Impaired attention-dependent augmentation of MMN in nonparanoid vs paranoid schizophrenic patients: a comparison with obsessive-compulsive disorder and healthy subjects

Stronger Top-Down and Weaker Bottom-Up Frontotemporal Connections During Sensory Learning Are Associated With Severity of Psychotic Phenomena

Recent theories in computational psychiatry propose that unusual perceptual experiences and delusional beliefs may emerge as a consequence of aberrant inference and disruptions in sensory learning. The current study investigates these theories and examines the alterations that are specific to schizophrenia spectrum disorders vs those that occur as psychotic phenomena intensify, regardless of diagnosis. We recruited 66 participants: 22 schizophrenia spectrum inpatients, 22 nonpsychotic inpatients, and 22 nonclinical controls. Participants completed the reversal oddball task with volatility manipulated. We recorded neural responses with electroencephalography and measured behavioral errors to inferences on sound probabilities. Furthermore, we explored neural dynamics using dynamic causal modeling (DCM). Attenuated prediction errors (PEs) were specifically observed in the schizophrenia spectrum, with reductions in mismatch negativity in stable, and P300 in volatile, contexts. Conversely, aberrations in connectivity were observed across all participants as psychotic phenomena increased. DCM revealed that impaired sensory learning behavior was associated with decreased intrinsic connectivity in the left primary auditory cortex and right inferior frontal gyrus (IFG); connectivity in the latter was also reduced with greater severity of psychotic experiences. Moreover, people who experienced more hallucinations and psychotic-like symptoms had decreased bottom-up and increased top-down frontotemporal connectivity, respectively. The findings provide evidence that reduced PEs are specific to the schizophrenia spectrum, but deficits in brain connectivity are aligned on the psychosis continuum. Along the continuum, psychotic experiences were related to an aberrant interplay between top-down, bottom-up, and intrinsic connectivity in the IFG during sensory uncertainty. These findings provide novel insights into psychosis neurocomputational pathophysiology.

Mismatch negativity indices and functional outcomes in unipolar and bipolar depression

The aim of the study was to explore the association between functional outcomes and mismatch negativity (MMN) activity in participants with mood disorders. The study participants were 27 subjects with major depressive disorder (MDD), 29 subjects with bipolar disorder (BD), and 33 healthy controls who performed a passive auditory oddball paradigm while electroencephalography (EEG) was recorded. Peak amplitudes and source activity of the MMN were compared across groups. Mood and anxiety symptoms were evaluated. The functional levels were the lowest in the BD group, followed by the MDD and healthy control groups. The subjects with BD had significantly lower MMN amplitudes at the frontal and frontocentral electrodes than the healthy controls. The source activity of the MMN from the left anterior cingulate cortex, inferior frontal gyrus, and middle frontal gyrus was significantly increased in the BD group compared to the MDD group. Significant correlations were detected between the functional outcomes and MMN amplitudes at frontal and frontocentral sites. The functional outcome was significantly correlated with left frontal regions. In conclusion, MMN activity appears to be a promising candidate as an evaluation tool for functional outcomes in mood disorders.

Impaired conscious access and abnormal attentional amplification in schizophrenia

Previous research suggests that the conscious perception of a masked stimulus is impaired in schizophrenia, while unconscious bottom-up processing of the same stimulus, as assessed by subliminal priming, can be preserved. Here, we test this postulated dissociation between intact bottom-up and impaired top-down processing and evaluate its brain mechanisms using high-density recordings of event-related potentials. Sixteen patients with schizophrenia and sixteen controls were exposed to peripheral digits with various degrees of visibility, under conditions of either focused attention or distraction by another task. In the distraction condition, the brain activity evoked by masked digits was drastically reduced in both groups, but early bottom-up visual activation could still be detected and did not differ between patients and controls. By contrast, under focused top-down attention, a major impairment was observed: in patients, contrary to controls, the late non-linear ignition associated with the P3 component was reduced. Interestingly, the patients showed an essentially normal attentional amplification of the P1 and N2 components. These results suggest that some but not all top-down attentional amplification processes are impaired in schizophrenia, while bottom-up processing seems to be preserved.

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An elevated consciousness threshold is observed in schizophrenia.

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Under unattended conditions, brain activity was similarly reduced in schizophrenic patients and controls.

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Under attended conditions, the late ignition associated with the P3 component is impaired in patients.

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In schizophrenia, top-down attentional amplification is abnormal while bottom-up processing is essentially spared.

Event-Related Potential Measures of Attention Capture in Adolescent Inpatients With Acute Suicidal Behavior

Impaired executive functions, modulated by the frontal lobes, have been suggested to be associated with suicidal behavior. The present study examines one of these executive functions, attentional control, maintaining attention to the task-at-hand. A group of inpatient adolescents with acute suicidal behavior and healthy controls were studied using a passively presented auditory optimal paradigm. This "optimal" paradigm consisted of a series of frequently presented homogenous pure tone "standards" and different "deviants," constructed by changing one or more features of the standard. The optimal paradigm has been shown to be a more time-efficient replacement to the traditional oddball paradigm, which makes it suitable for use in clinical populations. The extent of processing of these "to-be-ignored" auditory stimuli was measured by recording event-related potentials (ERPs). The P3a ERP component is thought to reflect processes associated with the capturing of attention. Rare and novel stimuli may result in an executive decision to switch attention away from the current cognitive task and toward a probe of the potentially more relevant "interrupting" auditory input. On the other hand, stimuli that are quite similar to the standard should not elicit P3a. The P3a has been shown to be larger in immature brains in early compared to later adolescence. An overall enhanced P3a was observed in the suicidal group. The P3a was larger in this group for both the environmental sound and white noise deviants, although only the environmental sound P3a attained significance. Other deviants representing only a small change from the standard did not elicit a P3a in healthy controls. They did elicit a small P3a in the suicidal group. These findings suggest a lowered threshold for the triggering of the involuntary switch of attention in these patients, which may play a role in their reported distractibility. The enhanced P3a is also suggestive of an immature frontal central executive and may provide a promising marker for early identification of some of the risk factors for some of the cognitive difficulties linked to suicidality.

Mismatch negativity and P3a amplitude in young adolescents with first-episode psychosis: a comparison with ADHD

BACKGROUND

Deficient mismatch negativity (MMN) has been proposed as a candidate biomarker in schizophrenia and may therefore be potentially useful in early identification and intervention in early onset psychosis. In this study we explored whether deficits in the automatic orienting and reorienting responses, measured as MMN and P3a amplitude, are present in young adolescents with first-episode psychosis (FEP) and whether findings are specific to psychosis compared to young adolescents with attention deficit hyperactivity disorder (ADHD).

METHOD

MMN and P3a amplitude were assessed in young adolescents (age 12-17 years) with either FEP (N = 27) or ADHD (N = 28) and age- and gender-matched healthy controls (N = 43). The MMN paradigm consisted of a four-tone auditory oddball task with deviant stimuli based on frequency, duration and their combination.

RESULTS

Significantly less MMN was found in patients with psychosis compared to healthy controls in response to frequency and duration deviants. MMN amplitudes in the group of patients with ADHD were not significantly different from patients with psychosis or healthy controls. No significant group differences were found on P3a amplitude.

CONCLUSION

Young adolescents with FEP showed impaired MMN compared to healthy controls while intermediate and overlapping levels of MMN were observed in adolescents with ADHD. The findings suggest that young FEP patients already exhibit pre-attentive deficits that are characteristic of schizophrenia albeit expressed on a continuum shared with other neuropsychiatric disorders.

