezi SM, Gillain B, Kiswanga AP, Constant E. Inter-individual variability of social perception and social knowledge impairments among patients with schizophrenia. Psychiatry Res 2020; 290:112951. [PMID: 32505926 DOI: 10.1016/j.psychres.2020.112951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 11/26/2022]
Abstract
Deficits in social perception and knowledge and their negative impact on social functioning, have been repeatedly reported among patients with schizophrenia. However, earlier studies have focused on an overall assessment of social perception and social knowledge, without exploring their sub-components nor the interindividual variation of the deficit. This study aims to refine the exploration of this deficit and to assess its interindividual variation. Twenty-nine patients with schizophrenia and 24 healthy controls, matched for age and gender, completed a validated and integrated social perception and knowledge task (i.e. the PerSo test). Patients with schizophrenia had reduced performance in all PerSo subtests, namely contextual fluency, interpretation and social convention. However, these deficits were not correlated with the severity of clinical symptoms, and individual profiles analyses showed a marked heterogeneity among patients on their abilities. Our study confirms the existence of deficits in social perception and knowledge and underlines their considerable heterogeneity. Therefore, it is necessary to test and rehabilitate individually social perception and knowledge.
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Affiliation(s)
- Germain Manzekele Bin Kitoko
- Department of Psychiatry, Saint-Luc University Hospital and Institute of Neuroscience (IoNS), Université catholique de Louvain, 10 Avenue Hippocrate, B-1200 Brussels, Belgium; Department of Psychiatry, University of Kinshasa, Lemba, Kinshasa, Democratic Republic of Congo
| | - Pierre Maurage
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université Catholique de Louvain, 10 Place C. Mercier, B-1348 Louvain-la-Neuve, Belgium
| | | | - Benoit Gillain
- Department of Psychiatry, Saint Pierre Clinic, B-1348 Ottignies, Belgium
| | - Alain Pierre Kiswanga
- Hôpital Nord AP-HM - Centre Hospitalo-Universitaire chemin des Bourrely, 13015 Marseille, France
| | - Eric Constant
- Clinique Notre-Dame des Anges, 4000 Liège, and Institute of Neuroscience (IoNS), Université catholique de Louvain, 10 Avenue Hippocrate, B-1200 Brussels, Belgium.
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7
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Marotta G, Delvecchio G, Pigoni A, Mandolini G, Ciappolino V, Oldani L, Madonna D, Grottaroli M, Altamura AC, Brambilla P. The metabolic basis of psychosis in bipolar disorder: A positron emission tomography study. Bipolar Disord 2019; 21:151-158. [PMID: 30506616 DOI: 10.1111/bdi.12710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Psychotic symptoms are a common feature in bipolar disorder (BD), especially during manic phases, and are associated with a more severe course of illness. However, not all bipolar subjects experience psychosis during the course of their illness, and this difference often guides assessment and pharmacological treatment. The aim of the present study is to elucidate, for the first time, the FDG uptake dysfunctions associated with psychosis in BD patients with and without a history of past psychotic symptoms, through a positron emission tomography (PET) approach. METHODS Fifty BD patients with lifetime psychotic symptoms, 40 BD patients without lifetime psychotic symptoms and 27 healthy controls (HC) were recruited and underwent an 18F-FDG-PET session. RESULTS Compared to HC, BD subjects shared common FDG uptake deficits in several brain areas, including insula, inferior temporal gyrus and middle occipital gyrus. Moreover, we found that BD patients with a history of past psychotic symptoms had a unique FDG uptake alteration in the right fusiform gyrus compared to both BD patients without lifetime psychotic symptoms and HC (all P < 0.01, cFWE corrected). CONCLUSIONS Overall, our results suggest that FDG uptake alterations in brain regions involved in emotion regulation are a key feature of BD, regardless the presence of past psychosis. Finally, we demonstrated that the FDG uptake reduction in fusiform gyrus is associated with the presence of past psychotic symptoms in BD, ultimately leading towards the idea that the fusiform gyrus might be considered a putative biomarker of psychosis.
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Affiliation(s)
- Giorgio Marotta
- Department of Nuclear Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Scientific Institute, IRCCS E. Medea, Pordenone, Italy
| | - Alessandro Pigoni
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianmario Mandolini
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Ciappolino
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucio Oldani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Domenico Madonna
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marika Grottaroli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfredo Carlo Altamura
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Psychiatry and Behavioural Sciences, UT Houston Medical School, Houston, TX, USA
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Xiang J, Tian C, Niu Y, Yan T, Li D, Cao R, Guo H, Cui X, Cui H, Tan S, Wang B. Abnormal Entropy Modulation of the EEG Signal in Patients With Schizophrenia During the Auditory Paired-Stimulus Paradigm. Front Neuroinform 2019; 13:4. [PMID: 30837859 PMCID: PMC6390065 DOI: 10.3389/fninf.2019.00004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/22/2019] [Indexed: 12/20/2022] Open
Abstract
The complexity change in brain activity in schizophrenia is an interesting topic clinically. Schizophrenia patients exhibit abnormal task-related modulation of complexity, following entropy of electroencephalogram (EEG) analysis. However, complexity modulation in schizophrenia patients during the sensory gating (SG) task, remains unknown. In this study, the classical auditory paired-stimulus paradigm was introduced to investigate SG, and EEG data were recorded from 55 normal controls and 61 schizophrenia patients. Fuzzy entropy (FuzzyEn) was used to explore the complexity of brain activity under the conditions of baseline (BL) and the auditory paired-stimulus paradigm (S1 and S2). Generally, schizophrenia patients showed significantly higher FuzzyEn values in the frontal and occipital regions of interest (ROIs). Relative to the BL condition, the normalized values of FuzzyEn of normal controls were decreased greatly in condition S1 and showed less variance in condition S2. Schizophrenia patients showed a smaller decrease in the normalized values in condition S1. Moreover, schizophrenia patients showed significant diminution in the suppression ratios of FuzzyEn, attributed to the higher FuzzyEn values in condition S1. These results suggested that entropy modulation during the process of sensory information and SG was obvious in normal controls and significantly deficient in schizophrenia patients. Additionally, the FuzzyEn values measured in the frontal ROI were positively correlated with positive scores of Positive and Negative Syndrome Scale (PANSS), indicating that frontal entropy was a potential indicator in evaluating the clinical symptoms. However, negative associations were found between the FuzzyEn values of occipital ROIs and general and total scores of PANSS, likely reflecting the compensation effect in visual processing. Thus, our findings provided a deeper understanding of the deficits in sensory information processing and SG, which contribute to cognitive deficits and symptoms in patients with schizophrenia.
