The effects of antipsychotics on interactions of dynamic functional connectivity in the triple-network in first episode schizophrenia

Association of core brain networks with antipsychotic therapeutic effects in first-episode schizophrenia

Elucidating neurobiological mechanisms underlying the heterogeneity of antipsychotic treatment will be of great value for precision medicine in schizophrenia, yet there has been limited progress. We combined static and dynamic functional connectivity (FC) analysis to examine the abnormal communications among core brain networks [default-mode network (DMN), central executive network (CEN), salience network (SN), primary network (PN), and subcortical network (SCN) in clinical subtypes of schizophrenia (responders and nonresponders to antipsychotic monotherapy). Resting-state functional magnetic resonance imaging data were collected from 79 first-episode schizophrenia and 90 healthy controls. All patients received antipsychotic monotherapy for up to 12 weeks and underwent a second scan. We found that significantly reduced static FC in CEN-DMN/SN and SN-SCN were observed in nonresponders after treatment, whereas almost no difference was observed in responders. The nonresponders showed significantly higher dynamic FC in PN-DMN/SN than responders at baseline. Further, the baseline FC in core brain networks were treated as moderators involved in symptom relief and distinguished response subtypes with high classification accuracy. Collectively, the current work highlights the potential of communications among five core brain networks in searching biomarkers of antipsychotic monotherapy response and neuroanatomical subtypes, advancing the understanding of antipsychotic treatment mechanisms in schizophrenia.

Neuroimage Analysis Methods and Artificial Intelligence Techniques for Reliable Biomarkers and Accurate Diagnosis of Schizophrenia: Achievements Made by Chinese Scholars Around the Past Decade

BACKGROUND AND HYPOTHESIS

Schizophrenia (SZ) is characterized by significant cognitive and behavioral disruptions. Neuroimaging techniques, particularly magnetic resonance imaging (MRI), have been widely utilized to investigate biomarkers of SZ, distinguish SZ from healthy conditions or other mental disorders, and explore biotypes within SZ or across SZ and other mental disorders, which aim to promote the accurate diagnosis of SZ. In China, research on SZ using MRI has grown considerably in recent years.

STUDY DESIGN

The article reviews advanced neuroimaging and artificial intelligence (AI) methods using single-modal or multimodal MRI to reveal the mechanism of SZ and promote accurate diagnosis of SZ, with a particular emphasis on the achievements made by Chinese scholars around the past decade.

STUDY RESULTS

Our article focuses on the methods for capturing subtle brain functional and structural properties from the high-dimensional MRI data, the multimodal fusion and feature selection methods for obtaining important and sparse neuroimaging features, the supervised statistical analysis and classification for distinguishing disorders, and the unsupervised clustering and semi-supervised learning methods for identifying neuroimage-based biotypes. Crucially, our article highlights the characteristics of each method and underscores the interconnections among various approaches regarding biomarker extraction and neuroimage-based diagnosis, which is beneficial not only for comprehending SZ but also for exploring other mental disorders.

CONCLUSIONS

We offer a valuable review of advanced neuroimage analysis and AI methods primarily focused on SZ research by Chinese scholars, aiming to promote the diagnosis, treatment, and prevention of SZ, as well as other mental disorders, both within China and internationally.

Advances in MRI Research for First-Episode Schizophrenia: A Selective Review and NSFC-Funded Analysis

BACKGROUND AND HYPOTHESES

The causes of schizophrenia remain unclear, and research has been hindered by the lack of quantifiable standards. However, magnetic resonance imaging (MRI) is addressing these challenges, revealing critical neurobiological details and emphasizing its importance in both evaluation and treatment.

STUDY DESIGN

First, we reviewed the progress of research on structural MRI (sMRI), functional MRI (fMRI), multimodal/multiomics analysis, artificial intelligence, and neuromodulation in first-episode schizophrenia (FES) over the past 5 years. Second, we summarize the current state of schizophrenia research funded by the National Natural Science Foundation of China (NSFC) to facilitate academic exchange and cooperation both domestically and internationally.

