Abnormalities of auditory event-related potentials in schizophrenia prior to treatment

Reduced duration mismatch negativity elicited by the multi-feature 'optimal' paradigm in early-phase psychosis

BACKGROUND

MMN and P3a are EEG-derived event related potentials that are thought to be prospective biomarkers for schizophrenia and, potentially, early-phase psychosis (EPP).

METHODS

EPP (n = 12) and healthy control (n = 35) participants listened to a multi-feature optimal paradigm with five deviant types (gap, duration, location, intensity, and frequency).

RESULTS

There was a significant amplitude difference between the EPP and HC group with duration MMN (p =.02). No significant amplitude differences between groups were found for the P3a waveform. There were several correlations for the EPP group with the BNSS, SOFAS, and PANSS-general questionnaires. Length of illness was not associated with MMN or P3a.

CONCLUSIONS

The optimal paradigm is suitable for eliciting multiple deviant types within a short amount of time in both clinical and healthy populations. This study confirms duration MMN deficits within an EPP group and that MMN is related to functional outcomes and positive and negative symptomology.

Altered Visuospatial Processing in Schizophrenia: An Event-related Potential Microstate Analysis Comparing Patients with and without Hallucinations with Healthy Controls

Patients with schizophrenia present with various symptoms related to different domains. Abnormalities of auditory and visual perception are parts of a more general problem. Nevertheless, the relationship between the lifetime history of auditory verbal hallucination (AVH), one of the most prevalent symptoms in schizophrenia, and visuospatial deficits remains unclear. This study aimed to investigate differences in hemispheric involvement and visuospatial processing between healthy controls (HCs) and schizophrenia patients with and without AVHs. HCs (N = 20), schizophrenia patients with AVH (AVH group, N = 16), and schizophrenia patients without hallucinations (NH group, N = 10) participated in a 4-choice reaction task with lateralized stimuli. An event-related potential (ERP)-microstate approach was used to analyze ERP differences between the conditions and groups. The schizophrenia patients without hallucinations had slower responses than the HCs. An early visual N1 contralateral to stimulation side was prominent in all groups of participants but with decreased amplitude in the patients with schizophrenia, especially in the AVH group over the right hemisphere. The amplitude of P3b, a cognitive evaluation component, was also decreased in schizophrenia. Compared to AVH and HC groups, the patients in the NH group had altered microstate patterns: P3b was replaced by a novelty component, P3a. Although the difference between both patient groups was only based on the presence of AVHs, our findings indicated that patients had specific visuospatial deficits associated with a lifetime history of hallucinations: patients with AVHs showed early visual component alterations in the right hemisphere, and those without AVHs had more prominent visuospatial impairment.

The effects of roflumilast, a phosphodiesterase type-4 inhibitor, on EEG biomarkers in schizophrenia: A randomised controlled trial

BACKGROUND

Patients with schizophrenia have significant cognitive deficits, which may profoundly impair quality of life. These deficits are also evident at the neurophysiological level with patients demonstrating altered event-related potential in several stages of cognitive processing compared to healthy controls; within the auditory domain, for example, there are replicated alterations in Mismatch Negativity, P300 and Auditory Steady State Response. However, there are no approved pharmacological treatments for cognitive deficits in schizophrenia.

AIMS

Here we examine whether the phosphodiesterase-4 inhibitor, roflumilast, can improve neurophysiological deficits in schizophrenia.

METHODS

Using a randomised, double-blind, placebo-controlled, crossover design study in 18 patients with schizophrenia, the effect of the phosphodiesterase-4 inhibitor, roflumilast (100 µg and 250 µg) on auditory steady state response (early stage), mismatch negativity and theta (intermediate stage) and P300 (late stage) was examined using electroencephalogram. A total of 18 subjects were randomised and included in the analysis.

RESULTS

Roflumilast 250 µg significantly enhanced the amplitude of both the mismatch negativity (p=0.04) and working memory-related theta oscillations (p=0.02) compared to placebo but not in the other (early- or late-stage) cognitive markers.

CONCLUSIONS

The results suggest that phosphodiesterase-4 inhibition, with roflumilast, can improve electroencephalogram cognitive markers, which are impaired in schizophrenia, and that phosphodiesterase-4 inhibition acts at an intermediate rather than early or late cognitive processing stage. This study also underlines the use of neurophysiological measures as cognitive biomarkers in experimental medicine.

EEG-Based Measures in At-Risk Mental State and Early Stages of Schizophrenia: A Systematic Review

Introduction: Electrophysiological (EEG) abnormalities in subjects with schizophrenia have been largely reported. In the last decades, research has shifted to the identification of electrophysiological alterations in the prodromal and early phases of the disorder, focusing on the prediction of clinical and functional outcome. The identification of neuronal aberrations in subjects with a first episode of psychosis (FEP) and in those at ultra high-risk (UHR) or clinical high-risk (CHR) to develop a psychosis is crucial to implement adequate interventions, reduce the rate of transition to psychosis, as well as the risk of irreversible functioning impairment. The aim of the review is to provide an up-to-date synthesis of the electrophysiological findings in the at-risk mental state and early stages of schizophrenia. Methods: A systematic review of English articles using Pubmed, Scopus, and PsychINFO was undertaken in July 2020. Additional studies were identified by hand-search. Electrophysiological studies that included at least one group of FEP or subjects at risk to develop psychosis, compared to healthy controls (HCs), were considered. The heterogeneity of the studies prevented a quantitative synthesis. Results: Out of 319 records screened, 133 studies were included in a final qualitative synthesis. Included studies were mainly carried out using frequency analysis, microstates and event-related potentials. The most common findings included an increase in delta and gamma power, an impairment in sensory gating assessed through P50 and N100 and a reduction of Mismatch Negativity and P300 amplitude in at-risk mental state and early stages of schizophrenia. Progressive changes in some of these electrophysiological measures were associated with transition to psychosis and disease course. Heterogeneous data have been reported for indices evaluating synchrony, connectivity, and evoked-responses in different frequency bands. Conclusions: Multiple EEG-indices were altered during at-risk mental state and early stages of schizophrenia, supporting the hypothesis that cerebral network dysfunctions appear already before the onset of the disorder. Some of these alterations demonstrated association with transition to psychosis or poor functional outcome. However, heterogeneity in subjects' inclusion criteria, clinical measures and electrophysiological methods prevents drawing solid conclusions. Large prospective studies are needed to consolidate findings concerning electrophysiological markers of clinical and functional outcome.