Electrophysiological Endophenotypes for Schizophrenia

Endophenotypes are quantitative, heritable traits that may help to elucidate the pathophysiologic mechanisms underlying complex disease syndromes, such as schizophrenia. They can be assessed at numerous levels of analysis; here, we review electrophysiological endophenotypes that have shown promise in helping us understand schizophrenia from a more mechanistic point of view. For each endophenotype, we describe typical experimental procedures, reliability, heritability, and reported gene and neurobiological associations. We discuss recent findings regarding the genetic architecture of specific electrophysiological endophenotypes, as well as converging evidence from EEG studies implicating disrupted balance of glutamatergic signaling and GABAergic inhibition in the pathophysiology of schizophrenia. We conclude that refining the measurement of electrophysiological endophenotypes, expanding genetic association studies, and integrating data sets are important next steps for understanding the mechanisms that connect identified genetic risk loci for schizophrenia to the disease phenotype.

Event-related potentials in substance use disorders: a narrative review based on articles from 1984 to 2012

Mechanisms that mediate the transition from occasional, controlled, drug use to the impaired control that characterizes severe dependence are still a matter of investigation. The etiology of substance use disorders (SUDs) is complex, and in this context of complexity, the concept of "endophenotype," has gained extensive popularity in recent years. The main aim of endophenotypes is to provide a simpler, more proximal target to discover the biological underpinnings of a psychiatric syndrome. In this view, neurocognitive and neurophysiological impairments that suggest functional impairments associated with SUDs have been proposed as possible endophenotypes. Because of its large amplitude and relatively easy elicitation, the most studied of the cognitive brain event-related potentials (ERPs), the P300 component, has been proposed as one possible candidate. However, if a P300 amplitude alteration is a common finding in SUDs, it is also observable in other psychiatric afflictions, suggesting that the associations found may just reflect a common measure of brain dysfunction. On this basis, it has been proposed that a multivariate endophenotype, based on a weighted combination of electrophysiological features, may provide greater diagnostic classification power than any single endophenotype. The rationale for investigating multiple features is to show that combining them provides extra useful information that is not available in the individual features, leading ultimately to a multivariate phenotype.The aim of the present article is to outline the potential usefulness of this kind of "combined electrophysiological procedure" applied to SUDs. We present a review of ERP studies, combining data from people with SUD, family members, and normal control subjects, to verify whether the combination of 4ERPs (P50, MMN, P300, and N400) may produce profiles of cortical anomalies induced by different types of SUD (alcohol vs cocaine vs cannabis vs heroin).

Physiological correlates of positive symptoms in schizophrenia

Patients with schizophrenia have been hypothesized to have a functional impairment in filtering irrelevant sensory information, which may result in positive symptoms such as hallucinations or delusions. Many evidences suggest that abnormalities in the event-related brain potentials (ERPs), resting state electroencephalography (EEG) and synchronized oscillatory activity of neurons may reflect core pathophysiological mechanisms of schizophrenia. Abnormalities in amplitude and latency of the ERPs reflecting aberrations in gating and difficulties in the detection of changes in auditory stimuli, as well as defects in stimuli evaluation and integration of information are common in patients with schizophrenia. This chapter highlights the findings of electrophysiological studies in schizophrenia dealing with early sensory perception and attention, automatic sensory detection of stimuli changes and cognitive evaluation and integration of information, relevant to the pathophysiological mechanisms underpinning hallucinations and delusions. Results of electrophysiological studies investigating the neural correlates of positive symptoms suggest aberrant intrinsic organization of functional brain networks.

Neuroimaging of cognitive brain function in paediatric obsessive compulsive disorder: a review of literature and preliminary meta-analysis

Obsessive compulsive disorder (OCD) is a frequent psychiatric disorder with a prevalence of 1-3 %, and it places an enormous burden on patients and their relatives. Up to 50 % of all cases suffer from onset in childhood or adolescence, and the disorder often takes a chronic course with a poor long-term prognosis. Paediatric OCD, with its high familiality, is often referred to as a distinct OCD subtype that coincides with a developmental period in which the prefrontal cortex exhibits extensive structural and functional maturation. In the present review, we included all studies examining cognitive brain activation in children and/or adolescents with OCD. We conducted extensive literature searches for relevant articles (Pubmed, ScienceDirect) and summarize, tabulate, and discuss their results. For the eight activation studies using functional magnetic resonance imaging, we also performed preliminary meta-analyses to assess the most consistent hypo- and hyperactivation in paediatric OCD patients during cognitive task performance. The review of literature as well as our preliminary meta-analyses of paediatric studies indicated altered functional activation in the same brain regions of affective and cognitive cortico-striatal-thalamic (CST) circuits as for adult OCD patients despite some variations in the direction of activation difference. The still small number of studies that examined brain activation in paediatric OCD patients thereby largely converged with previous findings in adult patients and with the established neurobiological models of CST circuit dysfunction in OCD.

Differentiation of schizophrenia patients from healthy subjects by mismatch negativity and neuropsychological tests

BACKGROUND

Schizophrenia is a heterogeneous disorder with diverse presentations. The current and the proposed DSM-V diagnostic system remains phenomenologically based, despite the fact that several neurobiological and neuropsychological markers have been identified. A multivariate approach has better diagnostic utility than a single marker method. In this study, the mismatch negativity (MMN) deficit of schizophrenia was first replicated in a Han Chinese population, and then the MMN was combined with several neuropsychological measurements to differentiate schizophrenia patients from healthy subjects.

METHODOLOGY/PRINCIPAL FINDINGS

120 schizophrenia patients and 76 healthy controls were recruited. Each subject received examinations for duration MMN, Continuous Performance Test, Wisconsin Card Sorting Test, and Wechsler Adult Intelligence Scale Third Edition (WAIS-III). The MMN was compared between cases and controls, and important covariates were investigated. Schizophrenia patients had significantly reduced MMN amplitudes, and MMN decreased with increasing age in both patient and control groups. None of the neuropsychological indices correlated with MMN. Predictive multivariate logistic regression models using the MMN and neuropsychological measurements as predictors were developed. Four predictors, including MMN at electrode FCz and three scores from the WAIS-III (Arithmetic, Block Design, and Performance IQ) were retained in the final predictive model. The model performed well in differentiating patients from healthy subjects (percentage of concordant pairs: 90.5%).

CONCLUSIONS/SIGNIFICANCE

MMN deficits were found in Han Chinese schizophrenia patients. The multivariate approach combining biomarkers from different modalities such as electrophysiology and neuropsychology had a better diagnostic utility.

MMN responsivity to manipulations of frequency and duration deviants in chronic, clozapine-treated schizophrenia patients

Event-related potential (ERP) probing of abnormal sensory processes in schizophrenia with the mismatch negativity (MMN) has shown impairments in auditory change detection, but knowledge of the acoustic features leading to this deficit is incomplete. Changes in the duration and frequency properties of sound stimuli result in diminished MMNs in schizophrenia but it is unclear as to whether this reduced responsiveness is seen with more subtle changes in sound frequency. In a sample of 19 healthy controls and 21 patients with chronic schizophrenia treated with clozapine, MMN was assessed in response to tone frequency changes of 5%, 10% and 20%, and to tone duration changes. Patients exhibited reduced amplitudes and shorter latencies than controls to all frequency changes, and attenuated amplitudes to tone duration increments and decrements. Clozapine dose was related to MMN, with increasing dose being positively associated with frequency-MMN amplitudes (10% ∆f, 20% ∆f) and negatively associated with the amplitude and latency of duration-MMNs. These data support the well-established findings of auditory sensory abnormality in schizophrenia and underscore the sensitivity of MMN to relatively small auditory change detection deficits that may appear to characterize chronic schizophrenia.