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Affiliation(s)
- Jie Xiang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Cheng Tian
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Yan Niu
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Ting Yan
- Translational Medicine Research CenterShanxi Medical University, Taiyuan, China
| | - Dandan Li
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Rui Cao
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Hao Guo
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Xiaohong Cui
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Huifang Cui
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Shuping Tan
- Psychiatry Research Center, Beijing Huilongguan Hospital, Peking University, Beijing, China
| | - Bin Wang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
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9
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Oker A, Del Goleto S, Vignes A, Passerieux C, Roux P, Gouet EB. Schizophrenia patients are impaired in recognition task but more for intentionality than physical causality. Conscious Cogn 2018; 67:98-107. [PMID: 30557768 DOI: 10.1016/j.concog.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 10/24/2018] [Accepted: 11/25/2018] [Indexed: 11/16/2022]
Abstract
It is now largely accepted that patients with schizophrenia have a deficit to attribute mental states to others, such as intentions, needs and motivations but also to perform memory tasks. According to one hypothesis, these impairments may be due to an early visual attention deficit during the encounter of social stimuli. Another hypothesis posits a robust correlation between intention attribution and autobiographical memory that results in impaired recollection of past events making it difficult to infer others' intentions. In sum, the link between intention attribution and encoding process is yet to be explored in patients with schizophrenia. The objective of the present study is to contribute to this debate by investigating whether schizophrenic patients' recollection can be boosted by an attentional cueing on relevant information and to determine the influence of two different situational contexts: attribution of intentions or physical causality scripts. By using a supraliminal attentional cue, we made relevant areas of our material more salient across two conditions: attribution of intentions (AI) and physical causality with human characters (PCCH). The results confirmed expected deficit of explicit memory in schizophrenia patients while attentional cueing on relevant areas for intentions attribution or physical causality had no effect on recollection in any group. However, it seems that the recollection performances are highly influenced by the nature of intentions attribution. Also, it is the first time that the material used for the assessment of theory of mind performances has been tested with a recognition test.
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Affiliation(s)
- Ali Oker
- Laboratoire C2S (Cognition, Santé, Société), EA 6291, Department ESPE, Université de Reims Champagne-Ardenne, Reims, France.
| | - Sarah Del Goleto
- Laboratoire de Psychopathologie et Neuropsychologie (EA 2027), Université Paris Lumières, Paris 8, St. Denis, France
| | - Alice Vignes
- Laboratoire HANDIReSP (EA4047), Université de Versailles Saint-Quentin-En-Yvelines, Versailles, France
| | - Christine Passerieux
- Laboratoire HANDIReSP (EA4047), Université de Versailles Saint-Quentin-En-Yvelines, Versailles, France; Service de Psychiatrie de l'Adulte et d'Addictologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Paul Roux
- Laboratoire HANDIReSP (EA4047), Université de Versailles Saint-Quentin-En-Yvelines, Versailles, France; Service de Psychiatrie de l'Adulte et d'Addictologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Eric-Brunet Gouet
- Laboratoire HANDIReSP (EA4047), Université de Versailles Saint-Quentin-En-Yvelines, Versailles, France; Service de Psychiatrie de l'Adulte et d'Addictologie, Centre Hospitalier de Versailles, Le Chesnay, France
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10
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Peyroux E, Prost Z, Danset-Alexandre C, Brenugat-Herne L, Carteau-Martin I, Gaudelus B, Jantac C, Attali D, Amado I, Graux J, Houy-Durand E, Plasse J, Franck N. From "under" to "over" social cognition in schizophrenia: Is there distinct profiles of impairments according to negative and positive symptoms? SCHIZOPHRENIA RESEARCH-COGNITION 2018; 15:21-29. [PMID: 30534527 PMCID: PMC6260279 DOI: 10.1016/j.scog.2018.10.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/10/2018] [Indexed: 12/04/2022]
Abstract
Interactions between social cognition and symptoms of schizophrenia have been investigated, but mostly component by component. Here we tested the assumption that two categories of deficits exist depending on clinical profiles, one corresponding to a defect in social cognition – “under-social cognition” – and one corresponding to excessive attributions leading to social cognitive impairments – “over-social cognition”. To conduct the investigation, we performed a Hierarchical Clustering Analysis using positive and negative symptoms in seventy patients with schizophrenia and we compared the clusters obtained to a group of healthy controls on social cognitive measures. We distinguished two social cognitive profiles based on prevailing symptoms for emotion processes and Theory of Mind. Actually, patients with negative symptoms showed lower performances in emotion recognition task than both those with positive symptoms and controls. Concerning Theory of Mind, patients with positive symptoms had a significant tendency to make over interpretative errors than both patients with negative symptoms and controls. For other processes assessed, further explorations are needed. Actually, concerning social perception and knowledge both patients' groups presented significant impairments compared to controls. Assessment of attribution bias showed that patients in the positive group presented a significant hostility bias and a higher intentionality score compared to healthy controls. These results favor the existence of different categories of impairments depending more on the clinical characteristics of patients than on nosographical categories, but further investigations are now necessary to specify these profiles. It nevertheless showed the importance of assessing symptoms in relationship with cognitive functioning.