Deficit Effect Sizes and Correlations of Auditory Event-Related Potentials at First Hospitalization in the Schizophrenia Spectrum

The N1, P2, and P3 event-related potentials (ERPs) are impaired in first-episode schizophrenia (FESz). Reduced pitch-deviant mismatch negativity (MMN) is present in chronic schizophrenia but not FESz. We examined effect sizes of, and correlations between, N1, P2, P3, and MMN in 106 FESz and 114 matched psychiatrically well controls to determine which ERPs maximally differentiated groups, and whether late sensory/perceptual deficits (N1, P2) affected preattentive memory (MMN) and conscious attention (P3). Furthermore, we compared hallucinators and nonhallucinators within FESz. Participants completed 1 of 3 oddball tasks, silently counting target tones among standard tones. Sixty-seven FESz and 72 matched participants also completed pitch-deviant MMN testing. Measures were z-scored from task appropriate controls before merging samples. Mean z-scores for N1, P2, and P3 were significantly abnormal in FESz, while pitch-deviant MMN was not. N1 showed the largest deficit (z = 0.53), and only N1 was smaller in hallucinators (n = 71) than nonhallucinators (n = 27). Among all participants, early sensory processing (N1, P2) correlated with later cognitive processing (P3), and P2 and P3 also correlated with automatic preattentive memory (pitch-deviant MMN). In well individuals, N1 was associated with MMN. These data are consistent with bottom-up sensory/perceptual processes affecting more cognitive processes. However, N1 and MMN were not associated in FESz, suggesting different auditory cortex physiology underlie these ERPs, which is differentially affected in FESz. Larger P2 and P3 with greater estimated premorbid intellect in patients indicate a possible neuroprotective effect of intellect in FESz.

[Neurophysiological characteristics of juvenile schizophrenia patients examined at the very remote follow up stage]

OBJECTIVE

To determine neurophysiological characteristics of patients with long-term follow up (>20 years) and to find correlations between neurophysiological parameters and clinical features of schizophrenia.

MATERIAL AND METHODS

The patients were divided into three groups: with predomination of personality changes (group 1, n=17), with negative disorders (group 2, n=23) and with positive and negative disorders (group 3, n=40). A psychopathological method and electroencephalography with evoked potentials testing were used.

RESULTS AND CONCLUSION

In group 3, the statistically significant higher frequencies of theta-rhythm and lower of alpha-rhythm were found. Also, theta frequency correlated with PANSS positive scores. The significant intergroup differences by auditory oddball P300 were lacked. The findings are discussed in view of the hypothesis of theta-rhythm as a marker of hippocampal-prefrontal connectivity.

Staging model in psychiatry: Review of the evolution of electroencephalography abnormalities in major psychiatric disorders

AIM

Clinical staging in psychiatry aims to classify patients according to the severity of their symptoms, from stage 0 (increased risk, asymptomatic) to stage 4 (severe illness), enabling adapted treatment at each stage of the illness. The staging model would gain specificity if one or more quantifiable biological markers could be identified. Several biomarkers reflecting possible causal mechanisms and/or consequences of the pathophysiology are candidates for integration into the clinical staging model of psychiatric illnesses.

METHODS

This review covers the evolution (from stage 0 to stage 4) of the most important brain functioning impairments as measured with electroencephalography (EEG), in psychosis spectrum and in severe mood disorders.

RESULTS

The present review of the literature demonstrates that it is currently not possible to draw any conclusion with regard to the state or trait character of any of the EEG impairments in both major depressive disorder and bipolar disorder. As for schizophrenia, the most promising markers of the stage of the illness are the pitch mismatch negativity as well as the p300 event-related potentials, as these components seem to deteriorate with increasing severity of the illness.

CONCLUSIONS

Given the complexity of major psychiatric disorders, and that not a single impairment can be observed in all patients, future research should most likely consider combinations of markers in the quest for a better identification of the stages of the psychiatric illnesses.

Sex differences in event-related potential (ERP) waveforms of primary psychotic disorders: A systematic review

Research aimed at understanding primary psychotic disorders such as schizophrenia, schizophreniform disorder, and schizoaffective disorder, with electrophysiological methods has flourished over recent years. However, a significant component that is often overlooked or underreported in electrophysiological research of psychosis is the factor of biological sex. Thus, the goal of this systematic review was to summarize the current understanding of EEG sex differences in primary psychotic disorders. Our study found a consistent sex difference relating to the P300 component (male amplitude < females), and that research examining sex differences of ERP waveforms, other than the P300, is very limited with ambiguous findings. This review also addressed the lack of consideration of sex as an influencing factor in electrophysiological research.

A longitudinal study of event related potentials and correlations with psychosocial functioning and clinical features in first episode psychosis patients

BACKGROUND

Deficits in auditory event-related potentials (ERPs), brain responses to stimuli indexing different cognitive processes, have been demonstrated widely in chronic schizophrenia (SZ) patients though much less is known about these responses across the early course of psychosis. The present study examined multiple ERP components in first episode psychosis (FEP) patients longitudinally and investigated the relationships between ERPs, psychosocial functioning, and clinical features over time.

METHODS

N1, P2, P3a, and P3b ERPs were elicited using a three-stimulus (novelty) auditory oddball paradigm. FEP patients included SZ-spectrum and psychotic bipolar disorder (BD) diagnoses. Data were collected from 41 patients at baseline, 20 patients at 12-month follow-up, 14 at 24-month follow-up, and 29 healthy control subjects.

RESULTS

N1 and P2 ERPs were intact across the early stages of psychosis. Baseline P2 was significantly larger in BD than SZ patients. Reduced P3a and P3b ERPs were found in patients followed longitudinally and are stable over time. ERPs tracked distinct aspects of symptomology and medication, though specific associations were inconsistent across time. Baseline P3a amplitude predicted later psychosocial functioning. The pattern of correlations between ERP components in patients differed from controls.

DISCUSSION

Baseline P3a ERP, and PANSS general score were significant and independent predictors of later MCAS functioning at 12-month. Overall, individuals with worse functioning and greater symptomology produced smaller amplitudes. Our results highlight the heterogeneity within the FEP population. Correlation patterns among ERPs are similar between patients and controls. P3a and P3b amplitudes appear to link with higher-order cognitive and psychosocial functioning.

Mismatch Negativity But Not P300 Is Associated With Functional Disability in Schizophrenia

Mismatch negativity (MMN) and P300 event-related potential (ERP) reductions in schizophrenia (SZ) reflect preattentive and attention-mediated auditory processing deficits, respectively. Although both have been linked to cognitive deficits in SZ, their relative contributions to real-world functioning are unclear. We sought to determine the functional significance of disrupted auditory processing in SZ by examining MMN and P300 in typically disabled low-functioning patients and in patients with high levels of independent role functioning. MMN to auditory deviants and P300 to infrequent auditory target and nontarget novel stimuli were assessed in 20 high-functioning SZ patients (HF-SZ), 17 low-functioning patients (LF-SZ), and 35 healthy comparison (HC) subjects. There was a group effect on MMN and P300 amplitudes across stimulus types. MMN was significantly diminished in LF-SZ compared to HF-SZ and HC, and HF-SZ demonstrated comparable MMN to HC. In contrast, P300 was significantly reduced in both LF-SZ and HF-SZ compared to HC. Logistic regression suggested independent sensitivity of MMN to functioning in SZ over and above P300 measures. Neither MMN nor P300 were associated with positive or negative symptom severity. Results replicate MMN and P300 abnormalities in SZ, and also suggest that the neural mechanisms associated with the preattentive detection of auditory deviance are most compromised in patients with functional disability. MMN may index pathophysiological processes that are critical for optimal functioning in SZ.