Electroencephalography (EEG) and event-related potentials (ERPs) with human participants

Understanding the basic neural processes that underlie complex higher-order cognitive operations and functional domains is a fundamental goal of cognitive neuroscience. Electroencephalography (EEG) is a non-invasive and relatively inexpensive method for assessing neurophysiological function that can be used to achieve this goal. EEG measures the electrical activity of large, synchronously firing populations of neurons in the brain with electrodes placed on the scalp. This unit outlines the basics of setting up an EEG experiment with human participants, including equipment, and a step-by-step guide to applying and preparing an electrode cap. Also included are support protocols for two event-related potential (ERP) paradigms, P50 suppression, and mismatch negativity (MMN), which are measures of early sensory processing. These paradigms can be used to assess the integrity of early sensory processing in normal individuals and clinical populations, such as individuals with schizophrenia.

Schizophrenia and language--shall we look for a deficit of deviance detection?

In this article, we consider the view on schizophrenia that asserts this disease originates from a deficit in the hemispheric specialization for language. We suggest that a deficit in the hemispheric specialization for language may be a consequence of the other recently shown neurophysiological deficit of schizophrenia, namely deviance detection. We hypothesise that a deficit of deviance detection related to the dysfunction of NMDA receptors in schizophrenia leads to the abnormal interaction between the parallel and sequential streams of speech processing in the brain. This hypothesis opens perspectives for genetic, molecular and pharmacological studies of the deficit of deviance detection in schizophrenia, as reflected by event-related potentials and neuroimaging during speech processing.

Electroencephalography (EEG) and event-related potentials (ERPs) with human participants

Understanding the basic neural processes that underlie complex higher-order cognitive operations and functional domains is a fundamental goal of cognitive neuroscience. Electroencephalography (EEG) is a non-invasive and relatively inexpensive method for assessing neurophysiological function that can be used to achieve this goal. EEG measures the electrical activity of large, synchronously firing populations of neurons in the brain with electrodes placed on the scalp. This unit outlines the basics of setting up an EEG experiment with human participants, including equipment, and a step-by-step guide to applying and preparing an electrode cap. Also included are support protocols for two event-related potential (ERP) paradigms, P50 suppression, and mismatch negativity (MMN), which are measures of early sensory processing. These paradigms can be used to assess the integrity of early sensory processing in normal individuals and clinical populations, such as individuals with schizophrenia.

Somatosensory system deficits in schizophrenia revealed by MEG during a median-nerve oddball task

Although impairments related to somatosensory perception are common in schizophrenia, they have rarely been examined in functional imaging studies. In the present study, magnetoencephalography (MEG) was used to identify neural networks that support attention to somatosensory stimuli in healthy adults and abnormalities in these networks in patient with schizophrenia. A median-nerve oddball task was used to probe attention to somatosensory stimuli, and an advanced, high-resolution MEG source-imaging method was applied to assess activity throughout the brain. In nineteen healthy subjects, attention-related activation was seen in a sensorimotor network involving primary somatosensory (S1), secondary somatosensory (S2), primary motor (M1), pre-motor (PMA), and paracentral lobule (PCL) areas. A frontal-parietal-temporal "attention network", containing dorsal- and ventral-lateral prefrontal cortex (DLPFC and VLPFC), orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), superior parietal lobule (SPL), inferior parietal lobule (IPL)/supramarginal gyrus (SMG), and temporal lobe areas, was also activated. Seventeen individuals with schizophrenia showed early attention-related hyperactivations in S1 and M1 but hypo-activation in S1, S2, M1, and PMA at later latency in the sensorimotor network. Within this attention network, hypoactivation was found in SPL, DLPFC, orbitofrontal cortex, and the dorsal aspect of ACC. Hyperactivation was seen in SMG/IPL, frontal pole, and the ventral aspect of ACC in patients. These findings link attention-related somatosensory deficits to dysfunction in both sensorimotor and frontal-parietal-temporal networks in schizophrenia.

Neurophysiological measures of sensory registration, stimulus discrimination, and selection in schizophrenia patients

Cortical Neurophysiological event related potentials (ERPs) are multidimensional measures of information processing that are well suited to efficiently parse automatic and controlled components of cognition that span the range of deficits exhibited in schizophrenia patients. Components following a stimulus reflect the sequence of neural processes triggered by the stimulus, beginning with early automatic sensory processes and proceeding through controlled decision and response related processes. Previous studies employing ERP paradigms have reported deficits of information processing in schizophrenia across automatic through attention dependent processes including sensory registration (N1), automatic change detection (MMN), the orienting or covert shift of attention towards novel or infrequent stimuli (P3a), and attentional allocation following successful target detection processes (P3b). These automatic and attention dependent information components are beginning to be recognized as valid targets for intervention in the context of novel treatment development for schizophrenia and related neuropsychiatric disorders. In this review, we describe three extensively studied ERP components (N1, mismatch negativity, P300) that are consistently deficient in schizophrenia patients and may serve as genetic endophenotypes and as quantitative biological markers of response outcome.

Wavelet analysis of the frontal auditory evoked potentials obtained in the passive oddball paradigm in healthy subjects and schizophrenics

The goal of the present study was to apply the oscillatory brain dynamics model to the structural and quantitative analysis of neurocognitive functions considered as a potential marker of schizophrenia. This was achieved in tests of the detection of auditory events deviating in the regular auditory stream (oddball paradigm, MMN effect). It was hypothesized that the post-stimulus peaks of the oscillation power localized in post-stimulus time in the definite EEG oscillators represented neuro-electrical 'events' evoked in the specific neuronal nets characterized by this oscillation frequency band. We suggest that the time-frequency destination of these events related to the activation of the functional neuronal nets could be used for the determination of specific neurocognitive functions. Thus it was an attempt to distinguish the different neuro-functional parts of auditory processing and to compare these results between healthy subjects and patients with schizophrenia. The present results demonstrate the significant difference between the frontal averaged EEG oscillatory dynamics in healthy subjects and patients with schizophrenia related to neurocognitive function marked by the MMN and orienting response N200/P300a.

Deviance-elicited Changes in Event-related Potentials are Attenuated by Ketamine in Mice

Background: People with schizophrenia exhibit reduced ability to detect change in the auditory environment, which has been linked to abnormalities in N-methyl-D-aspartate (NMDA) receptor-mediated glutamate neurotransmission. This ability to detect changes in stimulus qualities can be measured with electroencephalography using auditory event-related potentials (ERPs). For example, reductions in the N100 and mismatch negativity (MMN), in response to pitch deviance, have been proposed as endophenotypes of schizophrenia. This study examines a novel rodent model of impaired pitch deviance detection in mice using the NMDA receptor antagonist ketamine. Methods: ERPs were recorded from unanesthetized mice during a pitch deviance paradigm prior to and following ketamine administration. First, N40 amplitude was evaluated using stimuli between 4 and 10 kHz to assess the amplitude of responses across the frequency range used. The amplitude and latency of the N40 were analyzed following standard (7 kHz) and deviant (5–9 kHz) stimuli. Additionally, we examined which portions of the ERP are selectively altered by pitch deviance to define possible regions for the mouse MMN. Results: Mice displayed increased N40 amplitude that was followed by a later negative component between 50 and 75 msec in response to deviant stimuli. Both the increased N40 and the late N40 negativity were attenuated by ketamine. Ketamine increased N40 latency for both standard and deviant stimuli alike. Conclusions: The mouse N40 and a subsequent temporal region have deviance response properties similar to the human N100 and, possibly, MMN. Deviance responses were abolished by ketamine, suggesting that ketamine-induced changes in mice mimic deviance detection deficits in schizophrenia.