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Affiliation(s)
- Elodie Peyroux
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital, 4 rue Jean Sarrazin, 69008 Lyon, France.,Reference Center for Rare Diseases (GénoPsy), Le Vinatier hospital, 95 Bd Pinel, 69500 Bron, France
| | - Zelda Prost
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital, 4 rue Jean Sarrazin, 69008 Lyon, France
| | - Charlotte Danset-Alexandre
- Centre ressource et référent en remédiation cognitive et réhabilitation psychosociale de l'île de France (C3RP), 7 rue Cabanis, 75014 Paris, France.,INSERM U 894, Institut de Psychiatrie, Université Paris Descartes, Centre Hospitalier Sainte Anne, 7 rue Cabanis, 75014 Paris, France
| | - Lindsay Brenugat-Herne
- Centre ressource et référent en remédiation cognitive et réhabilitation psychosociale de l'île de France (C3RP), 7 rue Cabanis, 75014 Paris, France.,INSERM U 894, Institut de Psychiatrie, Université Paris Descartes, Centre Hospitalier Sainte Anne, 7 rue Cabanis, 75014 Paris, France
| | - Isabelle Carteau-Martin
- Espace de la Chevalerie, CHRU Bretonneau, 2 Boulevard Tonnellé, 37044 Tours Cedex 09, France.,UMR INSERM 930, Université François-Rabelais de Tours, 10 Boulevard Tonnellé, Faculté de médecine, 37032 Tours Cedex 01, France
| | - Baptiste Gaudelus
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital, 4 rue Jean Sarrazin, 69008 Lyon, France
| | - Célia Jantac
- INSERM U 894, Institut de Psychiatrie, Université Paris Descartes, Centre Hospitalier Sainte Anne, 7 rue Cabanis, 75014 Paris, France
| | - David Attali
- Centre ressource et référent en remédiation cognitive et réhabilitation psychosociale de l'île de France (C3RP), 7 rue Cabanis, 75014 Paris, France.,INSERM U 894, Institut de Psychiatrie, Université Paris Descartes, Centre Hospitalier Sainte Anne, 7 rue Cabanis, 75014 Paris, France
| | - Isabelle Amado
- Centre ressource et référent en remédiation cognitive et réhabilitation psychosociale de l'île de France (C3RP), 7 rue Cabanis, 75014 Paris, France.,INSERM U 894, Institut de Psychiatrie, Université Paris Descartes, Centre Hospitalier Sainte Anne, 7 rue Cabanis, 75014 Paris, France
| | - Jérôme Graux
- Espace de la Chevalerie, CHRU Bretonneau, 2 Boulevard Tonnellé, 37044 Tours Cedex 09, France.,UMR INSERM 930, Université François-Rabelais de Tours, 10 Boulevard Tonnellé, Faculté de médecine, 37032 Tours Cedex 01, France
| | - Emmanuelle Houy-Durand
- UMR INSERM 930, Université François-Rabelais de Tours, 10 Boulevard Tonnellé, Faculté de médecine, 37032 Tours Cedex 01, France.,Centre Universitaire de Pédopsychiatrie, 2 Boulevard Tonnellé, 37044 Tours Cedex 09, France
| | - Julien Plasse
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital, 4 rue Jean Sarrazin, 69008 Lyon, France
| | - Nicolas Franck
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital, 4 rue Jean Sarrazin, 69008 Lyon, France.,UMR 5229, CNRS et Université Claude Bernard Lyon 1, Université de Lyon, Institut des Sciences Cognitives Marc Jeannerod, 67 Boulevard Pinel, 69675 Bron Cedex, France
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11
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Dubourg L, Vrticka P, Debbané M, Chambaz L, Eliez S, Schneider M. Neural correlates of socio-emotional perception in 22q11.2 deletion syndrome. J Neurodev Disord 2018; 10:13. [PMID: 29631546 PMCID: PMC5891973 DOI: 10.1186/s11689-018-9232-2] [Citation(s) in RCA: 4] [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] [Received: 12/06/2017] [Accepted: 03/23/2018] [Indexed: 01/04/2023] Open
Abstract
Background Social impairments are described as a common feature of the 22q11.2 deletion syndrome (22q11DS). However, the neural correlates underlying these impairments are largely unknown in this population. In this study, we investigated neural substrates of socio-emotional perception. Methods We used event-related functional magnetic resonance imaging (fMRI) to explore neural activity in individuals with 22q11DS and healthy controls during the visualization of stimuli varying in social (social or non-social) or emotional (positive or negative valence) content. Results Neural hyporesponsiveness in regions of the default mode network (inferior parietal lobule, precuneus, posterior and anterior cingulate cortex and frontal regions) in response to social versus non-social images was found in the 22q11DS population compared to controls. A similar pattern of activation for positive and negative emotional processing was observed in the two groups. No correlation between neural activation and social functioning was observed in patients with the 22q11DS. Finally, no social × valence interaction impairment was found in patients. Conclusions Our results indicate atypical neural correlates of social perception in 22q11DS that appear to be independent of valence processing. Abnormalities in the social perception network may lead to social impairments observed in 22q11DS individuals. Electronic supplementary material The online version of this article (10.1186/s11689-018-9232-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lydia Dubourg
- Developmental Imaging and Psychopathology Laboratory, Department of Psychiatry, School of Medicine, University of Geneva, Campus Biotech, Chemin des mines 9, 1202, Geneva, Switzerland.
