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Mao Q, Lin X, Yin Q, Liu P, Zhang Y, Qu S, Xu J, Cheng W, Luo X, Kang L, Taximaimaiti R, Zheng C, Zhang H, Wang X, Ren H, Cao Y, Lin J, Luo X. A significant, functional and replicable risk KTN1 variant block for schizophrenia. Sci Rep 2023; 13:3890. [PMID: 36890161 PMCID: PMC9995530 DOI: 10.1038/s41598-023-27448-z] [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: 10/12/2022] [Accepted: 01/02/2023] [Indexed: 03/10/2023] Open
Abstract
Cortical and subcortical structural alteration has been extensively reported in schizophrenia, including the unusual expansion of gray matter volumes (GMVs) of basal ganglia (BG), especially putamen. Previous genome-wide association studies pinpointed kinectin 1 gene (KTN1) as the most significant gene regulating the GMV of putamen. In this study, the role of KTN1 variants in risk and pathogenesis of schizophrenia was explored. A dense set of SNPs (n = 849) covering entire KTN1 was analyzed in three independent European- or African-American samples (n = 6704) and one mixed European and Asian Psychiatric Genomics Consortium sample (n = 56,418 cases vs. 78,818 controls), to identify replicable SNP-schizophrenia associations. The regulatory effects of schizophrenia-associated variants on the KTN1 mRNA expression in 16 cortical or subcortical regions in two European cohorts (n = 138 and 210, respectively), the total intracranial volume (ICV) in 46 European cohorts (n = 18,713), the GMVs of seven subcortical structures in 50 European cohorts (n = 38,258), and the surface areas (SA) and thickness (TH) of whole cortex and 34 cortical regions in 50 European cohorts (n = 33,992) and eight non-European cohorts (n = 2944) were carefully explored. We found that across entire KTN1, only 26 SNPs within the same block (r2 > 0.85) were associated with schizophrenia across ≥ 2 independent samples (7.5 × 10-5 ≤ p ≤ 0.048). The schizophrenia-risk alleles, which increased significantly risk for schizophrenia in Europeans (q < 0.05), were all minor alleles (f < 0.5), consistently increased (1) the KTN1 mRNA expression in 12 brain regions significantly (5.9 × 10-12 ≤ p ≤ 0.050; q < 0.05), (2) the ICV significantly (6.1 × 10-4 ≤ p ≤ 0.008; q < 0.05), (3) the SA of whole (9.6 × 10-3 ≤ p ≤ 0.047) and two regional cortices potentially (2.5 × 10-3 ≤ p ≤ 0.042; q > 0.05), and (4) the TH of eight regional cortices potentially (0.006 ≤ p ≤ 0.050; q > 0.05), and consistently decreased (1) the BG GMVs significantly (1.8 × 10-19 ≤ p ≤ 0.050; q < 0.05), especially putamen GMV (1.8 × 10-19 ≤ p ≤ 1.0 × 10-4; q < 0.05, (2) the SA of four regional cortices potentially (0.010 ≤ p ≤ 0.048), and (3) the TH of four regional cortices potentially (0.015 ≤ p ≤ 0.049) in Europeans. We concluded that we identified a significant, functional, and robust risk variant block covering entire KTN1 that might play a critical role in the risk and pathogenesis of schizophrenia.
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Affiliation(s)
- Qiao Mao
- Department of Psychosomatic Medicine, People's Hospital of Deyang City, Deyang, 618000, Sichuan, China
| | - Xiandong Lin
- Laboratory of Radiation Oncology and Radiobiology, Fujian Provincial Cancer Hospital, the Teaching Hospital of Fujian Medical University, Fuzhou, 350014, Fujian, China
| | - Qin Yin
- Department of Respiratory and Critical Care Medicine, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, 430000, Hubei, China
| | - Ping Liu
- Department of Psychosomatic Medicine, People's Hospital of Deyang City, Deyang, 618000, Sichuan, China
| | - Yong Zhang
- Tianjin Mental Health Center, Tianjin, 300222, China
| | - Shihao Qu
- Zhuhai Center for Maternal and Child Health Care, Zhuhai, Guangdong, 519001, China
| | - Jianying Xu
- Zhuhai Center for Maternal and Child Health Care, Zhuhai, Guangdong, 519001, China
| | - Wenhong Cheng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Xinqun Luo
- Department of Neurosurgery, The First Hospital, Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Longli Kang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research On High Altitude Diseases of Tibet Autonomous Region, Xizang Minzu University School of Medicine, Xiangyang, 712082, Shaanxi, China
| | - Reyisha Taximaimaiti
- Department of Neurology, Shanghai Tongren Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Chengchou Zheng
- Minqing Psychiatric Hospital, Minqing, 350800, Fujian, China
| | - Huihao Zhang
- The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Xiaoping Wang
- Department of Neurology, The 1st People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 201620, USA
| | - Honggang Ren
- Department of Internal Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuping Cao
- Department of Psychiatry, Second Xiangya Hospital, Central South University, China National Clinical Research Center On Mental Disorders, China National Technology Institute On Mental Disorders, Changsha, 410011, Hunan, China.
| | - Jie Lin
- Fujian Center for Disease Control and Prevention, Fuzhou, 350012, Fujian, China.
- Fujian Institute of Preventive Medicine, Fuzhou, 350012, Fujian, China.
| | - Xingguang Luo
- Beijing Huilongguan Hospital, Peking University Huilongguan School of Clinical Medicine, Beijing, 100096, China.
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Shan X, Zhang H, Dong Z, Chen J, Liu F, Zhao J, Zhang H, Guo W. Increased subcortical region volume induced by electroconvulsive therapy in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2021; 271:1285-1295. [PMID: 34275006 DOI: 10.1007/s00406-021-01303-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/04/2021] [Indexed: 02/08/2023]
Abstract
Electroconvulsive therapy (ECT) has been widely used to treat patients with schizophrenia. However, the underlying mechanisms of ECT remain unknown. In the present study, the treatment effects of ECT on brain structure in patients with schizophrenia were explored. Seventy patients with schizophrenia were scanned using structural magnetic resonance imaging. Patients in the drug group were scanned at baseline (time 1) and follow-up (time 2, 6 weeks of treatment). Patients in the ECT group were scanned before ECT treatment (baseline, time 1) and 10-12 h after the last ECT treatment (time 2). Voxel-based morphometry was applied to analyze the imaging data. Patients in the ECT group showed significantly increased gray matter volume (GMV) in the bilateral hippocampus/amygdala and left superior temporal gyrus (STG)/middle temporal gyrus (MTG) after ECT combined with antipsychotic therapy at time 2. In contrast, patients in the drug group showed decreased GMV in widespread brain regions. Correlation analysis results showed significantly negative correlations between the increased GMV in the bilateral hippocampus/amygdala and PANSS scores at baseline in the ECT group. ECT may modulate brain structure in patients with schizophrenia. The GMV in distinct subcortical regions was related to the individual therapeutic response in patients with schizophrenia.
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Affiliation(s)
- Xiaoxiao Shan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Haisan Zhang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453002, Henan, China.,Xinxiang Key Laboratory of Multimodal Brain Imaging, Xinxiang, 453002, Henan, China
| | - Zhao Dong
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453002, Henan, China.,Zhumadian Psychiatric Hospital, Zhumadian, 463000, Henan, China
| | - Jindong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300000, China
| | - Jingping Zhao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Hongxing Zhang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453002, Henan, China. .,Xinxiang Key Laboratory of Multimodal Brain Imaging, Xinxiang, 453002, Henan, China. .,School of Psychology, Xinxiang Medical University, Xinxiang, 453003, Henan, China.
| | - Wenbin Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China. .,Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, 528000, Guangdong, China.
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Cui X, Deng Q, Lang B, Su Q, Liu F, Zhang Z, Chen J, Zhao J, Guo W. Less reduced gray matter volume in the subregions of superior temporal gyrus predicts better treatment efficacy in drug-naive, first-episode schizophrenia. Brain Imaging Behav 2020; 15:1997-2004. [PMID: 33033986 DOI: 10.1007/s11682-020-00393-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/26/2022]
Abstract
Decreased gray matter volume (GMV) in the superior temporal gyrus (STG) has been implicated in the neurophysiology of schizophrenia. However, it remains unclear whether volumetric reduction in the subregions of the STG can predict treatment efficacy for schizophrenia. Our cohort included 44 drug-naive, first-episode patients, 42 unaffected siblings and 44 healthy controls. Voxel-based morphometry and pattern classification were utilized to analyze the acquired imaging data as per the anatomical subdivision by a well-defined brainnetome atlas. The patients presented lower GMV values in left TE1.0/1.2 (TE, anterior temporal visual association area) than the siblings, and lower GMV values in the left/right TE1.0/1.2 and left A22r (rostral area 22) than the controls. A positive correlation is observed between the GMV values in the right A38l (lateral area 38) and baseline Positive and Negative Syndrome Scale (PANSS) total scores in the patients. Support vector regression (SVR) results exhibited a significant association between predicted (based on the GMV values in the right A38l) and actual symptomatic improvement based on the reduction ratio of the PANSS total scores (r = 0.498, p = 0.001). Our results suggest that normal structure in the right A38l of the STG may be an important factor indicative of the effects of antipsychotic drugs, which can be potentially used to monitor drug effects for first-episode patients at an early stage in clinical practice.
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Affiliation(s)
- Xilong Cui
- Department of Psychaitry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Qijian Deng
- Department of Psychaitry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Bing Lang
- Department of Psychaitry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Qinji Su
- Mental Health Center, the Second Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, 530007, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhikun Zhang
- Mental Health Center, the Second Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, 530007, China
| | - Jindong Chen
- Department of Psychaitry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Jingping Zhao
- Department of Psychaitry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Wenbin Guo
- Department of Psychaitry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
- The Third People's Hospital of Foshan, Foshan, Guangdong, 528000, China.
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Tarcijonas G, Foran W, Haas GL, Luna B, Sarpal DK. Intrinsic Connectivity of the Globus Pallidus: An Uncharted Marker of Functional Prognosis in People With First-Episode Schizophrenia. Schizophr Bull 2020; 46:184-192. [PMID: 31150557 PMCID: PMC6942165 DOI: 10.1093/schbul/sbz034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is growing evidence suggesting that abnormalities in cortical-basal ganglia circuitry may play a significant role in determining outcomes in schizophrenia. The globus pallidus (GP), a critical structure within this circuitry, unique in its role as a mediator of competing inputs through the striatum, has not been well characterized in schizophrenia. The following study examined functional interactions of the GP in individuals with first-episode schizophrenia (FES). To probe the large-scale intrinsic connectivity of the GP, resting-state fMRI scans were obtained from patients with FES and sex and age-matched healthy controls. Participants with FES were also evaluated after 6 months via the Strauss-Carpenter Outcomes Scale to assess overall functional trajectory. The GP was parcellated to generate seeds within its substructures, and connectivity maps were generated. Our FES cohort showed significantly lower functional connectivity between the left GP interna and a network of regions including the dorsolateral prefrontal cortex, caudate, and cerebellum at baseline. In addition, FES participants with lower overall scores of functioning at 6 months showed significantly decreased connectivity between the GP interna and the dorsal anterior cingulate and bilateral insula, all regions important for motivational salience. These results provide novel evidence for unique abnormalities in functional interactions of the GP with key prefrontal cortical regions in FES. Our findings also suggest that reduced prefrontal-pallidal connectivity may serve as a predictor of early functional outcome.