Neurobiology of early psychosis

Background

Neurobiological studies of the early course of psychoses, such as schizophrenia, allow investigation of pathophysiology without the confounds of illness chronicity and treatment.

Aims

To review the recent literature on the biology of the early course of psychoses.

Method

We carried out a critical appraisal of the recent findings in the neurobiology of early psychoses, using structural, functional and neurochemical imaging techniques.

Results

Brain structural alterations are present early in the illness and may predate symptom onset. Some changes, notably those in frontal and temporal lobes, can progress during the early phases of the illness. Functional and neurochemical brain abnormalities can also be seen in the premorbid and the early phases of the illness. Some, although not all, changes can be trait-like whereas some others might progress during the early years.

Conclusions

A better understanding of such changes, especially during the critical periods of the prodrome, around the transition to the psychotic phase and during the early phases of the illness is crucial for continued research into preventive intervention strategies.

Impact of Reward and Loss Anticipation on Cognitive Control: An Event-Related Potential Study in Subjects With Schizophrenia and Healthy Controls

INTRODUCTION

Deficits of cognitive functions and motivation are core aspects of schizophrenia. The interaction of these deficits might contribute to impair the ability to flexibly adjust behavior in accordance with one's intentions and goals. Many studies have focused on the anterior N2 as a correlate of cognitive control based on motivational value.

AIMS

Given the key role of motivation impairment in schizophrenia as a predictor of functional outcome, we aimed to study the impact of reward- and avoidance-based motivation on cognitive control using N2.

METHOD

Event-related potentials were recorded during the execution of the "Monetary Incentive Delay (MID)" task in 34 patients with schizophrenia (SCZ) stabilized on second-generation antipsychotics and 22 healthy controls (HC). Cognitive domains were assessed using the MATRICS Consensus Cognitive Battery. Negative symptom domains (Avolition/apathy and Expressive deficit), as well as positive and disorganization dimensions were also assessed in SCZ.

RESULTS

We did not observe any group difference in N2 amplitude or latency. In HC, N2 amplitude was significantly larger for anticipation of large loss with regard to all reward conditions and for all incentive versus neutral conditions. In SCZ, N2 amplitude did not discriminate between large loss and reward or between incentive and neutral conditions. N2 amplitude was not correlated with psychopathological dimensions or MCCB-assessed cognitive deficits in SCZ.

CONCLUSION

Our data in HC are in line with the hypothesis that N2 amplitude reflects the impact of motivational salience on cognitive control. Our results in SCZ indicate a deficit in the discrimination of motivational salience to the service of cognitive control, independently of psychopathology and other cognitive deficits.

Lack of progressive reduction in P3 amplitude after the first-episode of schizophrenia: A 6-year follow-up study

P3 event-related potential may track the course of neurophysiological pathology in schizophrenia. Reduction in the amplitude of the auditory P3 is a widely replicated finding, already present at the first psychotic episode, in schizophrenia. Whether a progressive deficit is present in auditory P3 in schizophrenia over the course of illness is yet to be clarified. Previous longitudinal studies did not report any change in P3 over time in schizophrenia. However, these studies have been inconclusive, because of their relatively short follow-up periods, lack of follow-up data on controls, and assessment of patients already at the chronic stages of schizophrenia. Auditory P3 potentials, elicited by an oddball paradigm, were assessed in 14 patients with first-episode schizophrenia and 22 healthy controls at baseline and at the 6-year follow-up. P3 amplitudes were smaller in patients with first-episode schizophrenia than in controls. Importantly, over the 6-year interval, the P3 amplitudes were reduced in controls, but they did not change in patients. The lack of P3 reduction over time in patients with schizophrenia might be explained by the maximal reduction in P3 already at baseline or by the alleviation of P3 reduction over time.

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.

P300 waveform and dopamine transporter availability: a controlled EEG and SPECT study in medication-naive patients with schizophrenia and a meta-analysis

BACKGROUND

Reduced P300 event-related potential (ERP) amplitude and latency prolongation have been reported in patients with schizophrenia compared to healthy controls. However, the influence of antipsychotics (and dopamine) on ERP measures are poorly understood and medication confounding remains a possibility.

METHOD

We explored ERP differences between 36 drug-naive patients with schizophrenia and 138 healthy controls and examined whether P300 performance was related to dopamine transporter (DAT) availability, both without the confounding effects of medication. We also conducted a random effects meta-analysis of the available literature, synthesizing the results of three comparable published articles and our local study.

RESULTS

No overall significant difference was found in mean P300 ERP between patients and controls in latency or in amplitude. There was a significant gender effect, with females showing greater P300 amplitude than males. A difference between patients and controls in P300 latency was evident with ageing, with latency increasing faster in patients. No effect of DAT availability on P300 latency or amplitude was detected. The meta-analysis computed the latency pooled standardized effect size (PSES; Cohen's d) of -0.13 and the amplitude PSES (Cohen's d) of 0.48, with patients showing a significant reduction in amplitude.

CONCLUSIONS

Our findings suggest the P300 ERP is not altered in the early stages of schizophrenia before medication is introduced, and the DAT availability does not influence the P300 ERP amplitude or latency. P300 ERP amplitude reduction could be an indicator of the progression of illness and chronicity.

P300 aberration in first-episode schizophrenia patients: a meta-analysis

BACKGROUND

Decreased P300 amplitude is one of the most consistent findings in patients with schizophrenia. However, whether prolonged P300 latency occurs in patients with schizophrenia, especially first-episode schizophrenia (FES) patients, remains controversial.

METHODS

A meta-analyses of P300 aberration in FES patients and healthy control(HC) group was conducted. The meta-regression analysis was performed using a random effects model. The pooled standardized effect size (PSES) was calculated as the division of the difference between the means of the two groups by the common standard deviation.

RESULTS

A total of 569 FES patients and 747 HCs were included in this meta-analysis. P300 amplitude was significantly reduced (PSES = -0.83, 95% CI: -1.02-0.65, P = 0.00001) and P300 latency was delayed significantly in FES patients (PSES = -0.48, 95% CI: 0.14-0.81, P = 0.005). The meta-regression analysis showed that task difficulty was a source of heterogeneity.

CONCLUSIONS

The meta-analysis confirms that disrupted information processing is found in FES patients, which is manifested by smaller P300 amplitude and delayed P300 latency.