| | - Pascal Vrticka
- Department of Social Neuroscience, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Martin Debbané
- Developmental Imaging and Psychopathology Laboratory, Department of Psychiatry, School of Medicine, University of Geneva, Campus Biotech, Chemin des mines 9, 1202, Geneva, Switzerland.,Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Léa Chambaz
- Developmental Imaging and Psychopathology Laboratory, Department of Psychiatry, School of Medicine, University of Geneva, Campus Biotech, Chemin des mines 9, 1202, Geneva, Switzerland
| | - Stephan Eliez
- Developmental Imaging and Psychopathology Laboratory, Department of Psychiatry, School of Medicine, University of Geneva, Campus Biotech, Chemin des mines 9, 1202, Geneva, Switzerland.,Department of Genetic Medicine and Development, School of Medicine, University of Geneva, Geneva, Switzerland
| | - Maude Schneider
- Center for Contextual Psychiatry, Department of Neurosciences, Research Group Psychiatry, KU Leuven, Leuven, Belgium
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12
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Heredity characteristics of schizophrenia shown by dynamic functional connectivity analysis of resting-state functional MRI scans of unaffected siblings. Neuroreport 2018; 27:843-8. [PMID: 27295028 DOI: 10.1097/wnr.0000000000000622] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Previous static resting-state functional connectivity (FC) MRI (rs-fcMRI) studies have suggested certain heredity characteristics of schizophrenia. Recently, dynamic rs-fcMRI analysis, which can better characterize the time-varying nature of intrinsic activity and connectivity and may therefore unveil the special connectivity patterns that are always lost in static FC analysis, has shown a potential neuroendophenotype of schizophrenia. In this study, we have extended previous static rs-fcMRI studies to a dynamic study by exploring whether healthy siblings share aberrant dynamic FC patterns with schizophrenic patients, which may imply a potential risk for siblings to develop schizophrenia. We utilized the dynamic rs-fcMRI method using a sliding window approach to evaluate FC discrepancies within transient states across schizophrenic patients, unaffected siblings, and matched healthy controls. Statistical analysis showed five trait-related connections that are related to cingulo-opercular, occipital, and default mode networks, reflecting the shared connectivity alterations between schizophrenic patients and their unaffected siblings. The findings suggested that schizophrenic patients and their unaffected siblings shared common transient functional disconnectivity, implying a potential risk for the healthy siblings of developing schizophrenia.
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13
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Sasabayashi D, Takayanagi Y, Takahashi T, Koike S, Yamasue H, Katagiri N, Sakuma A, Obara C, Nakamura M, Furuichi A, Kido M, Nishikawa Y, Noguchi K, Matsumoto K, Mizuno M, Kasai K, Suzuki M. Increased Occipital Gyrification and Development of Psychotic Disorders in Individuals With an At-Risk Mental State: A Multicenter Study. Biol Psychiatry 2017; 82:737-745. [PMID: 28709499 DOI: 10.1016/j.biopsych.2017.05.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anomalies of brain gyrification have been reported in schizophrenia, possibly reflecting its neurodevelopmental pathology. However, it remains elusive whether individuals at risk for psychotic disorders exhibit deviated gyrification patterns, and whether such findings, if present, are predictive of transition to psychotic disorders. METHODS This multicenter magnetic resonance imaging study investigated brain gyrification and its relationship to later transition to psychotic disorders in a large sample of at-risk mental state (ARMS) individuals. T1-weighted magnetic resonance imaging scans were obtained from 104 ARMS individuals, of whom 21 (20.2%) exhibited the transition to psychotic disorders during clinical follow-up (mean = 4.9 years, SD = 2.6 years), and 104 healthy control subjects at 4 different sites. The local gyrification index (LGI) of the entire cortex was compared across the groups using FreeSurfer software. RESULTS Compared with the control subjects, ARMS individuals showed a significantly higher LGI in widespread cortical areas, including the bilateral frontal, temporal, parietal, and occipital regions, which was partly associated with prodromal symptomatology. ARMS individuals who exhibited the transition to psychotic disorders showed a significantly higher LGI in the left occipital region compared with individuals without transition. CONCLUSIONS These findings suggested that increased LGI in diverse cortical regions might represent vulnerability to psychopathology, while increased LGI in the left occipital cortex might be related to subsequent manifestation of florid psychotic disorders as a possible surrogate marker.
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Affiliation(s)
- Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.