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Affiliation(s)
- Goda Tarcijonas
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - William Foran
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Gretchen L Haas
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,Department of Psychology, University of Pittsburgh, Pittsburgh, PA,Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | - Deepak K Sarpal
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,To whom correspondence should be addressed; Department of Psychiatry, University of Pittsburgh, 3501 Forbes Avenue, Suite 530, Pittsburgh, PA 15213, US; tel: 412-246-5618, fax: 412-246-5007, e-mail:
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O'Connell KS, McGregor NW, Emsley R, Seedat S, Warnich L. The Potential Role of Regulatory Genes ( DNMT3A, HDAC5, and HDAC9) in Antipsychotic Treatment Response in South African Schizophrenia Patients. Front Genet 2019; 10:641. [PMID: 31354789 PMCID: PMC6635553 DOI: 10.3389/fgene.2019.00641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 06/18/2019] [Indexed: 12/22/2022] Open
Abstract
Despite advances in pharmacogenetics, the majority of heritability for treatment response cannot be explained by common variation, suggesting that factors such as epigenetics may play a key role. Regulatory genes, such as those involved in DNA methylation and transcriptional repression, are therefore excellent candidates for investigating antipsychotic treatment response. This study explored the differential expression of regulatory genes between patients with schizophrenia (chronic and antipsychotic-naïve first-episode patients) and healthy controls in order to identify candidate genes for association with antipsychotic treatment response. Seven candidate differentially expressed genes were identified, and four variants within these genes were found to be significantly associated with treatment response (DNMT3A rs2304429, HDAC5 rs11079983, and HDAC9 rs1178119 and rs11764843). Further analyses revealed that two of these variants (rs2304429 and rs11079983) are predicted to alter the expression of specific genes (DNMT3A, ASB16, and ASB16-AS1) in brain regions previously implicated in schizophrenia and treatment response. These results may aid in the development of biomarkers for antipsychotic treatment response, as well as novel drug targets.
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Affiliation(s)
| | | | - Robin Emsley
- Department of Psychiatry, Stellenbosch University, Tygerberg, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Tygerberg, South Africa
| | - Louise Warnich
- Department of Genetics, Stellenbosch University, Stellenbosch, South Africa
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Li H, Guo W, Liu F, Chen J, Su Q, Zhang Z, Fan X, Zhao J. Enhanced baseline activity in the left ventromedial putamen predicts individual treatment response in drug-naive, first-episode schizophrenia: Results from two independent study samples. EBioMedicine 2019; 46:248-255. [PMID: 31307956 PMCID: PMC6712417 DOI: 10.1016/j.ebiom.2019.07.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/20/2019] [Accepted: 07/08/2019] [Indexed: 11/28/2022] Open
Abstract
Background Antipsychotic medications are the common treatment for schizophrenia. However, reliable biomarkers that can predict individual treatment response are still lacking. The present study aimed to examine whether baseline putamen activity can predict individual treatment response in schizophrenia. Methods Two independent samples of patients with drug-naive, first-episode schizophrenia (32 patients in sample 1 and 44 in sample 2) and matched healthy controls underwent resting-state functional magnetic resonance imaging (fMRI) at baseline. Patients were treated with olanzapine for 8 weeks; symptom severity was assessed using the Positive and Negative Syndrome Scale (PANSS) at baseline and week 8. Fractional amplitude of low frequency fluctuation (fALFF) and pattern classification techniques were used to analyze the data. Findings Univariate analysis shows an elevated pre-treatment fALFF in the left ventromedial putamen in both patient samples compared to healthy controls (p's < 0.001). The support vector regression (SVR) analysis suggests a positive relationship between baseline pre-treatment fALFF in the left ventromedial putamen and improvement in positive symptom at week 8 in each patient group using a cross-validated method (r = 0.452, p = .002; r = 0.511, p = .003, respectively). Interpretation Our study suggests that elevated pre-treatment mean fALFF in the left ventromedial putamen may predict individual therapeutic response to olanzapine treatment in drug-naive, first-episode patients with schizophrenia. Future studies are needed to confirm whether this finding is generalizable to patients with schizophrenia treated with other antipsychotic medications. Fund The National Key R&D Program of China and the National Natural Science Foundation of China.
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Affiliation(s)
- Huabing Li
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Wenbin Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China.
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300000, China
| | - Jindong Chen
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China
| | - Qinji Su
- Mental Health Center, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530007, China
| | - Zhikun Zhang
- Mental Health Center, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530007, China
| | - Xiaoduo Fan
- University of Massachusetts Medical School, UMass Memorial Medical Center, One Biotech, Suite 100, 365 Plantation Street, Worcester, MA 01605, United States.
| | - Jingping Zhao
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China
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Luo X, Mao Q, Shi J, Wang X, Li CSR. Putamen gray matter volumes in neuropsychiatric and neurodegenerative disorders. WORLD JOURNAL OF PSYCHIATRY AND MENTAL HEALTH RESEARCH 2019; 3:1020. [PMID: 31328186 PMCID: PMC6641567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Putamen is enriched with dopamine and associated with dopamine-related phenotypes including many neuropsychiatric and neurodegenerative disorders that manifest with motor impairment, impulsive behavior, and cognitive deficits. The gray matter volume of the putamen is age-dependent and genetically controlled. In most neuropsychiatric and neurodegenerative disorders, including Parkinson's spectrum disorders, Huntington's disease, dementia with Lewy bodies, Alzheimer's disease, multiple sclerosis, attention deficit hyperactivity disorder, developmental dyslexia, and major depression, the putamen volume is significantly reduced. On the other hand, in individuals with bipolar disorder, schizophrenia spectrum disorders, especially neuroleptics-medicated patients with schizophrenia, autism spectrum disorders, obsessive-compulsive spectrum disorders, and cocaine/amphetamine dependence, the putamen volume is significantly enlarged. Therefore, the putamen volume may serve as a structural neural marker for many neuropsychiatric and neurodegenerative disorders and a predictor of treatment outcomes in individuals afflicted with these conditions. We provided an overview of the genetic bases of putamen volume and explored potential mechanisms whereby altered putamen volume manifests in these neuropsychiatric and neurodegenerative conditions, with a specific focus on dopaminergic processes.
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Affiliation(s)
- Xingguang Luo
- Biological Psychiatry Research Center, Beijing Huilongguan Hospital, Beijing 100096, China
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Qiao Mao
- Department of Psychosomatic Medicine, People’s Hospital of Deyang City, Deyang, Sichuan 618000, China
| | - Jing Shi
- Biological Psychiatry Research Center, Beijing Huilongguan Hospital, Beijing 100096, China
| | - Xiaoping Wang
- Department of Neurology, Shanghai Tongren Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Chiang-Shan R. Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA
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A transdiagnostic neuroanatomical signature of psychiatric illness. Neuropsychopharmacology 2019; 44:869-875. [PMID: 30127342 PMCID: PMC6461829 DOI: 10.1038/s41386-018-0175-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/15/2018] [Accepted: 07/19/2018] [Indexed: 02/05/2023]
Abstract
Despite an increasing focus on transdiagnostic approaches to mental health, it remains unclear whether different diagnostic categories share a common neuronatomical basis. The current investigation sought to investigate whether a transdiagnostic set of structural alterations characterized schizophrenia, depression, post-traumatic stress disorder, and obsessive-compulsive disorder, and determine whether any such alterations reflected markers of psychiatric illness or pre-existing familial vulnerability. A total of 404 patients with a psychiatric diagnosis were recruited (psychosis, n = 129; unipolar depression, n = 92; post-traumatic stress disorder, n = 91; obsessive-compulsive disorder, n = 92) alongside n = 201 healthy controls and n = 20 unaffected first-degree relatives. We collected structural magnetic resonance imaging scans from each participant, and tested for transdiagnostic alterations using Voxel-based morphometry. Inferences were made at p < 0.05 after family-wise error correction for multiple comparisons. The four psychiatric groups relative to healthy controls were all characterized by significantly greater gray matter volume in the putamen (right: z-score: 5.97, p-value < 0.001; left: z-score: 4.97, p-value = 0.001); the volume of this region was positively correlated with severity of symptoms across groups (r = 0.313; p < 0.001). Putamen enlargement was also evident in unaffected relatives compared to healthy controls (right: z-score: 8.13, p-value < 0.001; left: z-score: 9.38, p-value < 0.001). Taken collectively, these findings indicate that increased putamen volume may reflect a transdiagnostic marker of familial vulnerability to psychopathology. This is consistent with emerging conceptualizations of psychiatric illness, in which each disorder is understood as a combination of diagnosis-specific features and a transdiagnostic factor reflecting general psychopathology.
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Zhu F, Liu F, Guo W, Chen J, Su Q, Zhang Z, Li H, Fan X, Zhao J. Disrupted asymmetry of inter- and intra-hemispheric functional connectivity in patients with drug-naive, first-episode schizophrenia and their unaffected siblings. EBioMedicine 2018; 36:429-435. [PMID: 30241918 PMCID: PMC6197719 DOI: 10.1016/j.ebiom.2018.09.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/02/2018] [Accepted: 09/10/2018] [Indexed: 11/25/2022] Open
Abstract
Background Lack of normal asymmetry in the brain has been reported in patients with schizophrenia. However, it remains unclear whether disrupted asymmetry originates from inter-hemispheric functional connectivity (FC) and/or intra-hemispheric FC in this patient population. Methods Forty-four patients with drug-naive, first-episode schizophrenia, 42 unaffected siblings, and 44 healthy controls underwent resting-state functional magnetic resonance imaging (fMRI) scan. The parameter of asymmetry (PAS) and support vector machine (SVM) were used to analyze the data. Patients were treated with olanzapine for 8 weeks. Findings Compared with healthy controls, patients showed lower PAS scores in the left middle temporal gyrus (MTG)/inferior temporal gyrus (ITG), left posterior cingulate cortex (PCC)/precuneus and left angular gyrus, and higher PAS scores in the left precentral gyrus/postcentral gyrus. Unaffected siblings also showed lower PAS scores in the left MTG/ITG and left PCC/precuneus relative to healthy controls. Further, SVM analysis showed that a combination of the PAS scores in these two clusters in patients at baseline was able to predict clinical response after 8 weeks of olanzapine treatment with 77.27% sensitivity, 72.73% specificity, and 75.00% accuracy. Interpretation The present study suggests disrupted asymmetry of inter- and intra-hemispheric FC in drug-naive, first-episode schizophrenia; in addition, a reduced asymmetry of inter-hemispheric FC in the left MTG/ITG and left PCC/precuneus may serve as an endophenotype for schizophrenia, and may have clinical utility to predict response to olanzapine treatment. Fund The National Key R&D Program of China and the National Natural Science Foundation of China.
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Affiliation(s)
- Furong Zhu
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300000, China
| | - Wenbin Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China.
| | - Jindong Chen
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Qinji Su
- Mental Health Center, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530007, China
| | - Zhikun Zhang
- Mental Health Center, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530007, China
| | - Huabing Li
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Xiaoduo Fan
- University of Massachusetts Medical School, UMass Memorial Medical Center, One Biotech, Suite 100, 365 Plantation Street, Worcester, MA 01605, United States.
| | - Jingping Zhao
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
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Mitelman SA, Bralet MC, Haznedar MM, Hollander E, Shihabuddin L, Hazlett EA, Buchsbaum MS. Diametrical relationship between gray and white matter volumes in autism spectrum disorder and schizophrenia. Brain Imaging Behav 2018; 11:1823-1835. [PMID: 27882449 DOI: 10.1007/s11682-016-9648-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Autism spectrum disorders and schizophrenia have been variously characterized as separate nosological entities with overlapping deficits in social cognition or diametrical extremes of a phenotypic continuum. This study aimed to determine how these models apply to comparative morphometric data. MRI scans of the brain were obtained in 49 subjects with schizophrenia, 20 subjects with autism and 39 healthy controls. Images were parcellated into 40 Brodmann areas and entered into repeated-measures ANOVA for between-group comparison of global and localized gray and white matter volumes. A pattern of lower gray mater volumes and greater white matter volumes was found in subjects with schizophrenia in comparison to subjects with autism. For both gray and white matter, this pattern was most pronounced in regions associated with motor-premotor and anterior frontal cortex, anterior cingulate, fusiform, superior and middle temporal gyri. Patient groups tended to diverge from healthy controls in opposite directions, with greater-than-normal gray matter volumes and lower-than-normal white matter volumes in subjects with autism and reversed patterns in subjects with schizophrenia. White matter reductions in subjects with autism were seen in posterior frontal lobe and along the cingulate arch. Normal hemispheric asymmetry in the temporal lobe was effaced in subjects with autism and schizophrenia, especially in the latter. Nearly identical distribution of changes and diametrically divergent volumetry suggest that autism and schizophrenia may occupy opposite extremes of the same cognitive continuum.