Auditory hallucinations and the mismatch negativity: processing speech and non-speech sounds in schizophrenia

BACKGROUND

In line with emerging research strategies focusing on specific symptoms rather than global syndromes in psychiatric disorders, we examined the functional neural correlates of auditory verbal hallucinations (AHs) in schizophrenia. Recent neuroimaging and behavioural evidence suggest a reciprocal relationship between auditory cortex response to external sounds versus that induced by AHs.

METHODS

The mismatch negativity (MMN), a well established event-related potential (ERP) index of auditory cortex function, was assessed in 12 hallucinating patients (HP), 12 non-hallucinating patients (NP) and 12 healthy controls (HC). The primary endpoints, MMN amplitudes and latencies recorded from anterior and posterior scalp regions, were measured in response to non-phonetic and phonetic sounds.

RESULTS

While schizophrenia patients as a whole differed from HCs, no significant between-group differences were observed when patients were divided into hallucinated and non-hallucinated subgroups but, compared to NPs and HCs, whose MMN amplitudes were greatest in response to across phoneme change at frontal but not temporal sites, MMN amplitudes in HPs at frontal sites were not significantly different to any of the presented stimuli, while temporal MMNs in HPs were maximally sensitive to phonetic change.

SIGNIFICANCE

These findings demonstrate that auditory verbal hallucinations are associated with impaired pre-attentive processing of speech in fronto-temporal networks, which may involve defective attribution of significance that is sensitive to resource limitations. Overall, this research suggests that MMN may be a useful non-invasive tool for probing relationships between hallucinatory and neural states within schizophrenia and the manner in which auditory processing is altered in these afflicted patients.

Preattentive sensory processing as indexed by the MMN and P3a brain responses is associated with cognitive and psychosocial functioning in healthy adults

Understanding the basic neural processes that underlie complex higher order cognitive operations and psychosocial functioning is a fundamental goal of cognitive neuroscience. Event-related potentials allow investigators to probe the earliest stages of information processing. Mismatch negativity (MMN) and P3a are auditory event-related potential components that reflect automatic sensory discrimination. The aim of the present study was to determine if MMN and P3a are associated with higher order cognitive operations and psychosocial functioning in clinically normal healthy subjects. Twenty adults were assessed using standardized clinical, cognitive, and psychosocial functional instruments. All individuals were within the normal range on cognitive tests and functional ratings. Participants were also tested on a duration-deviant MMN/P3a paradigm (50-msec standard tones, p = .90; 100-msec deviant tones, p = .10; stimulus onset asynchrony [SOA] = 505 msec). Across fronto-central electrode regions, significant correlations were observed between psychosocial functioning and MMN (r = -.62, p < .01) and P3a (r = .63, p < .01) amplitudes. P3a amplitude was also highly associated with immediate and delayed recall of verbal information with robust correlations widely distributed across fronto-central recording areas (e.g., r = .72, p < .001). The latency of the P3a response was significantly associated with both working memory performance (r = -.53, p < .05) and functional ratings (r = -.48, p < .05). Neurophysiological measures of relatively automatic auditory sensory information processing are associated with higher order cognitive abilities and psychosocial functioning in normal subjects. Efficiency at elementary levels of information processing may underlie the successful encoding, retrieval, and discrimination of task-relevant information, which, in turn, facilitates the iterative and responsive processing necessary for adaptive cognitive and social functioning.

Annotation: what electrical brain activity tells us about brain function that other techniques cannot tell us - a child psychiatric perspective

BACKGROUND

Monitoring brain processes in real time requires genuine subsecond resolution to follow the typical timing and frequency of neural events. Non-invasive recordings of electric (EEG/ERP) and magnetic (MEG) fields provide this time resolution. They directly measure neural activations associated with a wide variety of brain states and processes, even during sleep or in infants. Mapping and source estimation can localise these time-varying activation patterns inside the brain.

METHODS

Recent EEG/ERP research on brain functions in the domains of attention and executive functioning, perception, memory, language, emotion and motor processing in ADHD, autism, childhood-onset schizophrenia, Tourette syndrome, specific language disorder and developmental dyslexia, anxiety, obsessive-compulsive disorder, and depression is reviewed.

RESULTS

Over the past two decades, electrophysiology has substantially contributed to the understanding of brain functions during normal development, and psychiatric conditions of children and adolescents. Its time resolution has been important to measure covert processes, and to distinguish cause and effect.

CONCLUSIONS

In the future, EEG/ERP parameters will increasingly characterise the interplay of neural states and information processing. They are particularly promising tools for multilevel investigations of etiological pathways and potential predictors of clinical treatment response.

Mismatch negativity in paranoid, schizotypal, and antisocial personality disorders

AIMS

The mismatch negativity (MMN) to frequency deviant tones has yielded conflicting results in patients with schizophrenia. This might be because Axis I schizophrenia overlaps with Axis II diagnoses such as paranoid or schizotypal personality disorders. This study was designed to address this issue.

METHODS

We evaluated the auditory MMN to frequency deviance in 17 patients with paranoid, 15 schizotypal, and 16 antisocial personality disorders. These were compared to 25 healthy subjects.

RESULTS

N1 to both deviant and standard tones was shorter in the paranoid group when compared to healthy controls. MMN latencies were shorter at Fz, Cz, and Pz in the paranoid group when compared to healthy controls, schizotypal, and antisocial groups. MMN amplitudes were higher at Fz and Cz in the schizotypal and antisocial groups when compared to healthy controls and the paranoid group.

CONCLUSIONS

Patients with paranoid personality disorder had faster automatic detection of auditory stimuli and of their change, but normal inhibition of irrelevant stimuli. By contrast, patients with schizotypal and antisocial personality disorders had normal discrimination of the auditory stimuli, but might have a deficit in inhibition on irrelevant stimuli. Our results might help differentiate these personality types, and clarify some MMN findings in schizophrenia.

Neurophysiological endophenotypes of schizophrenia: the viability of selected candidate measures

In an effort to reveal susceptibility genes, schizophrenia research has turned to the endophenotype strategy. Endophenotypes are characteristics that reflect the actions of genes predisposing an individual to a disorder, even in the absence of diagnosable pathology. Individual endophenotypes are presumably determined by fewer genes than the more complex phenotype of schizophrenia and would, therefore, reduce the complexity of genetic analyses. Unfortunately, despite there being rational criteria to define a viable endophenotype, the term is sometimes applied indiscriminately to characteristics that are deviant in affected individuals. Schizophrenia patients exhibit deficits in several neurophysiological measures of information processing that have been proposed as candidate endophenotypes. Successful processing of sensory inputs requires the ability to inhibit intrinsic responses to redundant stimuli and, reciprocally, to facilitate responses to less frequent salient stimuli. There is evidence to suggest that both these processes are "impaired" in schizophrenia. Measures of inhibitory failure include prepulse inhibition of the startle reflex, P50 auditory evoked potential suppression, and antisaccade eye movements. Measures of impaired deviance detection include mismatch negativity and the P300 event-related potential. The purpose of this review is to systematically evaluate the endophenotype candidacy of these key neurophysiological abilities. For each candidate, we describe typical experimental procedures, the current understanding of the underlying neurobiology, the nature of the abnormality in schizophrenia, the reliability, stability and heritability of the measure, and any reported gene associations. We conclude with a discussion of the few studies thus far that have employed a multivariate approach with these candidates.