| | - Yoichiro Takayanagi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Shinsuke Koike
- 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; Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoyuki Katagiri
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Atsushi Sakuma
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Chika Obara
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Mihoko Nakamura
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Atsushi Furuichi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Mikio Kido
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Yumiko Nishikawa
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Kyo Noguchi
- Department of Radiology, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Kazunori Matsumoto
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan; Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
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14
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Olszewski AK, Kikinis Z, Gonzalez CS, Coman IL, Makris N, Gong X, Rathi Y, Zhu A, Antshel KM, Fremont W, Kubicki MR, Bouix S, Shenton ME, Kates WR. The social brain network in 22q11.2 deletion syndrome: a diffusion tensor imaging study. Behav Brain Funct 2017; 13:4. [PMID: 28209179 PMCID: PMC5314621 DOI: 10.1186/s12993-017-0122-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 02/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chromosome 22q11.2 deletion syndrome (22q11.2DS) is a neurogenetic disorder that is associated with a 25-fold increase in schizophrenia. Both individuals with 22q11.2DS and those with schizophrenia present with social cognitive deficits, which are putatively subserved by a network of brain regions that are involved in the processing of social cognitive information. This study used two-tensor tractography to examine the white matter tracts believed to underlie the social brain network in a group of 57 young adults with 22q11.2DS compared to 30 unaffected controls. RESULTS Results indicated that relative to controls, participants with 22q11.2DS showed significant differences in several DTI metrics within the inferior fronto-occipital fasciculus, cingulum bundle, thalamo-frontal tract, and inferior longitudinal fasciculus. In addition, participants with 22q11.2DS showed significant differences in scores on measures of social cognition, including the Social Responsiveness Scale and Trait Emotional Intelligence Questionnaire. Further analyses among individuals with 22q11.2DS demonstrated an association between DTI metrics and positive and negative symptoms of psychosis, as well as differentiation between individuals with 22q11.2DS and overt psychosis, relative to those with positive prodromal symptoms or no psychosis. CONCLUSIONS Findings suggest that white matter disruption, specifically disrupted axonal coherence in the right inferior fronto-occipital fasciculus, may be a biomarker for social cognitive difficulties and psychosis in individuals with 22q11.2DS.
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Affiliation(s)
- Amy K Olszewski
- Department of Psychiatry, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
| | - Zora Kikinis
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Ioana L Coman
- Department of Psychiatry, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
| | - Nikolaos Makris
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Departments of Psychiatry and Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Xue Gong
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yogesh Rathi
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anni Zhu
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Wanda Fremont
- Department of Psychiatry, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA
| | - Marek R Kubicki
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sylvain Bouix
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha E Shenton
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,VA Boston Healthcare System, Harvard Medical School, Brockton, MA, USA
| | - Wendy R Kates
- Department of Psychiatry, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA.
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15
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Alústiza I, Radua J, Albajes-Eizagirre A, Domínguez M, Aubá E, Ortuño F. Meta-Analysis of Functional Neuroimaging and Cognitive Control Studies in Schizophrenia: Preliminary Elucidation of a Core Dysfunctional Timing Network. Front Psychol 2016; 7:192. [PMID: 26925013 PMCID: PMC4756542 DOI: 10.3389/fpsyg.2016.00192] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/31/2016] [Indexed: 12/04/2022] Open
Abstract
Timing and other cognitive processes demanding cognitive control become interlinked when there is an increase in the level of difficulty or effort required. Both functions are interrelated and share neuroanatomical bases. A previous meta-analysis of neuroimaging studies found that people with schizophrenia had significantly lower activation, relative to normal controls, of most right hemisphere regions of the time circuit. This finding suggests that a pattern of disconnectivity of this circuit, particularly in the supplementary motor area, is a trait of this mental disease. We hypothesize that a dysfunctional temporal/cognitive control network underlies both cognitive and psychiatric symptoms of schizophrenia and that timing dysfunction is at the root of the cognitive deficits observed. The goal of our study was to look, in schizophrenia patients, for brain structures activated both by execution of cognitive tasks requiring increased effort and by performance of time perception tasks. We conducted a signed differential mapping (SDM) meta-analysis of functional neuroimaging studies in schizophrenia patients assessing the brain response to increasing levels of cognitive difficulty. Then, we performed a multimodal meta-analysis to identify common brain regions in the findings of that SDM meta-analysis and our previously-published activation likelihood estimate (ALE) meta-analysis of neuroimaging of time perception in schizophrenia patients. The current study supports the hypothesis that there exists an overlap between neural structures engaged by both timing tasks and non-temporal cognitive tasks of escalating difficulty in schizophrenia. The implication is that a deficit in timing can be considered as a trait marker of the schizophrenia cognitive profile.
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Affiliation(s)
- Irene Alústiza
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de NavarraPamplona, Spain; Instituto de Investigación Sanitaria de NavarraNavarra, Spain
| | - Joaquim Radua
- Department of Psychosis Studies, Institute of Psychiatry, Kings CollegeLondon, UK; FIDMAG Germanes Hospitalaries Hospital Sant RafaelBarcelona, Spain; Centro de Investigación Biomédicaen Redde Salud MentalBarcelona, Spain
| | - Anton Albajes-Eizagirre
- FIDMAG Germanes Hospitalaries Hospital Sant RafaelBarcelona, Spain; Centro de Investigación Biomédicaen Redde Salud MentalBarcelona, Spain
| | - Manuel Domínguez
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de NavarraPamplona, Spain; Instituto de Investigación Sanitaria de NavarraNavarra, Spain
| | - Enrique Aubá
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de NavarraPamplona, Spain; Instituto de Investigación Sanitaria de NavarraNavarra, Spain
| | - Felipe Ortuño
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de NavarraPamplona, Spain; Instituto de Investigación Sanitaria de NavarraNavarra, Spain
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16
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Potvin S, Tikàsz A, Mendrek A. Emotionally Neutral Stimuli Are Not Neutral in Schizophrenia: A Mini Review of Functional Neuroimaging Studies. Front Psychiatry 2016; 7:115. [PMID: 27445871 PMCID: PMC4916183 DOI: 10.3389/fpsyt.2016.00115] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 06/10/2016] [Indexed: 11/13/2022] Open
Abstract
Reliable evidence shows that schizophrenia patients tend to experience negative emotions when presented with emotionally neutral stimuli. Similarly, several functional neuroimaging studies show that schizophrenia patients have increased activations in response to neutral material. However, results are heterogeneous. Here, we review the functional neuroimaging studies that have addressed this research question. Based on the 36 functional neuroimaging studies that we retrieved, it seems that the increased brain reactivity to neutral stimuli is fairly common in schizophrenia, but that the regions involved vary considerably, apart from the amygdala. Prefrontal and cingulate sub-regions and the hippocampus may also be involved. By contrasts, results in individuals at risk for psychosis are less consistent. In schizophrenia patients, results are less consistent in the case of studies using non-facial stimuli, explicit processing paradigms, and/or event-related designs. This means that human faces may convey subtle information (e.g., trustworthiness) other than basic emotional expressions. It also means that the aberrant brain reactivity to neutral stimuli is less likely to occur when experimental paradigms are too cognitively demanding as well as in studies lacking statistical power. The main hypothesis proposed to account for this increased brain reactivity to neutral stimuli is the aberrant salience hypothesis of psychosis. Other investigators propose that the aberrant brain reactivity to neutral stimuli in schizophrenia results from abnormal associative learning, untrustworthiness judgments, priming effects, and/or reduced habituation to neutral stimuli. In the future, the effects of antipsychotics on this aberrant brain reactivity will need to be determined, as well as the potential implication of sex/gender.