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Affiliation(s)
- Serge A Mitelman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA. .,Department of Psychiatry, Division of Child and Adolescent Psychiatry, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY, 11373, USA.
| | - Marie-Cecile Bralet
- Crisalid Unit (FJ5), CHI Clermont de l'Oise, 2 rue des finets, 60607, Clermont, France.,Inserm Unit U669, Maison de Solenn, Universities Paris 5-11, 75014, Paris, France.,GDR 3557 Recherche Psychiatrie, Paris, France
| | - M Mehmet Haznedar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.,Outpatient Psychiatry Care Center, James J. Peters VA Medical Center, Bronx, NY, 10468, USA
| | - Eric Hollander
- Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Department of Psychiatry and Behavioral Science, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 10467, USA
| | - Lina Shihabuddin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Erin A Hazlett
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.,Research and Development and VISN 3 Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, 10468, USA
| | - Monte S Buchsbaum
- Departments of Psychiatry and Radiology, San Diego School of Medicine, NeuroPET Center, University of California, 11388 Sorrento Valley Road, Suite #100, San Diego, CA, 92121, USA
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11
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Ma Q, Zhang T, Zanetti MV, Shen H, Satterthwaite TD, Wolf DH, Gur RE, Fan Y, Hu D, Busatto GF, Davatzikos C. Classification of multi-site MR images in the presence of heterogeneity using multi-task learning. Neuroimage Clin 2018; 19:476-486. [PMID: 29984156 PMCID: PMC6029565 DOI: 10.1016/j.nicl.2018.04.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/09/2018] [Accepted: 04/28/2018] [Indexed: 12/21/2022]
Abstract
With the advent of Big Data Imaging Analytics applied to neuroimaging, datasets from multiple sites need to be pooled into larger samples. However, heterogeneity across different scanners, protocols and populations, renders the task of finding underlying disease signatures challenging. The current work investigates the value of multi-task learning in finding disease signatures that generalize across studies and populations. Herein, we present a multi-task learning type of formulation, in which different tasks are from different studies and populations being pooled together. We test this approach in an MRI study of the neuroanatomy of schizophrenia (SCZ) by pooling data from 3 different sites and populations: Philadelphia, Sao Paulo and Tianjin (50 controls and 50 patients from each site), which posed integration challenges due to variability in disease chronicity, treatment exposure, and data collection. Some existing methods are also tested for comparison purposes. Experiments show that classification accuracy of multi-site data outperformed that of single-site data and pooled data using multi-task feature learning, and also outperformed other comparison methods. Several anatomical regions were identified to be common discriminant features across sites. These included prefrontal, superior temporal, insular, anterior cingulate cortex, temporo-limbic and striatal regions consistently implicated in the pathophysiology of schizophrenia, as well as the cerebellum, precuneus, and fusiform, middle temporal, inferior parietal, postcentral, angular, lingual and middle occipital gyri. These results indicate that the proposed multi-task learning method is robust in finding consistent and reliable structural brain abnormalities associated with SCZ across different sites, in the presence of multiple sources of heterogeneity.
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Affiliation(s)
- Qiongmin Ma
- College of Mechatronics and Automation, National University of Defense Technology, Changsha, Hunan 410073, China; Center for Biomedical Image Computing and Analytics, and Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States; Beijing Institute of System Engineering, China.
| | - Tianhao Zhang
- Center for Biomedical Image Computing and Analytics, and Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Marcus V Zanetti
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Hui Shen
- College of Mechatronics and Automation, National University of Defense Technology, Changsha, Hunan 410073, China
| | | | - Daniel H Wolf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Yong Fan
- Center for Biomedical Image Computing and Analytics, and Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Dewen Hu
- College of Mechatronics and Automation, National University of Defense Technology, Changsha, Hunan 410073, China
| | - Geraldo F Busatto
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics, and Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
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12
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Kurachi M, Takahashi T, Sumiyoshi T, Uehara T, Suzuki M. Early Intervention and a Direction of Novel Therapeutics for the Improvement of Functional Outcomes in Schizophrenia: A Selective Review. Front Psychiatry 2018; 9:39. [PMID: 29515467 PMCID: PMC5826072 DOI: 10.3389/fpsyt.2018.00039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A recent review reported that the median proportion of patients recovering from schizophrenia was 13.5% and that this did not change over time. Various factors including the duration of untreated psychosis, cognitive impairment, negative symptoms, and morphological changes in the brain influence the functional outcome of schizophrenia. The authors herein reviewed morphological changes in the brain of schizophrenia patients, effects of early intervention, and a direction of developing novel therapeutics to achieve significant improvement of the functional outcome. METHODS A selective review of the literature including studies from our department was performed. RESULTS Longitudinal structural neuroimaging studies on schizophrenia revealed that volume reductions in the peri-Sylvian regions (e.g., superior temporal gyrus and insula), which are related to positive psychotic symptoms, progress around the onset (critical stage) of schizophrenia, but become stable in the chronic stage. On the other hand, morphological changes in the fronto-thalamic regions and lateral ventricle, which are related to negative symptoms, neurocognitive dysfunction, and the functional outcome, progress during both the critical and chronic stages. These changes in the peri-Sylvian and fronto-thalamic regions may provide a pathophysiological basis for Crow's two-syndrome classification. Accumulated evidence from early intervention trials suggests that the transition risk from an at-risk mental state (ARMS) to psychosis is approximately 30%. Differences in the cognitive performance, event-related potentials (e.g., mismatch negativity), and brain morphology have been reported between ARMS subjects who later developed psychosis and those who did not. Whether early intervention for ARMS significantly improves the long-term recovery rate of schizophrenia patients remains unknown. With respect to the development of novel therapeutics, animal models of schizophrenia based on the N-methyl-d-aspartate receptor hypofunction hypothesis successfully mimicked behavioral changes associated with cognitive impairments characteristic of the disease. Furthermore, these animal models elicited histological changes in the brain similar to those observed in schizophrenia patients, i.e., decreased numbers of parvalbumin-positive interneurons and dendritic spines of pyramidal neurons in the frontal cortex. Some antioxidant compounds were found to ameliorate these behavioral and histological abnormalities. CONCLUSION Early intervention coupled with novel therapeutics may offer a promising approach for substantial improvement of the functional outcome of schizophrenia patients.
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Affiliation(s)
| | - Tsutomu Takahashi
- Department of Neuropsychiatry, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Tomiki Sumiyoshi
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takashi Uehara
- Department of Neuropsychiatry, Kanazawa Medical University, Kanazawa, Japan
| | - Michio Suzuki
- Department of Neuropsychiatry, Graduate School of Medicine, University of Toyama, Toyama, Japan
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13
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Wojtalik JA, Smith MJ, Keshavan MS, Eack SM. A Systematic and Meta-analytic Review of Neural Correlates of Functional Outcome in Schizophrenia. Schizophr Bull 2017; 43:1329-1347. [PMID: 28204755 PMCID: PMC5737663 DOI: 10.1093/schbul/sbx008] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Individuals with schizophrenia are burdened with impairments in functional outcome, despite existing interventions. The lack of understanding of the neurobiological correlates supporting adaptive function in the disorder is a significant barrier to developing more effective treatments. This research conducted a systematic and meta-analytic review of all peer-reviewed studies examining brain-functional outcome relationships in schizophrenia. A total of 53 (37 structural and 16 functional) brain imaging studies examining the neural correlates of functional outcome across 1631 individuals with schizophrenia were identified from literature searches in relevant databases occurring between January, 1968 and December, 2016. Study characteristics and results representing brain-functional outcome relationships were systematically extracted, reviewed, and meta-analyzed. Results indicated that better functional outcome was associated with greater fronto-limbic and whole brain volumes, smaller ventricles, and greater activation, especially during social cognitive processing. Thematic observations revealed that the dorsolateral prefrontal cortex, anterior cingulate, posterior cingulate, parahippocampal gyrus, superior temporal sulcus, and cerebellum may have role in functioning. The neural basis of functional outcome and disability is infrequently studied in schizophrenia. While existing evidence is limited and heterogeneous, these findings suggest that the structural and functional integrity of fronto-limbic brain regions is consistently related to functional outcome in individuals with schizophrenia. Further research is needed to understand the mechanisms and directionality of these relationships, and the potential for identifying neural targets to support functional improvement.
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Affiliation(s)
- Jessica A Wojtalik
- School of Social Work, University of Pittsburgh, Pittsburgh, PA,To whom correspondence should be addressed; School of Social Work, University of Pittsburgh, 2117 Cathedral of Learning, Pittsburgh, PA 15260, US; tel: 412-624-6304, e-mail:
| | - Matthew J Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Shaun M Eack
- School of Social Work, University of Pittsburgh, Pittsburgh, PA,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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14
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Calhoun VD. Integration of SNPs-FMRI-methylation data with sparse multi-CCA for schizophrenia study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:3310-3313. [PMID: 28269013 DOI: 10.1109/embc.2016.7591436] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Schizophrenia (SZ) is a complex mental disorder associated with genetic variations, brain development and activities, and environmental factors. There is an increasing interest in combining genetic, epigenetic and neuroimaging datasets to explore different level of biomarkers for the correlation and interaction between these diverse factors. Sparse Multi-Canonical Correlation Analysis (sMCCA) is a powerful tool that can analyze the correlation of three or more datasets. In this paper, we propose the sMCCA model for imaging genomics study. We show the advantage of sMCCA over sparse CCA (sCCA) through the simulation testing, and further apply it to the analysis of real data (SNPs, fMRI and methylation) from schizophrenia study. Some new genes and brain regions related to SZ disease are discovered by sMCCA and the relationships among these biomarkers are further discussed.
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15
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Kubota M, Nagashima T, Takano H, Kodaka F, Fujiwara H, Takahata K, Moriguchi S, Kimura Y, Higuchi M, Okubo Y, Takahashi H, Ito H, Suhara T. Affinity States of Striatal Dopamine D2 Receptors in Antipsychotic-Free Patients with Schizophrenia. Int J Neuropsychopharmacol 2017; 20:928-935. [PMID: 29016872 PMCID: PMC5737675 DOI: 10.1093/ijnp/pyx063] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/19/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Dopamine D2 receptors are reported to have high-affinity (D2High) and low-affinity (D2Low) states. Although an increased proportion of D2High has been demonstrated in animal models of schizophrenia, few clinical studies have investigated this alteration of D2High in schizophrenia in vivo. METHODS Eleven patients with schizophrenia, including 10 antipsychotic-naive and 1 antipsychotic-free individuals, and 17 healthy controls were investigated. Psychopathology was assessed by Positive and Negative Syndrome Scale, and a 5-factor model was used. Two radioligands, [11C]raclopride and [11C]MNPA, were employed to quantify total dopamine D2 receptor and D2High, respectively, in the striatum by measuring their binding potentials. Binding potential values of [11C]raclopride and [11C]MNPA and the binding potential ratio of [11C]MNPA to [11C]raclopride in the striatal subregions were statistically compared between the 2 diagnostic groups using multivariate analysis of covariance controlling for age, gender, and smoking. Correlations between binding potential and Positive and Negative Syndrome Scale scores were also examined. RESULTS Multivariate analysis of covariance demonstrated a significant effect of diagnosis (schizophrenia and control) on the binding potential ratio (P=.018), although the effects of diagnosis on binding potential values obtained with either [11C]raclopride or [11C]MNPA were nonsignificant. Posthoc test showed that the binding potential ratio was significantly higher in the putamen of patients (P=.017). The Positive and Negative Syndrome Scale "depressed" factor in patients was positively correlated with binding potential values of both ligands in the caudate. CONCLUSIONS The present study indicates the possibilities of: (1) a higher proportion of D2High in the putamen despite unaltered amounts of total dopamine D2 receptors; and (2) associations between depressive symptoms and amounts of caudate dopamine D2 receptors in patients with schizophrenia.