STUDY RESULTS

sMRI has identified early neurodevelopmental biomarkers in FES patients, and fMRI has highlighted functional abnormalities across disease stages. Multimodal/multiomics analysis has revealed complex brain-neurobiology interactions. Neuromodulation techniques, which directly modulate neural activity in specific brain regions, offer promising long-term benefits for stabilizing conditions and enhancing patients' quality of life. NSFC-funded analysis shows China is increasing its funding for schizophrenia research, though funding distribution remains uneven. The research focus has shifted from a single perspective on brain structure and function to multichannel, multimodal comprehensive analysis methods. This progress has driven the integration of machine learning-driven multiomics research, aiming to construct disease classification models, explore disease mechanisms, and guide treatment from multidimensional and interdisciplinary perspectives.

CONCLUSIONS

MRI technology has provided new perspectives for the diagnosis and treatment of schizophrenia, especially the neurobiological foundations of the disease. Support from the NSFC provides a scientific and financial basis for future research and treatment, heralding scientific discoveries and technological innovations in this field and bringing hope to schizophrenia patients.

Default Mode Network, Disorganization, and Treatment-Resistant Schizophrenia

BACKGROUND AND HYPOTHESIS

Disorganized thinking is a prominent feature of schizophrenia that becomes persistent in the presence of treatment resistance. Disruption of the default mode network (DMN), which regulates self-referential thinking, is now a well-established feature of schizophrenia. However, we do not know if DMN disruption affects disorganization and contributes to treatment-resistant schizophrenia (TRS).

STUDY DESIGN

This study investigated the DMN in 48 TRS, 76 non-TRS, and 64 healthy controls (HC) using a spatiotemporal approach with resting-state functional magnetic resonance imaging. We recovered DMN as an integrated network using multivariate group independent component analysis and estimated its loading coefficient (reflecting spatial prominence) and Shannon Entropy (reflecting temporal variability). Additionally, voxel-level analyses were conducted to examine network homogeneity and entropy within the DMN. We explored the relationship between DMN measures and disorganization using regression analysis.

RESULTS

TRS had higher spatial loading on population-level DMN pattern, but lower entropy compared to HC. Non-TRS patients showed intermediate DMN alterations, not significantly differing from either TRS or HC. No voxel-level differences were noted between TRS and non-TRS, emphasizing the continuum between the two groups. DMN's loading coefficient was higher in patients with more severe disorganization.

CONCLUSIONS

TRS may represent the most severe end of a spectrum of spatiotemporal DMN dysfunction in schizophrenia. While excessive spatial contribution of the DMN (high loading coefficient) is specifically associated with disorganization, both excessive spatial contribution and exaggerated temporal stability of DMN are features of schizophrenia that become more pronounced with refractoriness to first-line treatments.

Static and Dynamic Dysconnectivity in Early Psychosis: Relationship With Symptom Dimensions

BACKGROUND AND HYPOTHESIS

Altered functional connectivity (FC) has been frequently reported in psychosis. Studying FC and its time-varying patterns in early-stage psychosis allows the investigation of the neural mechanisms of this disorder without the confounding effects of drug treatment or illness-related factors.

STUDY DESIGN

We employed resting-state functional magnetic resonance imaging (rs-fMRI) to explore FC in individuals with early psychosis (EP), who also underwent clinical and neuropsychological assessments. 96 EP and 56 demographically matched healthy controls (HC) from the Human Connectome Project for Early Psychosis database were included. Multivariate analyses using spatial group independent component analysis were used to compute static FC and dynamic functional network connectivity (dFNC). Partial correlations between FC measures and clinical and cognitive variables were performed to test brain-behavior associations.

STUDY RESULTS

Compared to HC, EP showed higher static FC in the striatum and temporal, frontal, and parietal cortex, as well as lower FC in the frontal, parietal, and occipital gyrus. We found a negative correlation in EP between cognitive function and FC in the right striatum FC (pFWE = 0.009). All dFNC parameters, including dynamism and fluidity measures, were altered in EP, and positive symptoms were negatively correlated with the meta-state changes and the total distance (pFWE = 0.040 and pFWE = 0.049).