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Affiliation(s)
- Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada; Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Andràs Tikàsz
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada; Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Adrianna Mendrek
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada; Department of Psychology, Bishop's University, Sherbrooke, QC, Canada
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17
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Nelson BD, Bjorkquist OA, Olsen EK, Herbener ES. Schizophrenia symptom and functional correlates of anterior cingulate cortex activation to emotion stimuli: An fMRI investigation. Psychiatry Res 2015; 234:285-91. [PMID: 26596521 PMCID: PMC4679428 DOI: 10.1016/j.pscychresns.2015.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/04/2015] [Indexed: 11/27/2022]
Abstract
Schizophrenia is a chronic mental illness characterized by distinct positive and negative symptoms and functional impairment. The anterior cingulate cortex (ACC) is a region of the brain's limbic system that is hypoactive during emotion processing in schizophrenia. Recent evidence suggests the hypoactive ACC in schizophrenia is due to negative (and not positive) symptoms. However, this finding has not been replicated and the functional significance of this relationship remains unclear. The present study examined the association between positive and negative symptoms, ACC activation to emotional images, and functional outcome in schizophrenia. Specifically, 16 schizophrenia/schizoaffective disorder (SZ/SZAF) and 15 control (CON) participants underwent an fMRI scan while completing an emotional picture-rating task. SZ/SZAF participants also completed clinician-rated measures of positive and negative symptoms and functional abilities. SZ/SZAF participants with high negative symptoms had reduced ACC activation to pleasant images relative to those with low negative symptoms and CON, who did not differ. Furthermore, amongst all SZ/SZAF participants poorer social functioning was associated with decreased ACC activation to pleasant images. Finally, ACC activation partially mediated the relationship between negative symptoms and social dysfunction. These results provide evidence of the functional significance of the relationship between negative symptoms and ACC dysfunction in schizophrenia.
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Affiliation(s)
- Brady D. Nelson
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA,Correspondence concerning this article should be addressed to Brady D. Nelson, Department of Psychology, Stony Brook University, Stony Brook, NY, 11794. Phone: 631-632-7697; Fax: 631-632-7876;
| | | | - Emily K. Olsen
- Department of Psychology, University of Illinois-Chicago, Chicago, IL, USA
| | - Ellen S. Herbener
- Department of Psychology, University of Illinois-Chicago, Chicago, IL, USA,Department of Psychiatry, University of Illinois-Chicago, Chicago, IL, USA
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18
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Wang Y, Yang LQ, Li S, Zhou Y. Game Theory Paradigm: A New Tool for Investigating Social Dysfunction in Major Depressive Disorders. Front Psychiatry 2015; 6:128. [PMID: 26441689 PMCID: PMC4569817 DOI: 10.3389/fpsyt.2015.00128] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/02/2015] [Indexed: 12/15/2022] Open
Abstract
Social dysfunction is a prominent source of distress and disability in patients with major depressive disorder (MDD) but is commonly omitted from current clinical studies, although some researchers propose an evolutionary strategy to understand these negative outcomes. Limited knowledge about the neural basis of social dysfunction in MDD results from traditional paradigms, which lack insights into social interactions. Game theoretical modeling offers a new tool for investigating social-interaction impairments in neuropsychiatric disorders. This review first introduces three widely used games from game theory and the major behavioral and neuroimaging findings obtained using these games in healthy populations. We also address the factors that modulate behaviors in games and their neural bases. We then summarize the current findings obtained by using these games in depressed patients and discuss the clinical implications of these abnormal game behaviors. Finally, we briefly discuss future prospects that may further elucidate the clinical use of a game theory paradigm in MDD.
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Affiliation(s)
- Yun Wang
- Key Laboratory of Behavioral Science and Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Liu-Qing Yang
- Key Laboratory of Behavioral Science and Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Shu Li
- Key Laboratory of Behavioral Science and Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yuan Zhou
- Key Laboratory of Behavioral Science and Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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19
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Shin JE, Choi SH, Lee H, Shin YS, Jang DP, Kim JJ. Involvement of the dorsolateral prefrontal cortex and superior temporal sulcus in impaired social perception in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2015; 58:81-8. [PMID: 25545410 DOI: 10.1016/j.pnpbp.2014.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/05/2014] [Accepted: 12/19/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Schizophrenia is a mental disorder characterized by impairments in diverse thinking and emotional responses, which are related to social perception dysfunction. This fMRI study was designed to investigate a neurobiological basis of social perception deficits of patients with schizophrenia in various social situations of daily life and their relationship with clinical symptoms and social dysfunction. METHODS Seventeen patients and 19 controls underwent functional magnetic resonance imaging, during which participants performed a virtual social perception task, containing an avatar's speech with positive, negative or neutral emotion in a virtual reality space. Participants were asked to determine whether or not the avatar's speech was appropriate to each situation. RESULTS The significant group×appropriateness interaction was seen in the left dorsolateral prefrontal cortex (DLPFC), resulting from lower activity in patients in the inappropriate condition, and left DLPFC activity was negatively correlated with the severity of negative symptoms and positively correlated with the level of social functioning. The significant appropriateness×emotion interaction observed in the left superior temporal sulcus (STS) was present in controls, but absent in patients, resulting from the existence and absence of a difference between the inappropriate positive and negative conditions, respectively. CONCLUSIONS These findings indicate that dysfunction of the DLPFC-STS network may underlie patients' abnormal social perception in various social situations of daily life. Abnormal functioning of this network may contribute to increases of negative symptoms and decreases of social functioning.