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Affiliation(s)
- Manabu Kubota
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Kubota, Nagashima, Takano, Kodaka, Fujiwara, Moriguchi, Kimura, Higuchi, Takahashi, Ito, and Suhara); Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan (Dr Takano); Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan (Dr Kodaka); Department of Clinical and Experimental Neuroimaging, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, Obu, Japan (Dr Kimura); Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan (Dr Okubo); Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Dr Takahashi); Department of Radiology, School of Medicine, Fukushima Medical University, Fukushima, Japan (Dr Ito)
| | - Tomohisa Nagashima
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Kubota, Nagashima, Takano, Kodaka, Fujiwara, Moriguchi, Kimura, Higuchi, Takahashi, Ito, and Suhara); Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan (Dr Takano); Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan (Dr Kodaka); Department of Clinical and Experimental Neuroimaging, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, Obu, Japan (Dr Kimura); Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan (Dr Okubo); Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Dr Takahashi); Department of Radiology, School of Medicine, Fukushima Medical University, Fukushima, Japan (Dr Ito)
| | - Harumasa Takano
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Kubota, Nagashima, Takano, Kodaka, Fujiwara, Moriguchi, Kimura, Higuchi, Takahashi, Ito, and Suhara); Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan (Dr Takano); Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan (Dr Kodaka); Department of Clinical and Experimental Neuroimaging, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, Obu, Japan (Dr Kimura); Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan (Dr Okubo); Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Dr Takahashi); Department of Radiology, School of Medicine, Fukushima Medical University, Fukushima, Japan (Dr Ito)
| | - Fumitoshi Kodaka
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Kubota, Nagashima, Takano, Kodaka, Fujiwara, Moriguchi, Kimura, Higuchi, Takahashi, Ito, and Suhara); Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan (Dr Takano); Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan (Dr Kodaka); Department of Clinical and Experimental Neuroimaging, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, Obu, Japan (Dr Kimura); Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan (Dr Okubo); Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Dr Takahashi); Department of Radiology, School of Medicine, Fukushima Medical University, Fukushima, Japan (Dr Ito)
| | - Hironobu Fujiwara
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Kubota, Nagashima, Takano, Kodaka, Fujiwara, Moriguchi, Kimura, Higuchi, Takahashi, Ito, and Suhara); Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan (Dr Takano); Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan (Dr Kodaka); Department of Clinical and Experimental Neuroimaging, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, Obu, Japan (Dr Kimura); Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan (Dr Okubo); Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Dr Takahashi); Department of Radiology, School of Medicine, Fukushima Medical University, Fukushima, Japan (Dr Ito)
| | - Keisuke Takahata
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Kubota, Nagashima, Takano, Kodaka, Fujiwara, Moriguchi, Kimura, Higuchi, Takahashi, Ito, and Suhara); Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan (Dr Takano); Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan (Dr Kodaka); Department of Clinical and Experimental Neuroimaging, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, Obu, Japan (Dr Kimura); Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan (Dr Okubo); Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Dr Takahashi); Department of Radiology, School of Medicine, Fukushima Medical University, Fukushima, Japan (Dr Ito)
| | - Sho Moriguchi
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Kubota, Nagashima, Takano, Kodaka, Fujiwara, Moriguchi, Kimura, Higuchi, Takahashi, Ito, and Suhara); Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan (Dr Takano); Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan (Dr Kodaka); Department of Clinical and Experimental Neuroimaging, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, Obu, Japan (Dr Kimura); Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan (Dr Okubo); Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Dr Takahashi); Department of Radiology, School of Medicine, Fukushima Medical University, Fukushima, Japan (Dr Ito)
| | - Yasuyuki Kimura
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Kubota, Nagashima, Takano, Kodaka, Fujiwara, Moriguchi, Kimura, Higuchi, Takahashi, Ito, and Suhara); Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan (Dr Takano); Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan (Dr Kodaka); Department of Clinical and Experimental Neuroimaging, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, Obu, Japan (Dr Kimura); Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan (Dr Okubo); Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Dr Takahashi); Department of Radiology, School of Medicine, Fukushima Medical University, Fukushima, Japan (Dr Ito)
| | - Makoto Higuchi
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Kubota, Nagashima, Takano, Kodaka, Fujiwara, Moriguchi, Kimura, Higuchi, Takahashi, Ito, and Suhara); Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan (Dr Takano); Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan (Dr Kodaka); Department of Clinical and Experimental Neuroimaging, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, Obu, Japan (Dr Kimura); Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan (Dr Okubo); Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Dr Takahashi); Department of Radiology, School of Medicine, Fukushima Medical University, Fukushima, Japan (Dr Ito)
| | - Yoshiro Okubo
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Kubota, Nagashima, Takano, Kodaka, Fujiwara, Moriguchi, Kimura, Higuchi, Takahashi, Ito, and Suhara); Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan (Dr Takano); Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan (Dr Kodaka); Department of Clinical and Experimental Neuroimaging, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, Obu, Japan (Dr Kimura); Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan (Dr Okubo); Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Dr Takahashi); Department of Radiology, School of Medicine, Fukushima Medical University, Fukushima, Japan (Dr Ito)
| | - Hidehiko Takahashi
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Kubota, Nagashima, Takano, Kodaka, Fujiwara, Moriguchi, Kimura, Higuchi, Takahashi, Ito, and Suhara); Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan (Dr Takano); Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan (Dr Kodaka); Department of Clinical and Experimental Neuroimaging, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, Obu, Japan (Dr Kimura); Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan (Dr Okubo); Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Dr Takahashi); Department of Radiology, School of Medicine, Fukushima Medical University, Fukushima, Japan (Dr Ito)
| | - Hiroshi Ito
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Kubota, Nagashima, Takano, Kodaka, Fujiwara, Moriguchi, Kimura, Higuchi, Takahashi, Ito, and Suhara); Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan (Dr Takano); Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan (Dr Kodaka); Department of Clinical and Experimental Neuroimaging, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, Obu, Japan (Dr Kimura); Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan (Dr Okubo); Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Dr Takahashi); Department of Radiology, School of Medicine, Fukushima Medical University, Fukushima, Japan (Dr Ito)
| | - Tetsuya Suhara
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan (Drs Kubota, Nagashima, Takano, Kodaka, Fujiwara, Moriguchi, Kimura, Higuchi, Takahashi, Ito, and Suhara); Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan (Dr Takano); Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan (Dr Kodaka); Department of Clinical and Experimental Neuroimaging, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, Obu, Japan (Dr Kimura); Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan (Dr Okubo); Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Dr Takahashi); Department of Radiology, School of Medicine, Fukushima Medical University, Fukushima, Japan (Dr Ito).,Correspondence: Tetsuya Suhara, MD, PhD, Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, Chiba 263–8555, Japan ()
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Dietsche B, Kircher T, Falkenberg I. Structural brain changes in schizophrenia at different stages of the illness: A selective review of longitudinal magnetic resonance imaging studies. Aust N Z J Psychiatry 2017; 51:500-508. [PMID: 28415873 DOI: 10.1177/0004867417699473] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Schizophrenia is a devastating mental disorder accompanied by aberrant structural brain connectivity. The question whether schizophrenia is a progressive brain disorder is yet to be resolved. Thus, it is not clear when these structural alterations occur and how they develop over time. METHODS In our selective review, we summarized recent findings from longitudinal magnetic resonance imaging studies investigating structural brain alterations and its impact on clinical outcome at different stages of the illness: (1) subjects at ultra-high risk of developing psychosis, (2) patients with a first episode psychosis, and (3) chronically ill patients. Moreover, we reviewed studies examining the longitudinal effects of medication on brain structure in patients with schizophrenia. RESULTS (1) Studies from pre-clinical stages to conversion showed a more pronounced cortical gray matter loss (i.e. superior temporal and inferior frontal regions) in those individuals who later made transition to psychosis. (2) Studies investigating patients with a first episode psychosis revealed a decline in multiple gray matter regions (i.e. frontal regions and thalamus) over time as well as progressive cortical thinning in the superior and inferior frontal cortex. (3) Studies focusing on patients with chronic schizophrenia showed that gray matter decreased to a greater extent (i.e. frontal and temporal areas, thalamus, and cingulate cortices)-especially in poor-outcome patients. Very few studies reported effects on white matter microstructure in the longitudinal course of the illness. CONCLUSION There is adequate evidence to suggest that schizophrenia is associated with progressive gray matter abnormalities particularly during the initial stages of illness. However, causal relationships between structural changes and illness course-especially in chronically ill patients-should be interpreted with caution. Findings might be confounded by longer periods of treatment and higher doses of antipsychotics or epiphenomena related to the illness.
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Affiliation(s)
- Bruno Dietsche
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Irina Falkenberg
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
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17
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Rich AM, Cho YT, Tang Y, Savic A, Krystal JH, Wang F, Xu K, Anticevic A. Amygdala volume is reduced in early course schizophrenia. Psychiatry Res 2016; 250:50-60. [PMID: 27035063 PMCID: PMC4904038 DOI: 10.1016/j.pscychresns.2016.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 02/01/2016] [Accepted: 02/11/2016] [Indexed: 02/07/2023]
Abstract
Subcortical structural alterations have been implicated in the neuropathology of schizophrenia. Yet, the extent of anatomical alterations for subcortical structures across illness phases remains unknown. To assess this, magnetic resonance imaging (MRI) was used to examine volume differences of major subcortical structures: thalamus, nucleus accumbens, caudate, putamen, globus pallidus, amygdala and hippocampus. These differences were examined across four groups: (i) healthy comparison subjects (HCS, n=96); (ii) individuals at high risk (HR, n=21) for schizophrenia; (iii) early-course schizophrenia patients (EC-SCZ, n=28); and (iv) chronic schizophrenia patients (C-SCZ, n=20). Raw gray matter volumes and volumetric ratios (volume of specific structure/total gray matter volume) were extracted using automated segmentation tools. EC-SCZ group exhibited smaller bilateral amygdala volumetric ratios, compared to HCS and HR subjects. Findings did not change when corrected for age, level of education and medication use. Amygdala raw volumes did not differ among groups once adjusted for multiple comparisons, but the smaller amygdala volumetric ratio in EC-SCZ survived Bonferroni correction. Other structures were not different across the groups following Bonferroni correction. Smaller amygdala volumes during early illness course may reflect pathophysiologic changes specific to illness development, including disrupted salience processing and acute stress responses.
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Affiliation(s)
- Alyson M Rich
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06511, USA; College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI 48109, USA
| | - Youngsun T Cho
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06511, USA
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning, PR China
| | - Aleksandar Savic
- University Psychiatric Hospital Vrapce, University of Zagreb, Zagreb 10000, Croatia
| | - John H Krystal
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06511, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT 06519, USA; NIAAA Center for the Translational Neuroscience of Alcoholism, New Haven, CT 06519, USA
| | - Fei Wang
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06511, USA; Department of Radiology, The First Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning, PR China
| | - Ke Xu
- Department of Radiology, The First Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning, PR China.
| | - Alan Anticevic
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06511, USA; Department of Psychiatry, The First Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning, PR China; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT 06519, USA; NIAAA Center for the Translational Neuroscience of Alcoholism, New Haven, CT 06519, USA; Department of Psychology, Yale University, 2 Hillhouse Avenue, CT 06520, USA; Interdepartmental Neuroscience Program, Yale University, New Haven, CT 06520, USA.