Event-related potentials to auditory and visual selective attention in schizophrenia

BACKGROUND

Prior studies have shown a consistent reduction of the auditory P300 in schizophrenia, while the visual attention findings have been mixed. Both the auditory and visual N2b, an earlier, modality-specific attention index, are reduced in schizophrenia, sometimes despite sparing of the visual P300. Thus there may be a dissociation between the N2b and P300 attention effects in auditory and visual modalities in schizophrenia.

METHODS

Thirteen patients and thirteen controls observed symbols appearing on a screen, paired with simultaneous tones. In some blocks subjects responded to one of the symbols, in others to one of the tones. The N2b was predicted to be reduced in the patient group in both auditory and visual attention but the P300 reduced only while attending to tones.

RESULTS

Results showed a reduction of the N1 component in the patient group in the auditory condition but not in the visual. There was a reduction of the N2b target-minus-non-target difference wave in the patients in both auditory and visual target conditions. The P300 component was larger overall in the control group in both modalities, but did not show the usual enhancement to auditory targets in the control group.

CONCLUSIONS

These findings suggest that the ability to selectively attend to a target in one modality while ignoring the other is compromised in patients with schizophrenia. Perceptual processing appears to be impacted in the auditory modality while remaining intact in the visual. The N2b appears more vulnerable than the P300 in both auditory and visual attention in schizophrenia.

Auditory change detection in schizophrenia: sources of activity, related neuropsychological function and symptoms in patients with a first episode in adolescence, and patients 14 years after an adolescent illness-onset

BACKGROUND

The event-related brain response mismatch negativity (MMN) registers changes in auditory stimulation with temporal lobe sources reflecting short-term echoic memory and frontal sources a deviance-induced switch in processing. Impairment, controversially present at the onset of schizophrenia, develops rapidly and can remain independent of clinical improvement. We examined the characteristics of the scalp-recorded MMN and related these to tests of short-term memory and set-shifting. We assessed whether the equivalent dipole sources are affected already at illness-onset in adolescence and how these features differ after a 14-year course following an adolescent onset. The strength, latency, orientation and location of frontal and temporal lobe sources of MMN activity early and late in the course of adolescent-onset schizophrenia are analysed and illustrated.

METHODS

MMN, a measure of auditory change-detection, was elicited by short deviant tones in a 3-tone oddball-presentation and recorded from 32 scalp electrodes. Four dipole sources were placed following hypothesis-led calculations using brain electrical source analysis on brain atlas and MR-images. A short neuropsychological test battery was administered. We compared 28 adolescent patients with a first episode of schizophrenia and 18 patients 14 years after diagnosis in adolescence with two age-matched control groups from the community (n = 22 and 18, respectively).

RESULTS

MMN peaked earlier in the younger than the older subjects. The amplitude was reduced in patients, especially the younger group, and was here associated with negative symptoms and slow set-shifting. In first-episode patients the temporal lobe sources were more ventral than in controls, while the left cingular and right inferior-mid frontal sources were more caudal. In the older patients the left temporal locus remained ventral (developmental stasis), the right temporal locus extended more antero-laterally (illness progression), and the right frontal source moved antero-laterally (normalised).

CONCLUSION

From the start of the illness there were differences in the dipole-model between healthy and patient groups. Separate characteristics of the sources of the activity differences showed an improvement, stasis or deterioration with illness-duration. The precise nature of the changes in the sources of MMN activity and their relationship to selective information processing and storage depend on the specific psychopathology and heterogeneous course of the illness.

Mismatch negativity in schizophrenia: a meta-analysis

BACKGROUND

Mismatch negativity (MMN) is an auditory event-related potential that provides an index of automatic context-dependent information processing and auditory sensory memory. Many studies have reported abnormalities in the generation of MMN in schizophrenia. The objective of this study was to assess the magnitude of this deficit and associated factors.

METHOD

Studies of MMN in schizophrenia were identified and included in a meta-analysis to estimate the mean effect size. Effects of duration of illness, gender ratio, age of patients, type of MMN (duration versus frequency MMN) and characteristics of the test paradigms (deviant probability, magnitude of standard-deviant difference) on effect size were assessed.

RESULTS

Of 62 identified studies 32 met our inclusion criteria. The mean effect size was 0.99 (95% confidence intervals: 0.79, 1.29). Overall, no specific factor was significantly associated with MMN deficits, although MMN to stimuli differing in duration appeared more impaired in schizophrenia than MMN to frequency deviants. In addition, effect sizes of frequency MMN were significantly correlated with duration of illness.

CONCLUSIONS

MMN deficits are a robust feature in chronic schizophrenia and indicate abnormalities in automatic context-dependent auditory information processing and auditory sensory memory in these patients. Reports of normal MMN in first-episode schizophrenia and the association of deficits in frequency MMN with illness duration suggest that MMN may index ongoing neuropathological changes in the auditory cortex in schizophrenia.

Frontal and temporal sources of mismatch negativity in healthy controls, patients at onset of schizophrenia in adolescence and others at 15 years after onset

Mismatch negativity (MMN) is an event-related potential measure of auditory change detection. It is widely reported to be smaller in patients with schizophrenia and may not improve along with otherwise successful clinical treatment. The main aim of this report is to explore ways of measuring and presenting four features of frequency-deviant MMN dipole sources (dipole moment, peak latency, brain location and orientation) and to relate these to the processes of psychopathology and illness progression. Data from early onset patients (EOS) at the start of the illness in adolescence, and others who had their first break in adolescence 15 years ago (S-15Y) were compared with two groups of age-matched healthy controls (C-EOS, C-15Y). A four-source model fitted the MMN waveform recorded from all four groups, whether MMN amplitude was more (EOS) or less (S-15Y) reduced. The locations were in the left superior temporal and anterior cingulate gyri, right superior temporal and inferior/mid frontal cortices. Dipole latencies confirmed a bottom-up sequence of processing and dipole moments were larger in the temporal lobes and on the left. Patients showed small dipole location changes that were more marked in the S-15Y than the EOS group (more rostral for the left anterior cingulate, more caudal for the right mid-frontal dipole) consistent with illness progression. The modelling of MMN dipole sources on brain atlas and anatomical images suggests that there is a degree of dissociation during illness between small progressive anatomical changes and some functional recovery indexed by scalp recordings from patients with an onset in adolescence 15 years before compared to adolescents in their first episode.

[Mismatch negativity in schizophrenia research. An indicator of early processing disorders of acoustic information]

Mismatch negativity (MMN) represents an event-related component of the auditory evoked potentials at about 100-250 ms, evoked by discernible changes in an ongoing uniform acoustic stimulation. The current paper reviews all recently published MMN studies in the field of schizophrenia research. A reduced MMN in schizophrenic patients is found in the majority of the studies. This deficit is likely to be related to the disorder, since antipsychotic medication seems to have little influence on these results. Interestingly, a reduced MMN is also found in first-degree relatives of patients. Clear evidence for a hemispheric lateralization of the MMN reduction in schizophrenic patients is lacking. A hypofunction of the N-methyl-D-aspartate (NMDA) receptor is discussed as a possible explanation of this deficit.