CONCLUSIONS

Our findings support the view that psychosis is characterized from the early stages by complex alterations in intrinsic static and dynamic FC, that may ultimately result in positive symptoms and cognitive deficits.

Multilayer network analysis reveals instability of brain dynamics in untreated first-episode schizophrenia

Although aberrant static functional brain network activity has been reported in schizophrenia, little is known about how the dynamics of neural function are altered in first-episode schizophrenia and are modulated by antipsychotic treatment. The baseline resting-state functional magnetic resonance imaging data were acquired from 122 first-episode drug-naïve schizophrenia patients and 128 healthy controls (HCs), and 44 patients were rescanned after 1-year of antipsychotic treatment. Multilayer network analysis was applied to calculate the network switching rates between brain states. Compared to HCs, schizophrenia patients at baseline showed significantly increased network switching rates. This effect was observed mainly in the sensorimotor (SMN) and dorsal attention networks (DAN), and in temporal and parietal regions at the nodal level. Switching rates were reduced after 1-year of antipsychotic treatment at the global level and in DAN. Switching rates at baseline at the global level and in the inferior parietal lobule were correlated with the treatment-related reduction of negative symptoms. These findings suggest that instability of functional network activity plays an important role in the pathophysiology of acute psychosis in early-stage schizophrenia. The normalization of network stability after antipsychotic medication suggests that this effect may represent a systems-level mechanism for their therapeutic efficacy.

A Stepwise Multivariate Granger Causality Method for Constructing Hierarchical Directed Brain Functional Network

The directed brain functional network construction gives us the new insights into the relationships between brain regions from the causality point of view. The Granger causality analysis is one of the powerful methods to model the directed network. The complex brain network is also hierarchically constructed, which is particularly suited to facilitate segregated functions and the global integration of the segregated functions. Therefore, it is of great interest to explore new approach to model the hierarchical architecture of the directed network. In the present study, we proposed a new approach, namely, stepwise multivariate Granger causality (SMGC), considering both the directed and hierarchical features of brain functional network to explore the stepwise causal relationship in the network. The simulation study demonstrated that the diverse and complex hierarchical organization could be embedded in the apparently simple directed network. The proposed SMGC method could capture the multiple hierarchy of the directed network. When applying to the real functional magnetic resonance imaging (fMRI) datasets, the core triple resting-state networks in human brain showed within-network directed connections in the first-level directed network and rich and diverse between-network pathways in the second-level hierarchical network. The default mode network (DMN) had a prominent role in the resting-state acting as both the causal source and the important relay station. Further exploratory research on the adaption of directed hierarchical network in athletes suggested the enhanced bidirectional communication between the DMN and the central executive network (CEN) and the enhanced directed connections from the salience network (SN) to the CEN in the athlete group. The SMGC approach is capable of capturing the hierarchical architecture of the brain directed functional network, which refreshes the new stepwise causal relationship in the directed network. This might shed light on the potential application for exploring the altered hierarchical organization of brain directed network in neuropsychiatric disorders.

Dynamic functional connectivity in schizophrenia and bipolar disorder: A review of the evidence and associations with psychopathological features

Alterations of functional network connectivity have been implicated in the pathophysiology of schizophrenia (SCZ) and bipolar disorder (BD). Recent studies also suggest that the temporal dynamics of functional connectivity (dFC) can be altered in these disorders. Here, we summarized the existing literature on dFC in SCZ and BD, and their association with psychopathological and cognitive features. We systematically searched PubMed, Web of Science, and Scopus for studies investigating dFC in SCZ and BD and identified 77 studies. Our findings support a general model of dysconnectivity of dFC in SCZ, whereas a heterogeneous picture arose in BD. Although dFC alterations are more severe and widespread in SCZ compared to BD, dysfunctions of a triple network system underlying goal-directed behavior and sensory-motor networks were present in both disorders. Furthermore, in SCZ, positive and negative symptoms were associated with abnormal dFC. Implications for understanding the pathophysiology of disorders, the role of neurotransmitters, and treatments on dFC are discussed. The lack of standards for dFC metrics, replication studies, and the use of small samples represent major limitations for the field.