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18
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Ma G, Fan H, Shen C, Wang W. Genetic and Neuroimaging Features of Personality Disorders: State of the Art. Neurosci Bull 2016; 32:286-306. [PMID: 27037690 DOI: 10.1007/s12264-016-0027-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/03/2016] [Indexed: 12/11/2022] Open
Abstract
Personality disorders often act as a common denominator for many psychiatric problems, and studies on personality disorders contribute to the etiopathology, diagnosis, and treatment of many mental disorders. In recent years, increasing evidence from various studies has shown distinctive features of personality disorders, and that from genetic and neuroimaging studies has been especially valuable. Genetic studies primarily target the genes encoding neurotransmitters and enzymes in the serotoninergic and dopaminergic systems, and neuroimaging studies mainly focus on the frontal and temporal lobes as well as the limbic-paralimbic system in patients with personality disorders. Although some studies have suffered due to unclear diagnoses of personality disorders and some have included few patients for a given personality disorder, great opportunities remain for investigators to launch new ideas and technologies in the field.
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Affiliation(s)
- Guorong Ma
- Department of Clinical Psychology and Psychiatry, Zhejiang University School of Medicine, Hangzhou, 310058, China.,Department of Psychology and Behavioral Sciences, Zhejiang University College of Science, Hangzhou, 310007, China
| | - Hongying Fan
- Department of Clinical Psychology and Psychiatry, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Chanchan Shen
- Department of Psychology and Behavioral Sciences, Zhejiang University College of Science, Hangzhou, 310007, China
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry, Zhejiang University School of Medicine, Hangzhou, 310058, China. .,Department of Psychology and Behavioral Sciences, Zhejiang University College of Science, Hangzhou, 310007, China.
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19
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Sapara A, ffytche DH, Cooke MA, Williams SC, Kumari V. Is it me? Verbal self-monitoring neural network and clinical insight in schizophrenia. Psychiatry Res 2015; 234:328-35. [PMID: 26549744 PMCID: PMC4834462 DOI: 10.1016/j.pscychresns.2015.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 01/12/2023]
Abstract
Self-monitoring, defined as the ability to distinguish between self-generated stimuli from other-generated ones, is known to be impaired in schizophrenia. This impairment has been theorised as the basis for many of the core psychotic symptoms, in particular, poor clinical insight. This study aimed to investigate verbal self-monitoring related neural substrates of preserved and poor clinical insight in schizophrenia. It involved 40 stable schizophrenia outpatients, 20 with preserved and 20 with poor insight, and 20 healthy participants. All participants underwent functional magnetic resonance imaging with brain coverage covering key areas in the self-monitoring network during a verbal self-monitoring task. Healthy participants showed higher performance accuracy and greater thalamic activity than both preserved and poor insight patient groups. Preserved insight patients showed higher activity in the putamen extending into the caudate, insula and inferior frontal gyrus, compared to poor insight patients, and in the anterior cingulate and medial frontal gyrus, compared to healthy participants. Poor insight patients did not show greater activity in any brain area compared to preserved insight patients or healthy participants. Future studies may pursue therapeutic avenues, such as meta-cognitive therapies to promote self-monitoring or targeted stimulation of relevant brain areas, as means of enhancing insight in schizophrenia.
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Affiliation(s)
- Adegboyega Sapara
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Dominic H. ffytche
- Department of Old Age Psychiatry and Department of Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Michael A. Cooke
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Steven C.R. Williams
- Department of Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Veena Kumari
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.
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20
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Hong SB, Lee TY, Kwak YB, Kim SN, Kwon JS. Baseline putamen volume as a predictor of positive symptom reduction in patients at clinical high risk for psychosis: A preliminary study. Schizophr Res 2015; 169:178-185. [PMID: 26527246 DOI: 10.1016/j.schres.2015.10.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/13/2015] [Accepted: 10/20/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Illness course in individuals at clinical high risk (CHR) status for psychosis is heterogeneous, which limits effective treatment for all CHR subgroups. Baseline predictors of positive symptom trajectory in the CHR group will reduce such limitations. We singled out the putamen, thought to be involved in the generation of the key schizophrenia symptoms early in the course of disease, as a potential predictor of positive symptom trajectory in CHR patients. METHOD We recruited 45 CHR patients and 29 age- and gender-matched healthy controls (HC). The CHR group was divided into patients with positive symptom reduction (CHR-R) and patients without positive symptom reduction (CHR-NR) at 6 months. Comparisons were made between the baseline putamen volumes of CHR-R, CHR-NR and HC groups. The relationship between baseline putamen volumes and clinical measures was investigated. RESULTS Left putamen volumes of CHR-R patients were significantly smaller than those of HCs (p=0.002) and of CHR-NR patients (p=0.024). CHR-R patients had significantly reduced leftward laterality compared to HCs (p=0.007). In the CHR-R group, bilateral putamen volumes were correlated with positive symptom severity at baseline (r=-0.552, p=0.001) and at 6 months (r=-0.360, p=0.043), and predicted positive symptom score change in 6 months at a trend level (p=0.092). CONCLUSION Smaller left putamen volumes in CHR-R patients, and the correlation between positive symptom severity and putamen volumes suggest that putamen volume is a possible risk-stratifier and predictor of clinical course in the CHR population.
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Affiliation(s)
- Sang Bin Hong
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Yoo Bin Kwak
- Department of Brain & Cognitive Sciences, Seoul National University College of National Sciences, Seoul, Republic of Korea
| | - Sung Nyun Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Brain & Cognitive Sciences, Seoul National University College of National Sciences, Seoul, Republic of Korea
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21
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Chan HM, Stolwyk R, Neath J, Kelso W, Walterfang M, Mocellin R, Pantelis C, Velakoulis D. Neurocognitive similarities between severe chronic schizophrenia and behavioural variant frontotemporal dementia. Psychiatry Res 2015; 225:658-66. [PMID: 25510904 DOI: 10.1016/j.psychres.2014.11.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 10/25/2014] [Accepted: 11/07/2014] [Indexed: 11/15/2022]
Abstract
This study focuses on a group of patients with chronic schizophrenia who have a more severe form of the disorder, as indicated by socio-functional decline, treatment resistance, and recurrent hospitalisation. Previous research has suggested that the pattern and severity of cognitive deficits in people with severe chronic schizophrenia is similar to that observed in behavioural variant frontotemporal dementia (bvFTD). In the current study, we compared neurocognitive performance in 16 cognitive domains in 7 inpatients with severe chronic schizophrenia, 13 community-dwelling outpatients with chronic schizophrenia, 12 patients with bvFTD, and 18 healthy controls. Our findings revealed more similar cognitive profiles between the schizophrenia inpatient and bvFTD groups compared to the schizophrenia outpatient group, who outperformed the former groups. The current results provide preliminary evidence for a distinct schizophrenia subgroup, distinguishable from other chronic schizophrenia patients by poorer clinical and functional status, who have levels of cognitive impairment comparable to those seen in bvFTD patients.
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Affiliation(s)
- Hui-Minn Chan
- School of Psychological Sciences, Building 17, Wellington Road, Monash University, Clayton 3800, VIC, Australia; Neuropsychiatry Unit, John Cade Level 2, Royal Melbourne Hospital, Parkville 3050, VIC, Australia.
| | - Rene Stolwyk
- School of Psychological Sciences, Building 17, Wellington Road, Monash University, Clayton 3800, VIC, Australia
| | - Joanna Neath
- Neuropsychiatry Unit, John Cade Level 2, Royal Melbourne Hospital, Parkville 3050, VIC, Australia
| | - Wendy Kelso
- Neuropsychiatry Unit, John Cade Level 2, Royal Melbourne Hospital, Parkville 3050, VIC, Australia
| | - Mark Walterfang
- Neuropsychiatry Unit, John Cade Level 2, Royal Melbourne Hospital, Parkville 3050, VIC, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Parkville 3053, VIC, Australia
| | - Ramon Mocellin
- Neuropsychiatry Unit, John Cade Level 2, Royal Melbourne Hospital, Parkville 3050, VIC, Australia
| | - Christos Pantelis
- Adult Mental Health Rehabilitation Unit, Sunshine Hospital, St Albans 3021, VIC, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Parkville 3053, VIC, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, John Cade Level 2, Royal Melbourne Hospital, Parkville 3050, VIC, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Parkville 3053, VIC, Australia
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22
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Peters BD, Karlsgodt KH. White matter development in the early stages of psychosis. Schizophr Res 2015; 161:61-9. [PMID: 24893908 PMCID: PMC4250450 DOI: 10.1016/j.schres.2014.05.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/06/2014] [Accepted: 05/09/2014] [Indexed: 12/19/2022]
Abstract
Schizophrenia has been conceptualized as a disorder of both neurodevelopment and a disorder of connectivity. One important aspect of the neurodevelopmental hypothesis is that schizophrenia is no longer thought to have discrete illness time points, but rather a long trajectory of brain changes, spanning many years, across a series of stages of the disease including the prodrome, first episode, and chronic period. As the disease progresses, there is a complex relationship between age related changes and disease related changes. Therefore, neural changes, and specifically white matter based connectivity changes, in schizophrenia may be best conceptualized based on a lifespan trajectory. In this selective review, we discuss healthy changes in white matter integrity that occur with age, as well as changes that occur across illness stages. We further propose a set of models that might explain lifespan changes in white matter integrity in schizophrenia, with the conclusion that the evidence most strongly supports a pattern of disrupted maturation during adolescence, with the potential for later changes that may be a result of disease neurotoxicity, abnormal or excessive aging effects, as well as medication, cohort or other effects. Thus, when considering white matter integrity in psychosis, it is critical to consider age in addition to other contributing factors including disease specific effects. Discovery of the factors driving healthy white matter development across the lifespan and deviations from the normal developmental trajectory may provide insights relevant to the discovery of early treatment interventions.
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Affiliation(s)
- Bart D. Peters
- Division of Psychiatry Research, Zucker Hillside Hospital, NorthShore-LIJ Health System, Glen Oaks, NY
| | - Katherine H. Karlsgodt
- Division of Psychiatry Research, Zucker Hillside Hospital, NorthShore-LIJ Health System, Glen Oaks, NY,Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY,Department of Psychiatry, Hofstra NorthShore-LIJ School of Medicine, Hempstead, NY
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23
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Cropley VL, Pantelis C. Using longitudinal imaging to map the 'relapse signature' of schizophrenia and other psychoses. Epidemiol Psychiatr Sci 2014; 23:219-25. [PMID: 24849668 PMCID: PMC6998274 DOI: 10.1017/s2045796014000341] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Brain imaging studies in schizophrenia have typically involved single assessment and cross-sectional designs, while longitudinal studies rarely incorporate more than two time points. While informative, these studies do not adequately capture potential trajectories of neurobiological change, particularly in the context of a changing clinical picture. We propose that the analysis of brain trajectories using multiple time points may inform our understanding of the illness and the effect of treatment. This paper makes the case for frequent serial neuroimaging across the course of schizophrenia psychoses and its application to active illness epsiodes to provide a detailed examination of psychosis relapse and remission.
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Affiliation(s)
- V. L. Cropley
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - C. Pantelis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
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24
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Abstract
The study of schizotypal personality disorder (SPD) is important clinically, as it is understudied, challenging to treat, often under-recognized or misdiagnosed, and associated with significant functional impairment. SPD also represents an intermediate schizophrenia-spectrum phenotype, and therefore, can provide a better understanding of the genetics, pathogenesis, and treatment of related psychotic illnesses. In this review we discuss recent findings of SPD related to epidemiology and functional impairment, heritability and genetics, working memory and cognitive impairments, social-affective disturbances, and neurobiology. Additionally, we examine the challenges associated with treating patients with SPD, as well as clinical recommendations. Finally, we address future directions and areas in need of further exploration.