Auditory event-related potentials and α oscillations in the psychosis prodrome: neuronal generator patterns during a novelty oddball task

Prior research suggests that event-related potentials (ERP) obtained during active and passive auditory paradigms, which have demonstrated abnormal neurocognitive function in schizophrenia, may provide helpful tools in predicting transition to psychosis. In addition to ERP measures, reduced modulations of EEG alpha, reflecting top-down control required to inhibit irrelevant information, have revealed attentional deficits in schizophrenia and its prodromal stage. Employing a three-stimulus novelty oddball task, nose-referenced 48-channel ERPs were recorded from 22 clinical high-risk (CHR) patients and 20 healthy controls detecting target tones (12% probability, 500Hz; button press) among nontargets (76%, 350Hz) and novel sounds (12%). After current source density (CSD) transformation of EEG epochs (-200 to 1000ms), event-related spectral perturbations were obtained for each site up to 30Hz and 800ms after stimulus onset, and simplified by unrestricted time-frequency (TF) principal components analysis (PCA). Alpha event-related desynchronization (ERD) as measured by TF factor 610-9 (spectral peak latency at 610ms and 9Hz; 31.9% variance) was prominent over right posterior regions for targets, and markedly reduced in CHR patients compared to controls, particularly in three patients who later developed psychosis. In contrast, low-frequency event-related synchronization (ERS) distinctly linked to novels (260-1; 16.0%; mid-frontal) and N1 sink across conditions (130-1; 3.4%; centro-temporoparietal) did not differ between groups. Analogous time-domain CSD-ERP measures (temporal PCA), consisting of N1 sink, novelty mismatch negativity (MMN), novelty vertex source, novelty P3, P3b, and frontal response negativity, were robust and closely comparable between groups. Novelty MMN at FCz was, however, absent in the three converters. In agreement with prior findings, alpha ERD and MMN may hold particular promise for predicting transition to psychosis among CHR patients.

Functional abnormalities in the cortical processing of sound complexity and musical consonance in schizophrenia: evidence from an evoked potential study

BACKGROUND

Previous studies have demonstrated functional and structural temporal lobe abnormalities located close to the auditory cortical regions in schizophrenia. The goal of this study was to determine whether functional abnormalities exist in the cortical processing of musical sound in schizophrenia.

METHODS

Twelve schizophrenic patients and twelve age- and sex-matched healthy controls were recruited, and participants listened to a random sequence of two kinds of sonic entities, intervals (tritones and perfect fifths) and chords (atonal chords, diminished chords, and major triads), of varying degrees of complexity and consonance. The perception of musical sound was investigated by the auditory evoked potentials technique.

RESULTS

Our results showed that schizophrenic patients exhibited significant reductions in the amplitudes of the N1 and P2 components elicited by musical stimuli, to which consonant sounds contributed more significantly than dissonant sounds. Schizophrenic patients could not perceive the dissimilarity between interval and chord stimuli based on the evoked potentials responses as compared with the healthy controls.

CONCLUSION

This study provided electrophysiological evidence of functional abnormalities in the cortical processing of sound complexity and music consonance in schizophrenia. The preliminary findings warrant further investigations for the underlying mechanisms.

Neural activations during auditory oddball processing discriminating schizophrenia and psychotic bipolar disorder

BACKGROUND

Reduced amplitude of the P300 event-related potential in auditory oddball tasks may characterize schizophrenia (SZ) but is also reported in bipolar disorder. Similarity of auditory processing abnormalities between these diagnoses is uncertain, given the frequent combination of both psychotic and nonpsychotic patients in bipolar samples; abnormalities may be restricted to psychosis. In addition, typically only latency and amplitude of brain responses at selected sensors and singular time points are used to characterize neural responses. Comprehensive quantification of brain activations involving both spatiotemporal and time-frequency analyses could better identify unique auditory oddball responses among patients with different psychotic disorders.

METHODS

Sixty SZ, 60 bipolar I with psychosis (BPP), and 60 healthy subjects (H) were compared on neural responses during an auditory oddball task using multisensor electroencephalography. Principal components analysis was used to reduce multisensor data before evaluating group differences on voltage and frequency of neural responses over time.

RESULTS

Linear discriminant analysis revealed five variables that best differentiated groups: 1) late beta activity to standard stimuli; 2) late beta/gamma activity to targets discriminated BPP from other groups; 3) midlatency theta/alpha activity to standards; 4) target-related voltage at the late N2 response discriminated both psychosis groups from H; and 5) target-related voltage during early N2 discriminated BPP from H.

CONCLUSIONS

Although the P300 significantly differentiated psychotic groups from H, it did not uniquely discriminate groups beyond the above variables. No variable uniquely discriminated SZ, perhaps indicating utility of this task for studying psychosis-associated neurophysiology generally and BPP specifically.

Delayed preattentional functioning in early psychosis patients with cannabis use

RATIONALE

Cannabis use is prevalent among the early psychosis (EP) population. The event-related potentials, mismatch negativity (MMN) and P3a are reduced in EP. Cannabinoids have been shown to modulate N-methyl-D-aspartate receptors which are involved in MMN generation.

OBJECTIVES

This study is the first to investigate the effects of cannabis use on MMN/P3a in EP.

METHODS

EP was defined as a history of psychosis or psychotic symptoms with no progression to date to chronic schizophrenia. Twenty-two EP patients with cannabis use (EP + CANN), 22 non-cannabis-using EP patients (EP-CANN) and 21 healthy controls participated in this study. MMN/P3a was elicited using a two-tone, auditory paradigm with 8% duration deviants.

RESULTS

As expected, EP-CANN showed marked reductions in MMN/P3a amplitudes compared to controls. However, EP + CANN showed evidence of a different pattern of neurophysiological expression of MMN/P3a compared to non-using patients, most notably in terms of delayed frontal MMN/P3a latencies.

CONCLUSIONS

This study provides further evidence that MMN/P3a deficits are present during early psychosis and suggests that this biomarker may have utility in differentiating substance- from non-substance-related psychoses.

Auditory ERP components before and after transition to a first psychotic episode

We investigated the course of Event Related Potentials (ERP) from prior to until shortly after a first psychotic episode in subjects at Ultra High Risk (UHR) for psychosis. N1, N2, N2b, P2 and P3 amplitudes were assessed using an auditory active oddball paradigm in 15 UHR subjects who made a transition to psychosis (UHR+T) at follow up, 23 subjects without a transition (UHR+NT) and 17 matched healthy controls at inclusion and again after approximately 18 months. Repeated-measures analyses revealed no significant time effects for any of the ERP components. However, an interaction effect was found for N1 amplitudes. Post-hoc analyses showed that N1 amplitudes were smaller at follow up compared to baseline only in UHR+T subjects. P3 amplitudes showed no further reduction after psychotic onset. These findings suggest that discernable ERP components behave differently during progression from the prodromal phase to the first psychotic episode. These findings may give insight in pathophysiological mechanisms underlying the genesis of psychosis.