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Affiliation(s)
- Jung Eun Shin
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University College of Medicine and Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea
| | - Hyeongrae Lee
- Magnetoencephalography center, Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Seok Shin
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Dong-Pyo Jang
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Jae-Jin Kim
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea.
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20
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Gradin VB, Pérez A, MacFarlane JA, Cavin I, Waiter G, Engelmann J, Dritschel B, Pomi A, Matthews K, Steele JD. Abnormal brain responses to social fairness in depression: an fMRI study using the Ultimatum Game. Psychol Med 2015; 45:1241-1251. [PMID: 25277236 DOI: 10.1017/s0033291714002347] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Depression is a prevalent disorder that significantly affects the social functioning and interpersonal relationships of individuals. This highlights the need for investigation of the neural mechanisms underlying these social difficulties. Investigation of social exchanges has traditionally been challenging as such interactions are difficult to quantify. Recently, however, neuroeconomic approaches that combine multiplayer behavioural economic paradigms and neuroimaging have provided a framework to operationalize and quantify the study of social interactions and the associated neural substrates. METHOD We investigated brain activation using functional magnetic resonance imaging (fMRI) in unmedicated depressed participants (n = 25) and matched healthy controls (n = 25). During scanning, participants played a behavioural economic paradigm, the Ultimatum Game (UG). In this task, participants accept or reject monetary offers from other players. RESULTS In comparison to controls, depressed participants reported decreased levels of happiness in response to 'fair' offers. With increasing fairness of offers, controls activated the nucleus accumbens and the dorsal caudate, regions that have been reported to process social information and responses to rewards. By contrast, participants with depression failed to activate these regions with increasing fairness, with the lack of nucleus accumbens activation correlating with increased anhedonia symptoms. Depressed participants also showed a diminished response to increasing unfairness of offers in the medial occipital lobe. CONCLUSIONS Our findings suggest that depressed individuals differ from healthy controls in the neural substrates involved with processing social information. In depression, the nucleus accumbens and dorsal caudate may underlie abnormalities in processing information linked to the fairness and rewarding aspects of other people's decisions.
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Affiliation(s)
- V B Gradin
- CIBPsi, Faculty of Psychology,Universidad de la República,Montevideo,Uruguay
| | - A Pérez
- CIBPsi, Faculty of Psychology,Universidad de la República,Montevideo,Uruguay
| | | | - I Cavin
- Medical Physics,NHS Tayside,University of Dundee,UK
| | - G Waiter
- Aberdeen Biomedical Imaging Centre,University of Aberdeen,UK
| | - J Engelmann
- Department of Economics,University of Zurich,Switzerland
| | - B Dritschel
- Department of Psychology,University of St Andrews,UK
| | - A Pomi
- Biophysics Section,Faculty of Sciences,Universidad de la República,Montevideo,Uruguay
| | - K Matthews
- Division of Neuroscience,Medical Research Institute,University of Dundee,UK
| | - J D Steele
- Division of Neuroscience,Medical Research Institute,University of Dundee,UK
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Hashimoto N, Toyomaki A, Hirai M, Miyamoto T, Narita H, Okubo R, Kusumi I. Absent activation in medial prefrontal cortex and temporoparietal junction but not superior temporal sulcus during the perception of biological motion in schizophrenia: a functional MRI study. Neuropsychiatr Dis Treat 2014; 10:2221-30. [PMID: 25484590 PMCID: PMC4240192 DOI: 10.2147/ndt.s70074] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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
BACKGROUND Patients with schizophrenia show disturbances in both visual perception and social cognition. Perception of biological motion (BM) is a higher-level visual process, and is known to be associated with social cognition. BM induces activation in the "social brain network", including the superior temporal sulcus (STS). Although deficits in the detection of BM and atypical activation in the STS have been reported in patients with schizophrenia, it remains unclear whether other nodes of the "social brain network" are also atypical in patients with schizophrenia. PURPOSE We aimed to explore whether brain regions other than STS were involved during BM perception in patients with schizophrenia, using functional magnetic resonance imaging (fMRI). METHODS AND PATIENTS Seventeen patients with schizophrenia, and 17 age- and sex- matched healthy controls, underwent fMRI scanning during a one-back visual task, containing three experimental conditions: (1) BM, (2) scrambled motion (SM), and (3) static condition. We used one-sample t-tests to examine neural responses selective to BM versus SM within each group, and two-sample t-tests to directly compare neural patterns to BM versus SM in schizophrenics versus controls. RESULTS We found significant activation in the STS region when BM was contrasted with SM in both groups, with no significant difference between groups. On the contrary, significant activation in the medial prefrontal cortex (MPFC) and bilateral temporoparietal junction (TPJ) was found only in the control group. When we directly compared the two groups, the healthy controls showed significant greater activation in left MPFC and TPJ to BM versus SM than patients with schizophrenia. CONCLUSION Our findings suggest that patients with schizophrenia show normal activation to biologically and socially relevant motion stimuli in the STS, but atypical activation in other regions of the social brain network, specifically MPFC and TPJ. Moreover, these results were not due to atypical processing of motion, suggesting that patients with schizophrenia lack in the recruitment of neural circuits needed for the visual perception of social cognition.