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Affiliation(s)
- Daniel R. Rosell
- Icahn School of Medicine at Mount Sinai, New York, NY,James J. Peters Veterans Affairs Medical Center, Bronx, NY
| | - Shira E. Futterman
- Icahn School of Medicine at Mount Sinai, New York, NY,James J. Peters Veterans Affairs Medical Center, Bronx, NY
| | - Antonia McMaster
- Icahn School of Medicine at Mount Sinai, New York, NY,James J. Peters Veterans Affairs Medical Center, Bronx, NY
| | - Larry J. Siever
- Icahn School of Medicine at Mount Sinai, New York, NY,James J. Peters Veterans Affairs Medical Center, Bronx, NY
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25
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26
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Chiapponi C, Piras F, Fagioli S, Piras F, Caltagirone C, Spalletta G. Age-related brain trajectories in schizophrenia: a systematic review of structural MRI studies. Psychiatry Res 2013; 214:83-93. [PMID: 23972726 DOI: 10.1016/j.pscychresns.2013.05.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/12/2013] [Accepted: 05/19/2013] [Indexed: 12/29/2022]
Abstract
Using the Pubmed database, we performed a detailed literature search for structural magnetic resonance imaging studies on patients with schizophrenia, investigating the relationship between macroscopic and microscopic structural parameters and age, to delineate an age-related trajectory. Twenty-six studies were considered for the review, from January 2000 to June 2012. Research results are heterogeneous because of the multifactorial features of schizophrenia and the multiplicity of the methodological approaches adopted. Some areas, within the amygdala-hippocampus complex, which are affected early in life by schizophrenia, age in a physiological way. Other regions, such as the superior temporal gyrus, appear already impaired at the onset of symptoms, undergo a worsening in the acute phase but later stabilize, progressing physiologically over years. Finally, there are regions, such as the uncinate fasciculus, which are not altered early in life, but are affected around the onset of schizophrenia, with their impairment continuously worsening over time. Further extensive longitudinal studies are needed to understand the timing and the possible degenerative characteristics of structural impairment associated with schizophrenia.
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Affiliation(s)
- Chiara Chiapponi
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
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27
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Cortical grey matter and subcortical white matter brain microstructural changes in schizophrenia are localised and age independent: a case-control diffusion tensor imaging study. PLoS One 2013; 8:e75115. [PMID: 24124469 PMCID: PMC3790776 DOI: 10.1371/journal.pone.0075115] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/08/2013] [Indexed: 01/08/2023] Open
Abstract
It is still unknown whether the structural brain impairments that characterize schizophrenia (SZ) worsen during the lifetime. Here, we aimed to describe age-related microstructural brain changes in cortical grey matter and subcortical white matter of patients affected by SZ. In this diffusion tensor imaging study, we included 69 patients diagnosed with SZ and 69 healthy control (HC) subjects, age and gender matched. We carried out analyses of covariance, with diagnosis as fixed factor and brain diffusion-related parameters as dependent variables, and controlled for the effect of education. White matter fractional anisotropy decreased in the entire age range spanned (18–65 years) in both SZ and HC and was significantly lower in younger patients with SZ, with no interaction (age by diagnosis) effect in fiber tracts including corpus callosum, corona radiata, thalamic radiations and external capsule. Also, grey matter mean diffusivity increased in the entire age range in both SZ and HC and was significantly higher in younger patients, with no age by diagnosis interaction in the left frontal operculum cortex, left insula and left planum polare and in the right temporal pole and right intracalcarine cortex. In individuals with SZ we found that localized brain cortical and white matter subcortical microstructural impairments appear early in life but do not worsen in the 18–65 year age range.
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28
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Behere RV. Dorsolateral prefrontal lobe volume and neurological soft signs as predictors of clinical social and functional outcome in schizophrenia: A longitudinal study. Indian J Psychiatry 2013; 55:111-6. [PMID: 23825842 PMCID: PMC3696231 DOI: 10.4103/0019-5545.111445] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Schizophrenia is a disorder with variable outcome and the ability to predict the outcome has important clinical utility. Neurological soft signs (NSS) and dorsolateral prefrontal cortex volumes have been described as trait markers for schizophrenia and their relation to long-term outcome in schizophrenia has not been well studied. The aim of this study was to examine the correlation between baseline dorsolateral prefrontal lobe (DLPFL) volume and NSS scores to clinical and functional outcome variables in a cohort of schizophrenia patients who were anti-psychotic naïve at baseline. Fourteen anti-psychotic naive schizophrenia patients whose baseline magnetic resonance imaging scans, NSS scores and positive and negative signs and symptoms scale (PANSS) scores (assessed in drug naïve state) were available were reevaluated after a mean follow-up period of 74.2±24.2 months. The clinical outcome variables measured was PANSS. The social and functional outcome was assessed comprehensively by the socio occupational functioning scale and the Strauss Carpenter outcome scale. The DLPFL, volume was measured from the baseline scans using the region of interest method. Statistical analysis was done using the paired samples t-test and the Pearson's correlation co-efficient. The results showed that smaller left DLPFL volume and greater primitive reflexes at baseline predicted greater negative symptoms and poorer functional outcome on follow-up. This study also demonstrates the clinical utility of NSS as a simple bedside tool in assessing schizophrenia patients.
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Affiliation(s)
- Rishikesh V Behere
- Department of Psychiatry, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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29
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Chemerinski E, Byne W, Kolaitis JC, Glanton CF, Canfield EL, Newmark RE, Haznedar MM, Novakovic V, Chu KW, Siever LJ, Hazlett EA. Larger putamen size in antipsychotic-naïve individuals with schizotypal personality disorder. Schizophr Res 2013. [PMID: 23187070 PMCID: PMC3634353 DOI: 10.1016/j.schres.2012.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To (a) compare the size of the dorsal and ventral striatum (caudate and putamen) in a large sample of antipsychotic-naïve individuals with schizotypal personality disorder (SPD) and healthy control participants; (b) examine symptom correlates of striatal size in SPD. METHODS The left and right caudate and putamen were hand-traced on structural MRI at five dorsal to ventral slice levels in 76 SPD and 148 healthy control participants. A Group×Region (caudate, putamen)×Slice (1-5: ventral, 2, 3, 4, dorsal)×Hemisphere (left, right) mixed-model MANOVA was conducted on size relative to whole brain. RESULTS Primary results showed that compared with the controls, the SPD group showed (a) larger bilateral putamen size overall and this enlargement was more pronounced at the most ventral and dorsal levels; in contrast, there were no between-group differences in caudate volume; (b) larger bilateral size of the striatum ventrally, averaged across the caudate and putamen. Among the SPD group, larger striatal size ventrally, particularly in the left hemisphere was associated with less severe paranoid symptoms. CONCLUSIONS Striatal size is abnormal in SPD and resembles that of patients with schizophrenia who respond well to antipsychotic treatment. The results suggest that striatal size may be an important endophenotype to consider when developing new pharmacological treatments and when studying factors mitigating psychosis.
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Affiliation(s)
- Eran Chemerinski
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States,Department of Outpatient Psychiatry, James J. Peter Veterans Affairs Medical Center, Psychiatry, Bronx, NY, United States
| | - William Byne
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States,Department of Outpatient Psychiatry, James J. Peter Veterans Affairs Medical Center, Psychiatry, Bronx, NY, United States,Mental Illness Research, Education, and Clinical Center, James J. Peter Veterans Affairs Medical Center, Bronx, NY, United States
| | - Jeanine C. Kolaitis
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States,Research & Development, James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States
| | - Cathryn F. Glanton
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States
| | - Emily L. Canfield
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States
| | - Randall E. Newmark
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States
| | - M. Mehmet Haznedar
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States,Department of Outpatient Psychiatry, James J. Peter Veterans Affairs Medical Center, Psychiatry, Bronx, NY, United States
| | - Vladan Novakovic
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States
| | - King-Wai Chu
- Mental Illness Research, Education, and Clinical Center, James J. Peter Veterans Affairs Medical Center, Bronx, NY, United States
| | - Larry J. Siever
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States,Department of Outpatient Psychiatry, James J. Peter Veterans Affairs Medical Center, Psychiatry, Bronx, NY, United States,Mental Illness Research, Education, and Clinical Center, James J. Peter Veterans Affairs Medical Center, Bronx, NY, United States
| | - Erin A. Hazlett
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States,Mental Illness Research, Education, and Clinical Center, James J. Peter Veterans Affairs Medical Center, Bronx, NY, United States,Research & Development, James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States,Corresponding author at: Mental Illness Research, Education, and Clinical Center (MIRECC) VISN 3, JJP VA Medical Center, 130 West Kingsbridge Road, Rm 6A-45, Bronx, NY 10468, United States. Tel.: +1 718 584 9000x3701; fax: +1 718 364 3576. (E.A. Hazlett)
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30
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Brambilla P, Perlini C, Rajagopalan P, Saharan P, Rambaldelli G, Bellani M, Dusi N, Cerini R, Mucelli RP, Tansella M, Thompson PM. Schizophrenia severity, social functioning and hippocampal neuroanatomy: three-dimensional mapping study. Br J Psychiatry 2013; 202:50-5. [PMID: 23284150 PMCID: PMC4113031 DOI: 10.1192/bjp.bp.111.105700] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hippocampal shrinkage is commonly reported in schizophrenia, but its role in the illness is still poorly understood. In particular, it is unclear how clinical and psychosocial variables relate to hippocampal volumes. AIMS To investigate neuroanatomic differences in the hippocampus using three-dimensional (3D) computational image analysis. METHOD We used high-resolution magnetic resonance imaging and surface-based modelling to map the 3D profile of hippocampal differences in adults with schizophrenia (n = 67) and a healthy control group (n = 72). Manual tracings were used to create 3D parametric mesh models of the hippocampus. Regression models were used to relate diagnostic measures to maps of radial distance, and colour-coded maps were generated to show the profile of associations. RESULTS There was no detectable difference between the schizophrenia and control groups in hippocampal radial distance. In the schizophrenia group, however, bilateral shape deflation was associated with greater illness severity (length of illness, positive and negative symptoms) and with poorer social functioning (educational level, quality of life and health status), which survived Bonferroni correction. CONCLUSIONS Illness severity and poor social functioning may be associated with hippocampal deflation in schizophrenia. As a structural sign of poor outcome, imaging measures might help to identify a subgroup of patients who may need specific treatment to resist hippocampal shrinkage, such as cognitive rehabilitation or physical exercise.
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Affiliation(s)
- Paolo Brambilla
- DISM, InterUniversity Centre for Behavioral Neurosciences, University of Udine, Udine, Italy,Scientific Institute IRCCS ‘E. Medea’, Udine, Italy
| | - Cinzia Perlini
- Department of Public Health and Community Medicine, InterUniversity Centre for Behavioral Neurosciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
| | - Priya Rajagopalan
- Laboratory of Neuro Imaging (LONI), David Geffen School of Medicine at UCLA, Department of Neurology, Los Angeles, USA
| | - Priyanka Saharan
- Laboratory of Neuro Imaging (LONI), David Geffen School of Medicine at UCLA, Department of Neurology, Los Angeles, USA
| | - Gianluca Rambaldelli
- Department of Public Health and Community Medicine, InterUniversity Centre for Behavioral Neurosciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
| | - Marcella Bellani
- Department of Public Health and Community Medicine, InterUniversity Centre for Behavioral Neurosciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
| | - Nicola Dusi
- Department of Public Health and Community Medicine, InterUniversity Centre for Behavioral Neurosciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
| | - Roberto Cerini
- Department of Morphological and Biomedical Sciences, Section of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Roberto Pozzi Mucelli
- Department of Morphological and Biomedical Sciences, Section of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Michele Tansella
- Department of Public Health and Community Medicine, InterUniversity Centre for Behavioral Neurosciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
| | - Paul M. Thompson
- Laboratory of Neuro Imaging (LONI), David Geffen School of Medicine at UCLA, Department of Neurology, Los Angeles, USA
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Nenadic I, Gaser C, Sauer H. Heterogeneity of brain structural variation and the structural imaging endophenotypes in schizophrenia. Neuropsychobiology 2012; 66:44-9. [PMID: 22797276 DOI: 10.1159/000338547] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 03/29/2012] [Indexed: 11/19/2022]
Abstract
Schizophrenia is often assumed to comprise a group of biologically distinct disorders, yet it has been difficult to dissect subgroups using biological markers. We review recent brain imaging morphometry studies addressing the issue of heterogeneity within the diagnostic category of schizophrenia. Studies of subgroups of schizophrenia patients have mostly used either symptom structure or clinical course for the delineation of potentially meaningful subgroups. Studies defining subgroups according to outcome, i.e. good versus poor outcome (or 'non-Kraepelinian' vs. 'Kraepelinian', respectively) have shown that while these two subgroups might overlap in the extent (and possibly also strength) of prefrontal deficits, they differ in temporal and occipital areas, where poor-outcome patients show stronger deficits. More recent studies have investigated subgroups of schizophrenia based on factor analysis of psychopathology. They have demonstrated a complex pattern of regional changes, where the typical three subgroups might overlap in prefrontal changes, but show divergence in structural deficits in other areas such as the thalamus, hippocampus, or cerebellum. Altogether, these studies demonstrate that brain structure per se is not a uniform endophenotype, but rather a combination of regional deficits highly heterogeneous in both meeting endophenotype criteria as well as in their distribution within the disease category.