Reduced NGF serum levels and abnormal P300 event-related potential in first episode schizophrenia

Nerve growth factor (NGF) plays a crucial role in central nervous system neuron plasticity. Low levels of serum NGF in schizophrenic patients suggest that the neurotrophin contributes to the pathogenesis of the disease. NGF is also thought to alter characteristics of event-related brain potential (ERP) components. The auditory-evoked P300 ERP component, considered an index of brain activity, has reduced amplitude in acute and chronic schizophrenia. This study evaluated the relationship among serum NGF levels, P300 characteristics, and Positive and Negative Symptom Scale (PANSS) scores in first episode, neuroleptic naive schizophrenic patients (N=30) and healthy controls (N=28). Serum NGF was measured by ELISA and P300 elicited using auditory oddball paradigm. Compared to control subjects, schizophrenic patients had significantly reduced serum NGF (p<0.001) and lower P300 amplitudes at Fz (p=0.003). Additionally, there was a positive correlation between serum NGF serum and P300 amplitude at Fz. No correlation was found between serum NGF or P300 characteristics and PANSS scores. These results suggest that the effects of NGF in schizophrenia are related not only to regulation of neurodevelopment, but also to the electrophysiological characteristics of nerve growth factor.

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.

Evidence-based medicine and electrophysiology in schizophrenia

In research on schizophrenia electrophysiological measures have been investigated to identify biomarkers of the disorder, indices enabling differential diagnosis among psychotic disorders, prognostic indicators or endophenotypes. The present systematic review will focus on the most largely studied electrophysiological indices, i.e., qualitative or quantitative (limited to spectral analysis) EEG and the P300 event-related potential. The PubMed clinical query was used with research methodology filters for each of the following categories: diagnosis/prognosis/ aetiology and a broad sensitive search strategy. The key-words: SCHIZOPHRENIA AND EEG/P3/P300 were used. The search results were then narrowed by including the terms "human" and "English language", and cross-referenced. Systematic reviews and meta-analyses, when available, were also used for cross-referencing. Case reports and studies irrelevant to the topics and methodologies under examination were excluded. The remaining papers were screened to verify the eligibility for this systematic review. Inclusion criteria were: a) a diagnosis of schizophrenia confirmed by DSM-III/ICD-9 criteria (or later editions of the same classification systems); b) the inclusion of both a schizophrenia study group and an healthy control group (when appropriate, i.e., for P300 and quantitative EEG); c) qualitative or spectral EEG findings and amplitude measures for P300. The included studies were then reviewed to verify homogeneity of the results, as well as the presence of the information needed for the present systematic review and meta-analysis. Previous reviews and studies meeting the above requirements (n = 22 for qualitative EEG; n = 45 for spectral EEG and n = 132 for P300) were classified according to the Oxford Centre for Evidence-based Medicine (EBM) levels of evidence criteria. For qualitative EEG as a diagnostic test, the majority of studies predated the introduction of DSM-III and were excluded from the review. Few post DSM-III studies investigated the usefulness of qualitative EEG in the differential diagnosis between schizophrenia and psychosis due to general medical condition. None of them was Oxford CEBM level 3b (non-consecutive-study or cohort-study without consistently-applied reference standard) or better (exploratory or validating cohort-study). No meta-analysis could be conducted due to the lack of reliable quantification methods in the reviewed studies. For spectral EEG as a diagnostic test, most studies qualified as level 4 (case-control study with poor reference standard), and only 24% as level 3b or better. An increase of slow activity in patients is reported by most of these studies. As to meta-analyses examining 29 studies, with 32 independent samples for the delta band and 35 for the theta band, a moderate effect size was found and only 1 study yielded findings in the opposite direction for both measures. There was no identified source for the discrepancy. The analysis of moderator factors included medication, band frequency limits, spectral parameters and disease stage. The medication status was significant for the theta band but the effect was unclear as findings for drug-naïve and drug-free patients were in a different direction. Chronicity had a significant effect on both delta and theta bands, with slow activity increase larger in chronic than in first episode patients. For P3 amplitude reduction as a diagnostic index, 63% of the studies qualified as level 3b or better. Meta-analysis (52 studies, 60 independent samples) results demonstrated a large effect size. None of the studies reported opposite findings. The analysis of moderator factors, including medication status and disease stage, revealed no significant effect on data heterogeneity. In conclusion, the examined indices are good candidates but are not ready yet for clinical applications aimed to improve present diagnostic standards for schizophrenia. Further research carried out according to adequate methodological standards and based on large scale multi-center studies is mandatory.

P300 deficits are present in young first-episode patients with schizophrenia and not in their healthy young siblings

OBJECTIVE

To evaluated P300 (P3b) abnormalities in young first episode patients with schizophrenia and their healthy young siblings.

METHODS

An auditory oddball paradigm was used to assess P300 in 53 patients, 27 unaffected siblings and 28 healthy controls. Amplitude and latency of the three midline sites (Fz, Cz, and Pz) were compared between patients, siblings, and controls by a mixed-effects regression model.

RESULTS

P300 amplitude was significantly reduced in patients with schizophrenia but not in healthy siblings, when compared to healthy controls. P300 latency did not significantly differ between the three groups.

CONCLUSIONS

P300 amplitude but not latency was found to be affected in young patients with recent onset schizophrenia. However, P300 amplitude and latency were found not to be affected in healthy unaffected young siblings and, therefore, did not qualify as an endophenotype for schizophrenia.

SIGNIFICANCE

The failure to find the P300 (P3b) abnormality in healthy siblings of patients with schizophrenia is an important finding and should be added to P300 literature.

Increased absolute magnitude of gamma synchrony in first-episode psychosis

OBJECTIVES

Recent studies have explored a model of the disconnection hypothesis of schizophrenia through the demonstration of abnormal stimulus induced gamma phase synchrony (GPS). These studies have principally examined synchrony in the 40 Hz band elicited in post-stimulus time periods, relative to a pre-stimulus baseline. In this study we examined the absolute magnitude of GPS elicited by a selective attention task, in first-episode psychosis (FEP). We hypothesized that FEP would be associated with abnormalities in absolute GPS, particularly when required to selectively attend to task-relevant stimuli.

METHODS

Fifty-five first-episode psychosis (FEP) subjects and one hundred and ten matched healthy control subjects underwent an auditory oddball selective attention task during EEG recording. The absolute magnitude of GPS was extracted for the range 35-45 Hz, and time-locked to stimulus onset. GPS averaged were computed for oddball 'target' (task-relevant) and 'non-target' (task-irrelevant) stimuli, for each subject.