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Affiliation(s)
- Naoki Hashimoto
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Child and Adolescent Psychiatry, Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Atsuhito Toyomaki
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masahiro Hirai
- Center for Development of Advanced Medical Technology, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi, Japan
| | - Tamaki Miyamoto
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hisashi Narita
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ryo Okubo
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Bodapati AS, Herbener E. The impact of social content and negative symptoms on affective ratings in schizophrenia. Psychiatry Res 2014; 218:25-30. [PMID: 24745467 PMCID: PMC4063555 DOI: 10.1016/j.psychres.2014.03.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 02/03/2014] [Accepted: 03/29/2014] [Indexed: 10/25/2022]
Abstract
The anhedonia paradox has been a topic of ongoing study in schizophrenia. Previous research has found that schizophrenia patients report less enjoyment from various activities when compared to their healthy counterparts; however, the two groups appear to have similar in-the-moment emotional ratings of these events (Gard et al., 2007; Herbener et al., 2007; Horan et al., 2006). This study examined these in-the-moment experiences further, by assessing whether they differed between social and non-social experiences. The data were collected from 38 individuals with schizophrenia and 53 matched healthy controls in the greater Chicago area. In-the-moment emotional experience was measured by self-reported arousal and valence ratings for social and non-social stimuli taken from the International Affective Picture System (IAPS). Clinical ratings for patients were gathered by the Positive and Negative Syndrome Scale. A series of ANOVAs revealed that controls were more aroused by the social than nonsocial unpleasant stimuli, whereas patients did not show this distinction. Further, regression analyses revealed that negative symptom severity uniquely predicted lower arousal responses to unpleasant social, but not nonsocial, stimuli. Our results indicate that both subject and stimulus factors appear to contribute to differences in emotional responses in individuals with schizophrenia.
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Affiliation(s)
- Anjuli Singh Bodapati
- Department of Psychology, University of Illinois at Chicago, 1007 W Harrison Ave, Chicago IL 60607,Corresponding author: Anjuli Singh Bodapati, , Phone: 845-797-8390, Fax: 845-298-6191, Address: 1007 W Harrison Ave, Chicago IL 60607
| | - Ellen Herbener
- Department of Psychology, University of Illinois at Chicago, 1007 W Harrison Ave, Chicago IL 60607,Department of Psychiatry, University of Illinois at Chicago, 912 S Wood St, Chicago IL 60612
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Dahoun T, Eliez S, Chen F, Badoud D, Schneider M, Larøi F, Debbane M. Action simulation in hallucination-prone adolescents. Front Hum Neurosci 2013; 7:329. [PMID: 23847502 PMCID: PMC3701149 DOI: 10.3389/fnhum.2013.00329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 06/12/2013] [Indexed: 12/15/2022] Open
Abstract
Theoretical and empirical accounts suggest that impairments in self-other discrimination processes are likely to promote the expression of hallucinations. Studies using a variety of paradigms involving self-performed actions argue in favor of perspective taking confusion in hallucination-prone subjects. However, our understanding of such processes during adolescence is still at an early stage. The present study thus aims (1) to delineate the neural correlates sustaining mental simulation of actions involving self-performed actions (first-person perspective; 1PP) and other-performed actions (third-person perspective; 3PP) during adolescence (2) to identify atypical activation patterns during 1PP/3PP mental simulation of actions in hallucination-prone adolescents (3) to examine whether differential risk for schizophrenia (clinical vs. genetic) is also associated with differential impairments in the 1PP/3PP mental simulation of actions during adolescence. Twenty-two typically developing controls (Control group; 6 females), 12 hallucination-prone adolescents [auditory hallucination (AH) group; 7 females] and 13 adolescents with 22q11.2 Deletion Syndrome (22q11.2DS group; 4 females) were included in the study. During the fMRI task, subjects were presented with a cue (self-other priming cues) indicating to perform the task using either a first person perspective (“you”-1PP) or a third person perspective (“best friend”-3PP) and then they were asked to mentally simulate actions based on the type of cue. Hallucination-proneness was assessed using a self-report questionnaire [Cardiff Anomalous Perception Scale (CAPS)]. Our results indicated that atypical patterns of cerebral activation, particularly in the key areas of self-other distinction, were found in both groups at risk for auditory hallucinations (AHs and 22q11.2DS). More precisely, adolescents in the AH group presented decreased activations in the right middle occipital gyrus BA19, left cingulate gyrus BA31, and right precuneus BA31 for the 3PP > 1PP contrast. Adolescents in the 22q11.2DS group presented decreased activations in the right superior occipital gyrus BA19, left caudate tail and left precuneus BA7 for the 3PP > 1PP contrast. In comparison to the Control group, only the 22q11.2DS adolescents showed a decreased activation for other-related cues (prime other > prime self contrast) in areas of visual imagery, episodic memory and social cognition. This study characterizes the neural correlates of mental imagery for actions during adolescence, and suggests that a differential risk for hallucination-proneness (clinical vs. genetic) is associated to similar patterns of atypical activations in key areas sustaining self-other discrimination processes. These observations may provide relevant information for future research and prevention strategies with regards to hallucination-proneness during adolescence.
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Affiliation(s)
- Tarik Dahoun
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine Geneva, Switzerland
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