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Affiliation(s)
- Igor Nenadic
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
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Palaniyappan L, Balain V, Liddle PF. The neuroanatomy of psychotic diathesis: a meta-analytic review. J Psychiatr Res 2012; 46:1249-56. [PMID: 22790253 DOI: 10.1016/j.jpsychires.2012.06.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 05/24/2012] [Accepted: 06/13/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Several studies have found widespread structural changes affecting the grey matter at various stages of schizophrenia (the prodrome, first-episode, and the chronic stage). It is unclear which of these neuroanatomical changes are associated with a predisposition or vulnerability to develop schizophrenia rather than the appearance of the clinical features of the illness. METHODS 16 voxel-based morphometry (VBM) analyses involving 733 genetically high-risk relatives (HRR) of patients with schizophrenia, 563 healthy controls and 474 patients were meta-analysed using the Signed Differential Mapping (SDM) technique. Two meta-analyses were conducted, with one comparing HRR group with healthy controls and the other comparing HRR group with the patients. RESULTS A significant grey matter reduction in the lentiform nucleus, amygdala/parahippocampal gyrus and medial prefrontal cortex was seen in association with the genetic diathesis. Grey matter reduction in bilateral insula, inferior frontal gyrus, superior temporal gyrus and the anterior cingulate was seen in association with the disease expression. CONCLUSIONS The neuroanatomical changes associated with the genetic diathesis to develop schizophrenia appear to be different from those that contribute to the clinical expression of the illness. Grey matter abnormalities in multimodal brain regions that have a supervisory function are likely to be central to the expression of the clinical symptoms of schizophrenia.
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Affiliation(s)
- Lena Palaniyappan
- Division of Psychiatry, University of Nottingham, A Floor, South Block, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom.
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33
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Fraguas D, Gonzalez-Pinto A, Micó JA, Reig S, Parellada M, Martínez-Cengotitabengoa M, Castro-Fornieles J, Rapado-Castro M, Baeza I, Janssen J, Desco M, Leza JC, Arango C. Decreased glutathione levels predict loss of brain volume in children and adolescents with first-episode psychosis in a two-year longitudinal study. Schizophr Res 2012; 137:58-65. [PMID: 22365149 DOI: 10.1016/j.schres.2012.01.040] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 01/28/2012] [Accepted: 01/29/2012] [Indexed: 02/07/2023]
Abstract
Progressive loss of cortical gray matter (GM), as measured by magnetic resonance imaging, has been described early in the course of first-episode psychosis. This study aims to assess the relationship between oxidative balance and progression of cortical GM changes in a multicenter sample of first-episode early-onset psychosis (EOP) patients from baseline to two-year follow-up. A total of 48 patients (13 females, mean age 15.9±1.5 years) and 56 age- and gender-matched healthy controls (19 females, 15.3±1.5 years) were assessed. Magnetic resonance imaging (MRI) scans performed both at the time of the first psychotic episode and 2 years later were used for volumetric measurements of left and right gray matter regions (frontal, parietal, and temporal lobes) and total sulcal cerebrospinal fluid (CSF). Total glutathione (GSH) blood levels were determined at baseline. In patients, after controlling for possible confounding variables, lower baseline GSH levels were significantly associated with greater volume decrease in left frontal (B=0.034, 95% confidence interval (CI): 0.011 to 0.056, r=0.620, p=0.006), parietal (B=0.039, 95% CI: 0.020 to 0.059, r=0.739, p=0.001), temporal (B=0.026, 95% CI: 0.016 to 0.036, r=0.779, p<0.001), and total (B=0.022, 95% CI: 0.014 to 0.031, r=0.803, p<0.001) gray matter, and with greater increase in total CSF (B=-0.560, 95% CI: -0.270 to -0.850, r=-0.722, p=0.001). Controls did not show significant associations between brain volume changes and GSH levels. GSH deficit during the first psychotic episode was related to greater loss of cortical GM two years later in patients with first-episode EOP, suggesting that oxidative damage may contribute to the progressive loss of cortical GM found in patients with first-episode psychosis.
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Affiliation(s)
- David Fraguas
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
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Szeszko PR, Narr KL, Phillips OR, McCormack J, Sevy S, Gunduz-Bruce H, Kane JM, Bilder RM, Robinson DG. Magnetic resonance imaging predictors of treatment response in first-episode schizophrenia. Schizophr Bull 2012; 38:569-78. [PMID: 21084552 PMCID: PMC3329996 DOI: 10.1093/schbul/sbq126] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Identifying neurobiological predictors of response to antipsychotics in patients with schizophrenia is a critical goal of translational psychiatry. Few studies, however, have investigated the relationship between indices of brain structure and treatment response in the context of a controlled clinical trial. In this study, we sought to identify magnetic resonance (MR) imaging measures of the brain that predict treatment response in patients experiencing a first-episode of schizophrenia. Structural MR imaging scans were acquired in 39 patients experiencing a first-episode of schizophrenia with minimal or no prior exposure to antipsychotics participating in a double-blind 16-week clinical trial comparing the efficacy of risperidone vs olanzapine. Twenty-five patients were classified as responders by meeting operationally defined treatment response criteria on 2 consecutive study visits. Fourteen patients never responded to antipsychotic medication at any point during the clinical trial. MR imaging scans were also acquired in 45 age- and sex-matched healthy volunteers. Cortical pattern matching methods were used to compare cortical thickness and asymmetry measures among groups. Statistical mapping results, confirmed by permutation testing, indicated that responders had greater cortical thickness in occipital regions and greater frontal cortical asymmetry compared with nonresponders. Moreover, among responders, greater thickness in temporal regions was associated with less time to respond. Our findings are consistent with the hypothesis that plasticity and cortical thickness may be more preserved in responders and that MR imaging may assist in the prediction of antipsychotic drug response in patients experiencing a first-episode of schizophrenia.
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Affiliation(s)
- Philip R. Szeszko
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY,Division of Psychiatry Research, Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY,To whom correspondence should be addressed; Division of Psychiatry Research, Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA; tel: 718-470-8489, fax: 718-343-1659, e-mail:
| | - Katherine L. Narr
- Laboratory of Neuroimaging, Department of Neurology, David Geffen School of Medicine at Los Angeles, CA
| | - Owen R. Phillips
- Laboratory of Neuroimaging, Department of Neurology, David Geffen School of Medicine at Los Angeles, CA
| | - Joanne McCormack
- Division of Psychiatry Research, Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY
| | - Serge Sevy
- Division of Psychiatry Research, Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY
| | | | - John M. Kane
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY,Division of Psychiatry Research, Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY
| | - Robert M. Bilder
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, and Department of Psychology, College of Letters & Science, and Jane and Terry Semel Institute for Neuroscience and Human Behavior at University of California at Los Angeles, Los Angeles, CA
| | - Delbert G. Robinson
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY,Division of Psychiatry Research, Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY
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Optimized voxel brain morphometry: association between brain volumes and the response to atypical antipsychotics. Eur Arch Psychiatry Clin Neurosci 2011; 261:407-16. [PMID: 21191610 DOI: 10.1007/s00406-010-0182-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 12/15/2010] [Indexed: 01/18/2023]
Abstract
To date, few studies have addressed the relationship between brain structure alterations and responses to atypical antipsychotics in schizophrenia. To this end, in this study, magnetic resonance imaging (MRI) and voxel-based morphometry (VBM) were used to assess the relationship between the brain volumes of gray (GM) and white (WM) matters and the clinical response to risperidone or olanzapine in 30 schizophrenia patients. In comparison with healthy controls, the patients in this study showed a bilateral decrease in the anteromedial cerebellar hemispheres, the rectal gyrus and the insula, together with bilateral increases in GM in the basal ganglia. Both patient groups had a significantly smaller volume of WM in a region encompassing the internal and external capsules as compared to the controls. We found an inverse association between striatal size and the degree of clinical improvement, and a direct association between the degree of insular volume deficit and its improvement. The non-responder patient group showed a significant decrease in their left rectal gyrus as compared with the responder group. This study reveals a pattern of structural alterations in schizophrenia associated with the response to risperidone or olanzapine.
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36
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Olabi B, Ellison-Wright I, McIntosh AM, Wood SJ, Bullmore E, Lawrie SM. Are there progressive brain changes in schizophrenia? A meta-analysis of structural magnetic resonance imaging studies. Biol Psychiatry 2011; 70:88-96. [PMID: 21457946 DOI: 10.1016/j.biopsych.2011.01.032] [Citation(s) in RCA: 364] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 01/21/2011] [Accepted: 01/22/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND It is well established that schizophrenia is associated with structural brain abnormalities, but whether these are static or progress over time remains controversial. METHODS A systematic review of longitudinal volumetric studies using region-of-interest structural magnetic resonance imaging in patients with schizophrenia and healthy control subjects. The percentage change in volume between scans for each brain region of interest was obtained, and data were combined using random effects meta-analysis. RESULTS Twenty-seven studies were included in the meta-analysis, with 928 patients and 867 control subjects, and 32 different brain regions of interest. Subjects with schizophrenia showed significantly greater decreases over time in whole brain volume, whole brain gray matter, frontal gray and white matter, parietal white matter, and temporal white matter volume, as well as larger increases in lateral ventricular volume, than healthy control subjects. The time between baseline and follow-up magnetic resonance imaging scans ranged from 1 to 10 years. The differences between patients and control subjects in annualized percentage volume change were -.07% for whole brain volume, -.59% for whole brain gray matter, -.32% for frontal white matter, -.32% for parietal white matter, -.39% for temporal white matter, and +.36% for bilateral lateral ventricles. CONCLUSIONS These findings suggest that schizophrenia is associated with progressive structural brain abnormalities, affecting both gray and white matter. We found no evidence to suggest progressive medial temporal lobe involvement but did find evidence that this may be partly explained by heterogeneity between studies in patient age and illness duration. The causes and clinical correlates of these progressive brain changes should now be the focus of investigation.