RESULTS

FEP subjects showed a significant elevation in absolute GPS relative to controls, apparent across the 35-45 Hz range. This elevation was most marked in the left centro-temporal region, across the 800 ms post-stimulus period. In FEP subjects, the elevation in GPS was also greater for target compared to non-target stimuli, while healthy controls did not show a stimulus effect.

CONCLUSION

These findings complement previous evidence for reductions in peak gamma synchrony, calculated relative to a pre-stimulus baseline, in schizophrenia. The results an excess of absolute GPS in schizophrenia may contribute to an inability to effectively integrate task-relevant information, which underlie psychotic symptoms.

Neurophysiological biomarkers for drug development in schizophrenia

Schizophrenia represents a pervasive deficit in brain function, leading to hallucinations and delusions, social withdrawal and a decline in cognitive performance. As the underlying genetic and neuronal abnormalities in schizophrenia are largely unknown, it is challenging to measure the severity of its symptoms objectively, or to design and evaluate psychotherapeutic interventions. Recent advances in neurophysiological techniques provide new opportunities to measure abnormal brain functions in patients with schizophrenia and to compare these with drug-induced alterations. Moreover, many of these neurophysiological processes are phylogenetically conserved and can be modelled in preclinical studies, offering unique opportunities for use as translational biomarkers in schizophrenia drug discovery.

P300 asymmetry and positive symptom severity: a study in the early stage of a first episode of psychosis

The amplitude of the P300 event-related potential (ERP) has been reported to be reduced over left compared to right temporal sites in schizophrenia patients. This left temporal P300 reduction has been associated with positive symptom severity and gray matter reduction in the left superior temporal gyrus. We investigated a group of patients with a first episode of schizophrenia spectrum psychosis and a group of normal controls to verify if P300 amplitude asymmetry already exists around the time of presentation for treatment. Relative to normal control subjects, no P300 asymmetry was found in patients. Nevertheless, P300 asymmetry was correlated with the severity of positive symptoms and worse global functioning (GAF), a good predictor of poor outcome.

Novelty P3 and P3b in first-episode schizophrenia and chronic schizophrenia

The objective of this study was to evaluate P3b and novelty P3 responses in patients with first-episode schizophrenia (FES) and chronic schizophrenia (CS). P3b is consistently reported to be reduced in CS. However, novelty P3 results in CS are controversial. Novelty P3 is not studied, and there are only a few P3b studies in patients with FES. Subject groups comprised 31 patients with FES and 36 younger control subjects, and 26 patients with CS and 35 older control subjects. Automatically elicited auditory novelty P3 and effortfully elicited auditory P3b potentials were assessed. P3b amplitudes were reduced in both patients with FES and CS relative to their controls. CS and FES patients did not differ in P3b amplitude. Novelty P3 amplitude was reduced in patients with CS. Novelty P3 amplitude in patients with FES did not differ from their controls. P3b amplitude reduction may be a trait marker of schizophrenia and may not progress over the course of illness, although this can only be definitively determined by longitudinal studies. Novelty P3 amplitude reduction present in patients with CS, is not found at the onset of illness. Novelty P3 seems unaffected early in the disease process.

Abnormalities of auditory event-related potentials in students with high scores on the Schizotypal Personality Questionnaire

Some auditory event-related potential (ERP) abnormalities characterize both patients with schizophrenia and subjects with schizotypal personality disorder. It was therefore hypothesized that subjects from the community with schizotypal traits might also present ERP abnormalities. In this study, we compared auditory ERP latencies and amplitudes in 13 subjects with high (H-SPQ) and 12 subjects with low (L-SPQ) scores on the Schizotypal Personality Questionnaire (SPQ), selected from 198 Tunisian students. Auditory ERPs were recorded at Fz, Cz, and Pz, with a standard oddball paradigm. Smaller P300 amplitudes and delayed P300 latencies were found in H-SPQ compared with L-SPQ participants. Confirming previous reports, our results suggest that reduced P300 amplitudes and delayed P300 latencies may be considered as vulnerability markers of the schizophrenia spectrum in nonclinical subjects from the community.

Electrophysiological indices of automatic and controlled auditory information processing in first-episode, recent-onset and chronic schizophrenia

BACKGROUND

Deficits in amplitudes of auditory event-related potentials (ERP) indexing preattentive, automatic (mismatch negativity, MMN) and controlled, attention-dependent (N2, P3) auditory information processing have been well described in chronic schizophrenia. Normal MMN, but deficient N2 and P3 have been reported in first-episode patients. No study has investigated these ERPs concurrently in first-episode patients; thus, reported differences in MMN, N2 and P3 generation may reflect differences in patient samples rather than genuine differences in abnormal generation of these ERPs.

METHODS

We recorded MMN, N2 and P3 in 26 first-episode patients, 25 recent-onset patients within 1.5 to 5 years after first admission, 25 chronic patients and 39 healthy controls.

RESULTS

Recent-onset and chronic, but not first-episode patients showed reduced MMN. However, among first-episode patients those with low premorbid educational achievement demonstrated significantly reduced MMN. All patient groups showed pronounced N2 deficits and, to a variable extent, abnormalities in P3 generation.

CONCLUSIONS

Abnormalities in N2 and P3 generation appear to reflect premorbid neuropathology, whereas MMN deficits may index both ongoing disease processes associated with illness progression as well as premorbid neurocognitive impairment. ERPs may provide tools to assess static and progressive neuropathology in schizophrenia. These findings need confirmation in longitudinal studies.

Clozapine improves working memory updating in schizophrenia

This study investigated the effect of clozapine on working memory in 15 subjects with schizophrenia, using an event related potential paradigm designed to separate components reflecting working memory updating from components related to target detection and response. Compared to matched controls and prior to treatment with clozapine, subjects with schizophrenia had N1, P3 and Late Slow Wave abnormalities indicating impairment in early stimulus evaluation and subsequent working memory functions. Treatment with clozapine was associated with normalization of the P3 and Late Slow Waves, indicating improvement in working memory updating and executive processing. There was also a partial normalization of N1 amplitude, suggesting improvement in early stimulus evaluation.

Event-related potentials elicited by distractors in an auditory oddball paradigm in schizophrenia

Patients with schizophrenia are affected more adversely than healthy controls by distracting conditions, due to their inability to adequately apportion attentional resources to targets or distractors. We attempted to re-evaluate the effects of distractors in 25 patients with chronic schizophrenia and in 12 controls. They performed an auditory target-detection task with 1500 Hz tone distractors and an additional control condition where a 1500-Hz tone was used as the target. The rate of target misses for patients with schizophrenia was 3.79% in non-distractor conditions and 14.79% in distractor conditions. Significantly reduced N100 responses to distractors and distractor condition targets were found. P300 responses to all target stimulus categories were reduced, but P300 responses to distractors were equal to those in the control group. There was a reduction of P300 amplitudes to distractors in both groups; however, only the control group showed significant enlargement of P300 amplitude when the distractors became the target stimuli. There is evidence that patients with schizophrenia tend to be less able to allocate their attentional resources adequately to target vs. distractor stimuli. When the distractors became the target stimuli, their responses remained unchanged, which suggests their inability to appropriately integrate stimulus information with contextual information.