Preattentional and attentional cognitive deficits as targets for treating schizophrenia

BACKGROUND AND RATIONALE

Pharmacotherapy of schizophrenia has traditionally targeted positive psychotic symptoms. An emerging view is that developing medications that improve cognition in schizophrenia patients is a major step forward in achieving better functional outcome. The cognitive deficits that are often observed in schizophrenia can be assessed using (1) neuropsychological tests; and (2) neurophysiological tests, the topic of this article. These neurophysiological measures cover a spectrum from automatic preattentional to attention-dependent processes.

OBJECTIVES

This article focuses on cognitive deficits that appear to be promising targets for a new "third generation" of medications that may be used to treat schizophrenia and other patients with specific deficits in cognition and functioning. We discuss the possible use of the following six measures of preattentional and attention-dependent cognitive deficits: mismatch negativity, P50 event-related potential suppression, prepulse inhibition of the startle response, P300 event-related potential, continuous performance task performance, and oculomotor antisaccade performance.

CONCLUSIONS

The use of preattentional and attention-dependent measures offer unique opportunities to improve our armamentarium of pharmacologic strategies for the treatment of cognitive deficits in schizophrenia patients. This review illustrates the usefulness of these measures as targets for existing and new antipsychotic medications that will potentially (1) characterize the cognitive deficits that occur in schizophrenia patients and (2) assess medication-related improvement on these measures and the potential associated improvement in functional outcome.

Altered auditory processing in acutely psychotic never-medicated first-episode patients

Individuals with psychosis fail to differentiate external impulses and suffer from distortions of reality testing. Schizophrenia group illnesses are also associated with deficits in working memory and perception. We examined the manifestations of a very early phase of psychotic illness to automatic auditory deviance detection to clarify the basic mechanisms underlying misinterpretations of perception.

METHODS

Twenty-five never-medicated patients admitted for hospital evaluation of acute psychosis were studied. Fifty-eight EEG channels were recorded during an auditory oddball paradigm. Event-related potentials (ERPs) time-locked to non-attended deviant auditory stimuli were studied in patients and compared with healthy controls. Auditory processing was examined both at the level of the measured biosignals (standard and deviant responses) and with subtraction waveforms. Topographical differences were characterized using global field power (GFP) and minimum norm estimates.

RESULTS

The maximum GFP amplitudes and mean amplitudes of the 58 channels within the time windows corresponding to the previously known 'N2b', 'P3a' and 'P3b' components were clearly reduced in patients when compared to healthy controls. However, the groups did not differ during attention-independent automatic processing corresponding to the 'N1' and 'MMN' components, or with respect to the peak latencies of the GFP maxima.

CONCLUSIONS

Impairment of the processing of a deviance in simple auditory input in acutely ill drug-naive first-episode psychotic patients only appears in attention-dependent processing after about 250 ms. The alterations in auditory processing differed between stimulus types, suggesting at least two mechanisms underlying the auditory discrimination impairments in acute psychosis. After 250 ms there was a linear and gradually increasing difference in magnitude between the groups in their responses to deviant stimuli, probably related to arousal. In addition, however, there was a striking difference between the groups in the processing of standard stimuli. The early processing was similar in patients and controls, but the striking difference appeared in later processing. The sensory memory deficits associated with psychosis may be explained by an abnormality in sensory model formation rather than by impaired deviant detection.

Mismatch negativity in detection of interval duration deviation in schizophrenia

Temporal processing deficits have been noted in behavioral studies assessing patients with schizophrenia. The current study sought to explore the physiology of temporal perception while controlling the effects of motivation, attention and other cognitive processes that may contribute to behavioral measures of temporal processing. Mismatch negativity (MMN) waveforms were measured in response to variations in the temporal parameters of an ongoing train of pure tones. A standard inter-stimulus interval of 400 ms was interrupted, on average, every 20th tone by an inter-stimulus interval of 340 ms. Amplitude of MMN waveform elicited by the temporal deviance was significantly reduced in the schizophrenia group compared with controls (p = 0.016). Results suggest that behavioral difficulties on time processing tasks in schizophrenia may reflect a physiological deficit in temporal perception in this population rather than simply more general difficulties in attention or motivation.

How specific are deficits in mismatch negativity generation to schizophrenia?

BACKGROUND

Mismatch negativity (MMN) is an auditory event-related potential that provides an index of auditory sensory memory. Deficits in MMN generation have been repeatedly demonstrated in chronic schizophrenia. Their specificity to schizophrenia has not been established.

METHODS

Mismatch negativity to both duration and frequency deviants was investigated in gender- and age-matched patients with schizophrenia or schizoaffective disorder (n = 26), bipolar disorder (n = 16), or major depression (n = 22) and healthy control subjects (n = 25).

RESULTS

Only patients with schizophrenia demonstrated significantly smaller mean MMN than did healthy control subjects. Detailed analyses showed significantly smaller MMN to both duration and frequency deviants in patients with schizophrenia than in healthy control subjects; however, the reduction of frequency MMN in patients with schizophrenia was not significant in the comparison across all groups. Mismatch negativity topography did not differ among groups. No consistent correlations with clinical, psychopathologic, or treatment variables were observed.

CONCLUSIONS

Mismatch negativity deficits, and by extension deficits in early cortical auditory information processing, appear to be specific to schizophrenia. Animal and human studies implicate dysfunctional N-methyl-D-aspartate receptor functioning in MMN deficits. Thus MMN deficits may become a useful endophenotype to investigate the genetic underpinnings of schizophrenia, particularly with regard to the N-methyl-D-aspartate receptor.

Measuring duration mismatch negativity

OBJECTIVE

Automatic comparisons of sound duration in auditory sensory memory are typically investigated by comparing event-related potentials (ERPs) to standard and deviant stimuli presented in oddball blocks. Deviants elicit mismatch negativity (MMN). This procedure might overestimate an MMN contribution reflecting automatic sensory memory processes because of differential states of refractoriness of respectively recruited neural populations [Neuroreport 1996;7:3005; Psychophysiology 2001;38:723]. Here, memory-comparison-based Duration MMN contributions were investigated using various experimental protocols.

METHODS

Memory-comparison-based first-order Duration MMN was investigated using 4 blocked conditions: (a) descending Deviant (100 ms, P=0.14), 150 ms Standard; (b) reverse ascending Deviant (150 ms), 100 ms Standard; (c) Control comprised of 7 equiprobable durations between 25 and 175 ms; and additionally (d) equiprobable tones between 100 and 400 ms. Using the former 3 conditions, Deviants, Standards and Controls were physically identical.

RESULTS

Comparing Deviants and Controls excluded potential refractoriness effects, and a decomposition of memory-comparison-based MMN and residual MMN was demonstrated. Genuine Duration MMN was also obtained in the deviant-standard-reverse comparison.

CONCLUSIONS

Using a blocked control condition yielded equivalent results to reversing the role of deviant and standard in two separate oddball blocks. Using the reverse ascending deviant condition is thus sufficient as a control.