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Affiliation(s)
- Bayanne Olabi
- Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
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37
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Hartberg CB, Sundet K, Rimol LM, Haukvik UK, Lange EH, Nesvåg R, Melle I, Andreassen OA, Agartz I. Subcortical brain volumes relate to neurocognition in schizophrenia and bipolar disorder and healthy controls. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1122-30. [PMID: 21457744 DOI: 10.1016/j.pnpbp.2011.03.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 03/09/2011] [Accepted: 03/17/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Similar patterns of subcortical brain abnormalities and neurocognitive dysfunction have been demonstrated in schizophrenia and bipolar disorder, with more extensive findings in schizophrenia. It is unknown whether relationships between subcortical volumes and neurocognitive performance are similar or different between schizophrenia and bipolar disorder. METHODS MRI scans and neuropsychological test performance were obtained from 117 schizophrenia or 121 bipolar spectrum disorder patients and 192 healthy control subjects. Using the FreeSurfer software, volumes of 18 selected subcortical structures were automatically segmented and analyzed for relationships with results from 7 neurocognitive tests. RESULTS In schizophrenia, larger left ventricular volumes were related to poorer motor speed, and bilateral putamen volumes were related to poorer verbal learning, executive functioning and working memory performance. In bipolar disorder, larger left ventricular volumes were related to poorer motor speed and executive functioning. The relationship between left putamen volume and working memory was specific to schizophrenia. The relationships between left inferior lateral ventricles and motor speed and between right putamen volumes and executive functioning were similar in schizophrenia and bipolar disorder, and different from healthy controls. The results remained significant after corrections for use of antipsychotic medication. Significant structure-function relationships were also found when all subjects were combined into one group. CONCLUSION The present findings suggest that there are differences as well as similarities in subcortical structure/function relationships between patients with schizophrenia or bipolar disorder and healthy individuals. The observed differences further suggest that ventricular and putamen volume sizes may reflect severity of cognitive dysfunction in these disorders.
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Affiliation(s)
- Cecilie B Hartberg
- Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Norway.
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38
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Somerville SM, Lahti AC, Conley RR, Roberts RC. Mitochondria in the striatum of subjects with schizophrenia: relationship to treatment response. Synapse 2011; 65:215-24. [PMID: 20665724 DOI: 10.1002/syn.20838] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Schizophrenia (SZ) is a severe mental illness with neuropathology in many regions, including the striatum. The typical symptoms of this disease are psychosis (such as hallucinations and delusions), cognitive impairments, and the deficit syndrome. Not all patients respond to treatment and, in those who do, only psychotic symptoms are improved. Imaging studies support a biological distinction between treatment response and resistance, but postmortem examinations of this issue are rare. This study tests the hypotheses that abnormalities in mitochondria, the energy producing organelles in the cell, may correlate with treatment response. Postmortem striatal tissue was obtained from the Maryland Brain Collection. The density of mitochondria (in various neuropil compartments) and the number of mitochondria per synapse (all types of synapses combined) were tallied using electron microscopy and stereology in striatum from SZ subjects (rated treatment responsive or not) and normal controls. The number of mitochondria per synapse was significantly different among groups for both the caudate nucleus (P < 0.025) and putamen (P < 0.002). Compared to controls, treatment-responsive SZ subjects had a 37-43% decrease in the number of mitochondria per synapse in the caudate nucleus and putamen. In the putamen, treatment-responsive subjects also had decreases in this measure compared to treatment-resistant subjects (34%). Our results provide further support for a biological distinction between treatment response and treatment resistance in SZ. Because treatment responders have fewer mitochondria per synapse than controls, although the treatment-resistant subjects have similar results to that of controls, fewer mitochondria per synapse may be related to treatment response.
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Affiliation(s)
- Shahza M Somerville
- Neuroscience and Cognitive Sciences, University of Maryland, Baltimore County, Catonsville 21228, USA
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Longitudinal imaging studies in schizophrenia: the relationship between brain morphology and outcome measures. ACTA ACUST UNITED AC 2011. [DOI: 10.1017/s1121189x00001123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractImaging studies have tried to identify morphological outcome measures of schizophrenia in the last two decades. In particular, longitudinal studies have reported a correlation between larger ventricles, decreased prefrontal volumes and worse outcome. This would potentially allow to isolate subtypes of schizophrenia patients with a worse prognosis and more evident biological impairments, ultimately helping in designing specific rehabilitation interventions.
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Somerville SM, Conley RR, Roberts RC. Mitochondria in the striatum of subjects with schizophrenia. World J Biol Psychiatry 2011; 12:48-56. [PMID: 20698738 DOI: 10.3109/15622975.2010.505662] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Schizophrenia is a severe mental illness that manifests pathology in many brain regions, including the striatum. Among the abnormalities in schizophrenia are those related to mitochondria. The present study sought to determine whether the number of mitochondria was affected at the level of the synapse. METHODS Human postmortem striatum from schizophrenia subjects and controls was examined at the ultrastructural level. The density of mitochondria and synapses were tabulated using stereology. RESULTS There were similar overall numbers of mitochondria in the caudate nucleus and putamen of schizophrenia subjects vs. controls, but a differential distribution of existing mitochondria. Schizophrenia subjects had 26?30% fewer mitochondria per synapse compared to controls. This may contribute to the pathophysiology of the illness, may be a medication effect, or an adaptive response to normalize the high number of striatal synapses we have previously found. The higher density of mitochondria in dendrites in the caudate nucleus in certain subgroups of schizophrenia vs. controls (>34%) may be related to more synaptic inputs. CONCLUSIONS The role of mitochondria in the various symptoms of schizophrenia is still unclear. A comparison of schizophrenia subjects with differing symptoms or treatment response might shed light on whether differences in mitochondrial density are abnormal or adaptive.
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Affiliation(s)
- Shahza M Somerville
- Neuroscience and Cognitive Sciences, University of Maryland, Baltimore County, Catonsville, MD, USA
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Horga G, Bernacer J, Dusi N, Entis J, Chu K, Hazlett EA, Mehmet Haznedar M, Kemether E, Byne W, Buchsbaum MS. Correlations between ventricular enlargement and gray and white matter volumes of cortex, thalamus, striatum, and internal capsule in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2011; 261:467-76. [PMID: 21431919 PMCID: PMC3182327 DOI: 10.1007/s00406-011-0202-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 02/15/2011] [Indexed: 11/25/2022]
Abstract
Ventricular enlargement is one of the most consistent abnormal structural brain findings in schizophrenia and has been used to infer brain shrinkage. However, whether ventricular enlargement is related to local overlying cortex and/or adjacent subcortical structures or whether it is related to brain volume change globally has not been assessed. We systematically assessed interrelations of ventricular volumes with gray and white matter volumes of 40 Brodmann areas (BAs), the thalamus and its medial dorsal nucleus and pulvinar, the internal capsule, caudate and putamen. We acquired structural MRI ( patients with schizophrenia (n = 64) and healthy controls (n = 56)) and diffusion tensor fractional anisotropy (FA) (untreated schizophrenia n = 19, controls n = 32). Volumes were assessed by manual tracing of central structures and a semi-automated parcellation of BAs. Patients with schizophrenia had increased ventricular size associated with decreased cortical gray matter volumes widely across the brain; a similar but less pronounced pattern was seen in normal controls; local correlations (e.g. temporal horn with temporal lobe volume) were not appreciably higher than non-local correlations (e.g. temporal horn with prefrontal volume). White matter regions adjacent to the ventricles similarly did not reveal strong regional relationships. FA and center of mass of the anterior limb of the internal capsule also appeared differentially influenced by ventricular volume but findings were similarly not regional. Taken together, these findings indicate that ventricular enlargement is globally interrelated with gray matter volume diminution but not directly correlated with volume loss in the immediately adjacent caudate, putamen, or internal capsule.
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Affiliation(s)
- Guillermo Horga
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, 10029 New York, NY USA
- Schizophrenia Clinic Program, Department of Psychiatry, Hospital Clínic Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Javier Bernacer
- Laboratory of Functional Neuromorphology, Clinica Universitaria, Universidad de Navarra, Avda. Pío XII 36, 31008 Pamplona, Spain
| | - Nicola Dusi
- Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Policlinico Giambattista Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Jonathan Entis
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, 10029 New York, NY USA
| | - Kingwai Chu
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, 10029 New York, NY USA
| | - Erin A. Hazlett
- Department of Psychiatry, James J Peters VA Medical Center, 130 West Kingsbridge Road, 10468 Bronx, NY USA
| | - M. Mehmet Haznedar
- Department of Psychiatry, James J Peters VA Medical Center, 130 West Kingsbridge Road, 10468 Bronx, NY USA
| | - Eileen Kemether
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, 10029 New York, NY USA
| | - William Byne
- Department of Psychiatry, James J Peters VA Medical Center, 130 West Kingsbridge Road, 10468 Bronx, NY USA
| | - Monte S. Buchsbaum
- Departments of Psychiatry and Radiology, NeuroPET Center, University of California, 11388 Sorrento Valley Road, Suite #100, 92121 San Diego, CA USA
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Molina V, Hernández JA, Sanz J, Paniagua JC, Hernández AI, Martín C, Matías J, Calama J, Bote B. Subcortical and cortical gray matter differences between Kraepelinian and non-Kraepelinian schizophrenia patients identified using voxel-based morphometry. Psychiatry Res 2010; 184:16-22. [PMID: 20832256 DOI: 10.1016/j.pscychresns.2010.06.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 05/31/2010] [Accepted: 06/10/2010] [Indexed: 11/26/2022]
Abstract
The long-term outcome of schizophrenia patients may differ depending on their brain structure. This would be reflected in significant structural differences between poor-outcome (i.e., Kraepelinian) and non-Kraepelinian patients. To assess this possibility, we have evaluated the degree of deviation in brain structure in Kraepelinian patients with respect to controls and non-Kraepelinian schizophrenia patients. We used voxel-brain morphometry (VBM) to assess the differences in gray matter volume across the brain in the Kraepelinian group with respect to the healthy controls and non-Kraepelinian patients. Twenty-six Kraepelinian and 18 non-Kraepelinian schizophrenia patients and 41 healthy controls were included. With respect to the healthy controls, the Kraepelinian patients showed a very significant decrease in gray matter in the frontal, occipital, and limbic cortices, and, at a subcortical level, bilaterally in the striatum and thalamus. In comparison with the non-Kraepelinian patients, the Kraepelinian individuals continued to show a similar subcortical decrease. Thus, Kraepelinian patients may be characterized by a distinct pattern of brain abnormalities, in particular, in subcortical regions.
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Affiliation(s)
- Vicente Molina
- Servicio de Psiquiatría, Hospital Universitario de Salamanca, Salamanca, Spain.
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Harvey PD, Reichenberg A, Bowie CR, Patterson TL, Heaton RK. The course of neuropsychological performance and functional capacity in older patients with schizophrenia: influences of previous history of long-term institutional stay. Biol Psychiatry 2010; 67:933-9. [PMID: 20202624 PMCID: PMC2862804 DOI: 10.1016/j.biopsych.2010.01.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 12/29/2009] [Accepted: 01/05/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronically institutionalized patients with schizophrenia have been reported to manifest cognitive and functional decline. Previous studies were limited by the fact that current environment could not be separated from lifetime illness course. The present study examined older outpatients who varied in their lifetime history of long-term psychiatric inpatient stay. METHODS Community-dwelling patients with schizophrenia (n = 111) and healthy comparison subjects (n = 76) were followed up to 45 months and examined two or more times with a neuropsychological battery and performance-based measures of everyday living skills (University of California San Diego Performance-Based Skills Assessment Battery [UPSA]) and social competence. A mixed-effects model repeated-measures method was used to examine changes. RESULTS There was a significant effect of institutional stay on the course of the UPSA. When the schizophrenia patients who completed all three assessments were divided on the basis of length of institutional stay and compared with healthy comparison subjects, patients with longer stays worsened on the UPSA and social competence, while patients with shorter stays improved. For neuropsychological performance, both patient samples worsened slightly, while the healthy comparison group manifested a practice effect. Reliable change index analyses showed that worsening on the UPSA for longer stay patients was definitely nonrandom. CONCLUSIONS Lifetime history of institutional stay was associated with worsening on measures of social and everyday living skills. Neuropsychological performance in schizophrenia did not evidence the practice effect seen in the healthy comparison sample. These data suggest that schizophrenia patients with a history of long institutional stay may worsen even if they are no longer institutionalized.
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Affiliation(s)
- Philip D Harvey
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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