Integrative Brain Network and Salience Models of Psychopathology and Cognitive Dysfunction in Schizophrenia

Brain network models of cognitive control are central to advancing our understanding of psychopathology and cognitive dysfunction in schizophrenia. This review examines the role of large-scale brain organization in schizophrenia, with a particular focus on a triple-network model of cognitive control and its role in aberrant salience processing. First, we provide an overview of the triple network involving the salience, frontoparietal, and default mode networks and highlight the central role of the insula-anchored salience network in the aberrant mapping of salient external and internal events in schizophrenia. We summarize the extensive evidence that has emerged from structural, neurochemical, and functional brain imaging studies for aberrancies in these networks and their dynamic temporal interactions in schizophrenia. Next, we consider the hypothesis that atypical striatal dopamine release results in misattribution of salience to irrelevant external stimuli and self-referential mental events. We propose an integrated triple-network salience-based model incorporating striatal dysfunction and sensitivity to perceptual and cognitive prediction errors in the insula node of the salience network and postulate that dysregulated dopamine modulation of salience network-centered processes contributes to the core clinical phenotype of schizophrenia. Thus, a powerful paradigm to characterize the neurobiology of schizophrenia emerges when we combine conceptual models of salience with large-scale cognitive control networks in a unified manner. We conclude by discussing potential therapeutic leads on restoring brain network dysfunction in schizophrenia.

Frontal lobe fALFF measured from resting-state fMRI as a prognostic biomarker in first-episode psychosis

Clinical response to antipsychotic drug treatment is highly variable, yet prognostic biomarkers are lacking. The goal of the present study was to test whether the fractional amplitude of low-frequency fluctuations (fALFF), as measured from baseline resting-state fMRI data, can serve as a potential biomarker of treatment response to antipsychotics. Patients in the first episode of psychosis (n = 126) were enrolled in two prospective studies employing second-generation antipsychotics (risperidone or aripiprazole). Patients were scanned at the initiation of treatment on a 3T MRI scanner (Study 1, GE Signa HDx, n = 74; Study 2, Siemens Prisma, n = 52). Voxelwise fALFF derived from baseline resting-state fMRI scans served as the primary measure of interest, providing a hypothesis-free (as opposed to region-of-interest) search for regions of the brain that might be predictive of response. At baseline, patients who would later meet strict criteria for clinical response (defined as two consecutive ratings of much or very much improved on the CGI, as well as a rating of ≤3 on psychosis-related items of the BPRS-A) demonstrated significantly greater baseline fALFF in bilateral orbitofrontal cortex compared to non-responders. Thus, spontaneous activity in orbitofrontal cortex may serve as a prognostic biomarker of antipsychotic treatment.

Multimodal Magnetic Resonance Imaging Reveals Aberrant Brain Age Trajectory During Youth in Schizophrenia Patients

Accelerated brain aging had been widely reported in patients with schizophrenia (SZ). However, brain aging trajectories in SZ patients have not been well-documented using three-modal magnetic resonance imaging (MRI) data. In this study, 138 schizophrenia patients and 205 normal controls aged 20–60 were included and multimodal MRI data were acquired for each individual, including structural MRI, resting state-functional MRI and diffusion tensor imaging. The brain age of each participant was estimated by features extracted from multimodal MRI data using linear multiple regression. The correlation between the brain age gap and chronological age in SZ patients was best fitted by a positive quadratic curve with a peak chronological age of 47.33 years. We used the peak to divide the subjects into a youth group and a middle age group. In the normal controls, brain age matched chronological age well for both the youth and middle age groups, but this was not the case for schizophrenia patients. More importantly, schizophrenia patients exhibited increased brain age in the youth group but not in the middle age group. In this study, we aimed to investigate brain aging trajectories in SZ patients using multimodal MRI data and revealed an aberrant brain age trajectory in young schizophrenia patients, providing new insights into the pathophysiological mechanisms of schizophrenia.