Mismatch negativity is not correlated with neuroendocrine indicators of catecholaminergic activity in healthy subjects

The identification of the brain structures and neurotransmitters responsible for the generation and/or modulation of the mismatch negativity (MMN) may contribute to a clearer understanding of its functional significance, and may have clinical implications. In this context, some findings suggest that the scalp-recorded MMN reflects activity from multiple neuronal ensembles within or in the immediate vicinity of the primary auditory cortex and with possible contribution from the frontal cortex. However, few data are available concerning the influence of neurotransmitter systems on the MMN. In this study, the relationship between both noradrenergic and dopaminergic systems and the MMN were investigated in 34 healthy volunteers. Noradrenergic and dopaminergic activities were assessed with the apomorphine and clonidine challenge tests. The results showed no significant relationship between either growth hormone (GH) responses to apomorphine or clonidine and the MMN amplitude or latency. Therefore, this study does not demonstrate the implication of dopaminergic and noradrenergic activities as assessed by GH response to apomorphine and clonidine for the generation and/or the modulation of the MMN. However, given the complexity of the central neurotransmitter systems, these results cannot be considered as definitive evidence against a relationship between dopaminergic and noradrenergic activity and the MMN.

Neuromagnetic correlates of impaired automatic categorical perception of speech sounds in schizophrenia

Schizophrenia is associated with dysfunction in language processing. At the earliest stage of language processing, dysfunction of categorical perception of speech sounds in schizophrenia has been demonstrated in a behavioral task. The aim of this study was to assess automatic categorical perception of speech sounds as reflected by event-related changes in magnetic field power in schizophrenia. Using a whole-head magnetoencephalographic recording, the magnetic counterpart of mismatch negativity (MMNm) elicited by a phonetic change was evaluated in 16 right-handed patients with chronic schizophrenia and in 19 age-, sex-, and parental socioeconomic status-matched normal control subjects. Three types of MMNm (MMNm in response to a duration decrement of pure-tone stimuli; a vowel within-category change [duration decrement of Japanese vowel /a/]; vowel across-category change [Japanese vowel /a/ versus /o/]) were recorded. While the schizophrenia group showed an overall reduction in magnetic field power of MMNm, a trend was found toward more distinct abnormalities under the condition of vowel across-category change than under that of duration decrement of a vowel or tone. The patient group did not show abnormal asymmetries of MMNm power under any of the conditions. This study provides physiological evidence for impaired categorical perception of speech sounds in the bilateral auditory cortex in schizophrenia. The language-related dysfunction in schizophrenic patients may be present at the early stage of auditory processing of relatively simple stimuli such as phonemes, and not just at stages involving higher order semantic processes.

Auditory distraction with different presentation rates: an event-related potential and behavioral study

OBJECTIVE

The present study addresses the question of whether behavioral and electrophysiological effects obtained with the auditory distraction paradigm proposed by Schröger et al. [Clin Neurophysiol 2000;111:1450] depend on the timing of stimulus occurrence.

METHODS

Subjects had to discriminate the duration of tones. Occasionally, task-irrelevant frequency changes were used as distractors. In 3 experiments the stimulus onset asynchrony (SOA) was manipulated: In Experiment 1, SOAs of 1500, 2000 and 3000 ms were used in separate blocks; in Experiment 2, 5 different SOA of lengths between 1300 and 2500 ms were used within the blocks; in Experiment 3, a constant SOA of 1400 ms was compared with a SOA of random lengths between 1300 and 1500 ms. Performance data was analyzed for distraction effects. Event-related potentials (ERPs) were examined for deviance-related components, i.e. the mismatch negativity (MMN), the P3a and the re-orienting negativity (RON).

RESULTS

Behavioral distraction effects were obtained in all experimental conditions. The electrophysiological data show MMN, P3a and RON for the deviating tones in all experimental conditions as well.

CONCLUSIONS

The behavioral and electrophysiological deviance-related effects were not sensitive to the SOA manipulations. Therefore, the timing of the presentation can be adjusted to the proficiency level of the population to be tested without loosing the distraction effects.

Impairment in activation of a frontal attention-switch mechanism in schizophrenic patients

The present study addresses the difference in activities of frontal and temporal mismatch negativity (MMN) generators between healthy controls and schizophrenic patients. Auditory MMNs were measured from 13 medicated schizophrenic patients in a post-acute phase and 12 healthy controls. The probabilities of the standard stimuli were, in different experimental blocks, 95, 90, 80 or 70%. The mean amplitude of the MMN recorded at Fz was significantly smaller in schizophrenic patients than healthy controls only in the conditions with high probability of standard stimuli, while that recorded at mastoid sites was not different in any condition. The present study suggested that schizophrenic patients might fail to cause involuntary attention switch to stimulus change reflected in the lowered MMN amplitude recorded at Fz; whereas the patients might index an adequate detection of the deviant event reflected by the similar amplitude of MMN recorded at mastoid sites.

Effects of the 5-HT2A agonist psilocybin on mismatch negativity generation and AX-continuous performance task: implications for the neuropharmacology of cognitive deficits in schizophrenia

Previously the NMDA (N-methyl-D-aspartate) receptor (NMDAR) antagonist ketamine was shown to disrupt generation of the auditory event-related potential (ERP) mismatch negativity (MMN) and the performance of an 'AX'-type continuous performance test (AX-CPT)--measures of auditory and visual context-dependent information processing--in a similar manner as observed in schizophrenia. This placebo-controlled study investigated effects of the 5-HT(2A) receptor agonist psilocybin on the same measures in 18 healthy volunteers. Psilocybin administration induced significant performance deficits in the AX-CPT, but failed to reduce MMN generation significantly. These results indirectly support evidence that deficient MMN generation in schizophrenia may be a relatively distinct manifestation of deficient NMDAR functioning. In contrast, secondary pharmacological effects shared by NMDAR antagonists and the 5-HT(2A) agonist (ie disruption of glutamatergic neurotransmission) may be the mechanism underlying impairments in AX-CPT performance observed during both psilocybin and ketamine administration. Comparable deficits in schizophrenia may result from independent dysfunctions of 5-HT(2A) and NMDAR-related neurotransmission.

Duration mismatch negativity in biological relatives of patients with schizophrenia spectrum disorders

BACKGROUND

One of the most consistent findings in schizophrenia research over the past decade is a reduction in the amplitude of an auditory event-related brain potential known as mismatch negativity (MMN), which is generated whenever a deviant sound occurs in a background of repetitive auditory stimulation. The reduced amplitude of MMN in schizophrenia was first observed for deviant sounds that differ in duration relative to background standard sounds, and similar findings have been observed for sounds that are deviant in frequency. The aim of this study was to determine whether first-degree relatives of schizophrenia patients show a similar reduction in MMN amplitude to duration deviants.

METHODS

We measured MMN to duration increments (deviants 100 msec vs. standards 50 msec) in 22 medicated patients with a diagnosis in the schizophrenia spectrum, 17 individuals who were first-degree unaffected relatives of patients, and 21 healthy control subjects.

RESULTS

Mismatch negativity amplitude was reduced in patients and relatives compared with control subjects. There were no significant differences between patients and relatives. In contrast, the subsequent positive component, P3a, was larger in relatives compared with patients.

CONCLUSIONS

These findings suggest that a reduced MMN amplitude may be an endophenotype marker of the predisposition to schizophrenia.

The effects of benzodiazepines on event-related potential indices of automatic and controlled processing in schizophrenia: a preliminary report

The effects of benzodiazepines on cognitive function in schizophrenic patients were investigated using event-related potential (ERP) measurement during an auditory selective attention task. In this study, the authors compared the mismatch negativity (MMN) and N2b components between two subgroups of schizophrenic patients: one is comprised of patients who received no benzodiazepines (NT group, n = 7) and the other is comprised of those administered benzodiazepines in the daytime (T group, n = 7). There were no significant differences in MMN and N2b amplitudes between the two subgroups, whereas the N2b latency was significantly prolonged in the T group relative to the NT group. This suggested that benzodiazepines induce delayed stimulus classification processing in schizophrenic patients.