Dorsolateral prefrontal cortex contribution to abnormalities of the P300 component of the event-related potential in schizophrenia

Abnormalities of the P300 component of the event-related potential are a common finding in schizophrenia. It seems possible that the dysfunction in the dorsolateral prefrontal (DLPF) region that has been reported in schizophrenia contributes to this finding. To explore this possibility, we calculated the relationship between, on the one hand, P300 latency and amplitude and, on the other hand, the degree of DLPF atrophy (as measured by magnetic resonance imaging) and metabolic activity during an attentional task (as measured by positron emission tomography). Seventeen schizophrenia patients with a brief duration of illness and minimal exposition to treatment and 25 healthy controls were studied. Patients exhibited significantly lower metabolic activity in the DLPF region, but they did not show cortical atrophy. P300 amplitude was also significantly reduced in the schizophrenia patients compared with the controls. Right DLPF region metabolic activity correlated significantly with P300 amplitude. This pattern remained after partialling out the influence of activity in the hippocampus, superior temporal gyrus and parietal lobe. It is therefore suggested that the prefrontal cortex could be implicated in the P300 amplitude reduction in schizophrenia.

The Wisconsin Card Sort Test and P300 responses to novel auditory stimuli in schizophrenic patients

The authors studied the relationship between performance on the Wisconsin Card Sort Test (WCST) and P300 activity in schizophrenics and normal controls. Fourteen male predominantly medicated schizophrenics and matched non-ill controls were administered the WCST and tests of temporal lobe (delayed verbal and spatial memory) and general intellectual functioning (Shipley). Patients were rated with negative and positive symptom scales extracted from the Brief Psychiatric Rating Scale. Subjects performed a tone discrimination task requiring identification of rare targets in both a standard oddball paradigm and a three-stimulus paradigm that included rare novel sounds. Reference independent data from 16 scalp electrodes yielded Global Field Power (GFP), from which P300 latency was determined. P300 amplitude measures included amplitude at this identified latency as well as amplitude integrated over a 100 ms time window centered over it. These amplitude measures were examined at six selected electrode locations. Schizophrenics produced smaller P300 responses that tended to be slower, but there were no group differences in the relationships between neuropsychological performance and P300 responses. Across diagnostic groups percent perseverative errors predicted lower integrated and peak P300 amplitude during the novel but not the standard oddball paradigm. The effect on integrated P300 amplitude was localized to anterior leads after novel stimuli. Negative symptoms predicted lower WCST performance, lower integrated P300 amplitude, and smaller GFP after novel stimuli. Positive symptoms predicted reduced overall GFP and specific but inconsistent reductions in parietal P300 amplitude. The results suggest relationships between dorsolateral prefrontal competence, P300 activity in response to stimulus novelty, and negative symptoms in schizophrenic patients, paralleling findings obtained from blood flow and other measures of brain activity.

Influence of duration of untreated psychosis on auditory P300 in drug-naive and first-episode schizophrenia

P300 amplitude reduction in schizophrenia is, according to previous studies, partially recovered by treatment with neuroleptics. However, whether this medication-induced P300 recovery is associated with duration of untreated psychosis (DUP) remains unreported; the present study is a preliminary examination of this question. Auditory P300 was recorded from 18 drug-naive and first-episode schizophrenia patients, among whom 10 were identified as short DUP, and eight as long DUP. Follow-up event-related potential tests were carried out after treatment with haloperidol or bromperidol for approximately 2 months. Recovery of P300 amplitude was replicated after neuroleptic medication was administered. A significant interaction was found between DUP and the medication effect in P300 amplitude over the left temporo-parietal area; a significant P300 recovery was seen in short DUP but not in long DUP. These results suggest that first-episode schizophrenia patients with long DUP might have severe impairments in the left temporal structures, supporting DUP as a key variable in future neurobiological studies of first-episode schizophrenia.

Neurodevelopment, neuroplasticity, and new genes for schizophrenia

Schizophrenia is a complex, debilitating neuropsychiatric disorder. Epidemiological, clinical, neuropsychological, and neurophysiological studies have provided substantial evidence that abnormalities in brain development and ongoing neuroplasticity play important roles in the pathogenesis of the disorder. Complementing these clinical studies, a range of cytoarchitectural, morphometric, ultrastructural, immunochemical, and gene expression methods have been applied in investigations of postmortem brain tissues to characterize the cellular and molecular profile of putative developmental and plastic abnormalities in schizophrenia. While findings have been diverse and many are in need of replication, investigations focusing on higher cortical and limbic brain regions are increasingly demonstrating abnormalities in the structural and molecular integrity of the synaptic complex as well as glutamate-related receptors and signal transduction pathways that play critical roles in brain development, synaptogenesis, and synaptic plasticity. Most exciting have been recent associations of schizophrenia with specific genes, such as neuregulin-1, dysbindin-1, and AKT-1, which are vital to synaptic development, neurotransmission, and plasticity.

Positive and negative symptom profile schizophrenia and abnormalities in the P300 component of the event-related potential: a longitudinal controlled study

The relationship between symptoms of schizophrenia and abnormalities in the P300 component of the event-related potential (ERP) was investigated in 22 and 27 patients diagnosed with positive and negative profile schizophrenia, respectively. The Positive and Negative Syndrome Scale (PANSS) was used to characterize clinical symptoms. A group of 30 normal controls were also studied. Results showed that patients with schizophrenia exhibited reduced P300 amplitudes compared with controls and that those with negative profile schizophrenia had amplitude decrements and longer latencies. These findings suggest that there are neurobiological differences between positive and negative profile schizophrenia.

Recognition of facial expression and visual P300 in schizophrenic patients: differences between paranoid type patients and non-paranoid patients

This study compared the effects of facial affective stimuli on visual event-related potentials (ERP) in schizophrenic patients and healthy subjects using photographs of babies depicting sadness (crying face), neutrality (neutral face), and pleasure (smiling face). Visual ERP were recorded using an oddball paradigm in 32 schizophrenic patients (16 paranoid type and 16 non-paranoid patients) and 32 age-matched healthy subjects. The P300 amplitude, latency, and the subject's reaction time were recorded. The P300 amplitude when viewing a photograph of a smiling baby was the smallest registered of three photographs for healthy subjects and paranoid type patients with successively greater amplitudes for neutrality and sadness. However, the P300 amplitude was the smallest while viewing crying photographs and was the largest while viewing a smiling photograph for non-paranoid patients. These results suggest that the P300 amplitude is influenced by viewing emotionally moving facial expressions and that the effect is different for different subtypes of schizophrenia. These differences may reflect differences in information processing resulted from emotional influences caused by visual-affective stimuli.