The difference in Mismatch negativity between the acute and post-acute phase of schizophrenia

In order to investigate the trait and state aspects of Mismatch negativity (MMN) amplitude reduction in schizophrenia, auditory MMNs were measured from 13 schizophrenic patients on two occasions, initially when they showed acute exacerbation and later when their symptoms improved. Patients exhibited reduced mean amplitude of the MMN recorded at Fz. There were no significant changes in the amplitude of MMN at Fz between the acute patients and the post-acute patients, despite significant improvement in symptomatology. However, the acute patients showed a significant attenuation of MMN recorded at both mastoids as compared with the post-acute patients. Although the findings of the MMN at Fz support the overall longitudinal stability of MMN deficits in schizophrenia, the acute phase patients showed a modestly altered MMN activity compared with the post-acute phase patients, suggesting that there is some state-dependent modulation of these deficits.

Memory impairment in schizophrenia: a study using event-related potentials in implicit and explicit tasks

Although memory impairment is recognized as a major fact of schizophrenia, only a few studies have investigated memory impairments with specifically designed event-related potential (ERP) protocols. In this study, ERPs were recorded from 15 schizophrenia patients and 15 matched control subjects during implicit and explicit memory tasks for unfamiliar faces. The results showed that patients have a reduced modulation of an N400-like component in both the implicit and explicit tasks that suggests a deficient integration of incoming information with personal knowledge. Patients also displayed an enhanced frontally distributed activity in the explicit task that may represent an impairment in the integration of intrinsic contextual information, a disturbance in the ability to inhibit proactive interference or a combination of both processes. Finally, the modulation of the late positive component did not differ from that in control subjects in both implicit and explicit tasks, suggesting that the impairment in mnemonic binding processes suggested in schizophrenia is more qualitative, i.e. incomplete or inappropriate, due to the anomalies in antecedent processes. The correlations observed between impairments of ERP modulation and symptoms further support these interpretations.

What has MMN revealed about the auditory system in schizophrenia?

Evidence that deficits in early auditory processing occur in schizophrenia was first provided by an ERP study demonstrating that mismatch negativity (MMN) to duration increments is reduced in medicated patients. Our subsequent research, which is reviewed in this paper, demonstrates that duration MMN reduction cannot be attributed to neuroleptic medication, and is specific to schizophrenia. It is not dependent upon the nature of the task used to distract attention away from the auditory modality. Most importantly, a reduced duration MMN in schizophrenia is a replicable result, having been observed in multiple independently-selected groups of patients from two separate laboratories. It also occurs in unaffected first-degree relatives of patients, suggesting that it may be a vulnerability marker of the disorder. The most intriguing questions however, relate to what underpins the reduced MMN to duration increments in schizophrenia and therefore, what it reveals about the nature of the auditory system deficit in this disorder. Three hypotheses are considered here: a pervasive problem in auditory sensory memory; a specific impairment in duration processing; or an abnormality within the window of temporal integration, coincident with the early phase of auditory sensory memory. Our data so far offer preliminary support for the third hypothesis only, although the possibility of a more broadly defined deficit in temporal processing restricted to brief or rapidly-presented auditory stimuli is canvassed.

Amplitude reduction of the mismatch negativity in first-degree relatives of patients with schizophrenia

First-degree relatives of schizophrenic patients display alterations in various cognitive domains and their electrophysiological counterparts similar to schizophrenic subjects. The mismatch negativity (MMN) is an event-related potential that reflects sensory memory in the pre-attentive stage of auditory processing. An amplitude reduction of the MMN has been reported in schizophrenia. The present study investigated the MMN in patients with schizophrenia, first-degree relatives and control subjects. The MMN amplitude was reduced in relatives compared to controls. The MMN amplitude reduction in schizophrenic patients compared to controls, however, did not reach significance in the present study. These results provide first evidence for disturbed sensory memory in relatives of patients with schizophrenia.

Auditory feature conjunction in patients with schizophrenia

The neural mechanisms supporting performance during single feature and feature conjunction tasks were investigated in patients with schizophrenia and age-matched controls using event-related brain potentials. In different blocks of trials, participants responded to auditory targets defined by one of two pitches, one of two locations, or both pitch and location. All participants were faster and more accurate in detecting targets defined by a single feature than for targets defined by a conjunction of features. Compared with the single feature conditions, conjunction targets were associated with enhanced negativity between 200 and 250ms (N2) post-stimulus and showed a delayed P3b latency. Compared with controls, patients with schizophrenia showed reduced N1 and N2 amplitude elicited by single and conjunctive targets. The results are consistent with defective perceptual mechanisms in schizophrenia. The fact that both performance and P3b amplitude were similar in patients and controls suggests that controlled processes compensate for processes normally carried out by early perceptual mechanisms.

Reduced event-related current density in the anterior cingulate cortex in schizophrenia

There is good evidence from neuroanatomic postmortem and functional imaging studies that dysfunction of the anterior cingulate cortex plays a prominent role in the pathophysiology of schizophrenia. So far, no electrophysiological localization study has been performed to investigate this deficit. We investigated 18 drug-free schizophrenic patients and 25 normal subjects with an auditory choice reaction task and measured event-related activity with 19 electrodes. Estimation of the current source density distribution in Talairach space was performed with low-resolution electromagnetic tomography (LORETA). In normals, we could differentiate between an early event-related potential peak of the N1 (90-100 ms) and a later N1 peak (120-130 ms). Subsequent current-density LORETA analysis in Talairach space showed increased activity in the auditory cortex area during the first N1 peak and increased activity in the anterior cingulate gyrus during the second N1 peak. No activation difference was observed in the auditory cortex between normals and patients with schizophrenia. However, schizophrenics showed significantly less anterior cingulate gyrus activation and slowed reaction times. Our results confirm previous findings of an electrical source in the anterior cingulate and an anterior cingulate dysfunction in schizophrenics. Our data also suggest that anterior cingulate function in schizophrenics is disturbed at a relatively early time point in the information-processing stream (100-140 ms poststimulus).

Psychophysiological correlates of social skills deficits in persons with schizophrenia

Social skill deficits in schizophrenia profoundly affect patients' life-long outcome, although the profile of the underlying cognitive dysfunction still remains a matter of debate. In the present study, we investigated the relationship between social skills and event-related potentials (ERPs) in an auditory selective attention task, in addition to the neurocognitive indices obtained from the degraded-stimulus continuous performance test (CPT) and clinical indices, such as Brief Psychiatric Rating Scale (BRPS) and global assessment of function (GAF) scores. Social skills were assessed using a Japanese version of the structured role play test. Fourteen persons with schizophrenia participated in the study. Non-verbal skills showed a positive correlation with GAF, the performance level, N1 and N2b amplitude in the ERP task, and hit rate in the CPT, and a negative correlation with reaction time in the CPT. Verbal communication skills showed a positive correlation with GAF, the performance level and N2b amplitude in the ERP task, and hit rate in the CPT, and a negative correlation with reaction time in the CPT. Processing skills showed a positive correlation with the performance level and N1 amplitude in the ERP task and a negative correlation with reaction time in the CPT. These findings suggested that the social skill deficits of persons with schizophrenia were related to the vigilance level and controlled stimulus detection processing.