Increased rate of P300 latency prolongation with age in drug-naive and first episode schizophrenia

OBJECTIVE

Previous studies have found an increased rate of P300 latency prolongation with age in medicated chronic patients with schizophrenia, suggesting a pathological neurodegenerative process. In this study, we investigated whether this abnormality was identified in drug-naive and first episode patients with schizophrenia.

METHODS

P300 from auditory stimuli was recorded from 20 drug naive and first episode male patients with schizophrenia and compared with 23 age and handedness matched healthy male controls. The relationship of P300 latency and P300 amplitude to age in each group was evaluated using polynomial regression analyses.

RESULTS

Reduction of P300 amplitude was significant in drug-naive and first episode schizophrenia patients. P300 amplitude negatively correlated with age in schizophrenia patients but not in controls. Although the prolongation of P300 latency with age was observed in both groups, the regression slope for P300 latency with age was significantly steeper in patients with schizophrenia than in normal controls. Significant overall curvilinear correlations with age were also found for P300 latency and amplitude in patients with schizophrenia, and for P300 latency in normal controls.

CONCLUSIONS

The greater increase in P300 latency and reduction in P300 amplitude with age may be a primary neuropathological effect of schizophrenia.

SIGNIFICANCE

This study suggests that neurodegenerative processes are involved in the etiology of schizophrenia.

N400 abnormalities in unmedicated patients with schizophrenia during a lexical decision task

A lexical decision task was used to investigate semantic processing in schizophrenia. Eighteen unmedicated schizophrenics and 18 gender/age-matched controls were tested. Subjects were visually presented with pairs of words. The target word (S2) was either a non-word, semantically related, or unrelated to preceding word (S1). Subjects decided whether the S2 was a word or non-word. Event related potentials (ERPs) elicited by the S2, including N350, and the late positive component (LPC) were measured. The latency of the N350 was prolonged in schizophrenia. The N400 effect, measured by the mean amplitude (300-500 ms) from difference waves (unrelated word-related word, non-word-related word), was smaller in patients. Peak amplitude of the LPC was reduced and latency of the LPC was delayed in the schizophrenics. Behaviorally, control subjects responded much faster to related words compared to unrelated or non-words, while patients showed little difference in processing speed between word categories. A reduced N400 effect suggested inefficient utilization of the context, while prolonged latency of the ERP components suggested a general delay of semantic information processing in schizophrenia.

Target and non-target ERP disturbances in first episode vs. chronic schizophrenia

OBJECTIVES

Event-related potential (ERP) abnormalities to target stimuli are reliably found in schizophrenia. However, as people with schizophrenia are thought to have difficulty discerning the relevance of incoming sensory stimuli it is also important to examine ERPs to non-targets. To differentiate between potential trait markers of the disease and deficits that might be associated with the consequence of illness chronicity, this study investigated ERPs to both target and non-target stimuli in groups of people with either first episode or chronic schizophrenia (CSz).

METHODS

Using an auditory oddball paradigm, ERPs to target, non-target before target (Nt before) and non-target after target (Nt after) stimuli were analysed for 40 patients with CSz, 40 patients with first episode schizophrenia (FESz) and two groups of normal controls matched for age and sex with their patient counterparts.

RESULTS

The FESz group showed the same pattern of amplitude disturbance as the CSz group to both targets (reduced N100, N200, P300 and increased P200) and non-targets (reduced N100) compared to controls. Both CSz and FESz groups also failed to show the changes to the P200-N200 component between targets and non-target stimuli that was exhibited by controls (smaller earlier P200 to targets vs. increased delayed P200 to non-targets) or the reduction in N100 amplitude of ERPs to the Nt after stimuli compared with ERPs to the Nt before stimuli. Previous literature has focussed on the sensitivity of P300 deficits in classifying persons into schizophrenia and non-schizophrenia groups. This study demonstrated improved accuracy in the classification of patients with schizophrenia from controls using discriminant analysis of target and non-target N100 and P200 components.

CONCLUSIONS

The results suggest that ERP disturbances are evident at the time of first referral to mental health services and may be a potential trait (rather than secondary effect) of the illness. It is important to include both target and non-target stimuli processing, and their interrelationship in future research.

N2 and P3 components of event-related potential in first-episode schizophrenic patients: scalp topography, medication, and latency effects

Auditory N2 and P3 components of event-related potentials were assessed in first-episode schizophrenic and normal control subjects (n=12/group). P3 amplitude was decreased in the patients most prominently over the frontal areas in contrast to a widespread P3 amplitude decrease reported in chronic schizophrenia. Moreover, frontal attenuation of P3 amplitude was greater in the non-medicated compared with medicated patients, a finding that suggests frontal areas are primarily affected at the onset of the first schizophrenic episode. Prolongation of N2 and P3 latencies was also observed in the patients, which indicates that stimulus classification and memory updating processes were slowed even in early stages of schizophrenia. These findings indicate that first-episode schizophrenic patients produce N2 and P3 abnormalities that are distinct from those in chronic patients, and that psychotropic medication can attenuate event-related potential effects in specific ways.

Clinical and neuropsychological correlates of the P300 in schizophrenia

We investigated the relationship between the P300, neuropsychological test performance and symptomatology in recent-onset schizophrenic patients (n = 45) to gain insight into underlying mechanisms of abnormal P300 in schizophrenia. The P300 was recorded in two sessions with an intermission of five minutes, at the midline frontal, central and parietal electrode site. P300 amplitude and latency were compared with those obtained in 25 controls. Twenty patients were treated with olanzapine and 19 patients with risperidone. P300 amplitude was smaller and latency longer in patients than in controls. In the patient group, parietal P300 amplitude reduction was related to poorer performance on neuropsychological tests of memory. Frontal P300 amplitude reduction was related to impaired selective attention. In patients with negative symptomatology, P300 amplitude was reduced in the second P300 session compared with the first. Patients on risperidone demonstrated a smaller parietal P300 amplitude than patients using olanzapine. Reduced parietal P300 amplitude could signify a dysfunction in the continuous memory updating of current events. Negative symptomatology may be associated with a time dependent decrease in neuronal firing, as indicated by reduced P300 amplitude in the second P300 session.

Abnormalities of auditory event-related potentials in students with schizotypal personality disorder

Biological, phenomenological and cognitive similarities are known to exist between schizophrenia and schizotypal personality disorder (SPD). This study examined whether, and to what extent, abnormalities in event-related potentials (ERPs) already extensively reported in schizophrenia can also be observed in persons psychometrically identified with SPD. Event-related potentials were examined in nine SPD subjects and nine controls recruited from among 1693 college students, using the Schizotypal Personality Questionnaire (SPQ) and the Structured Clinical Interview for DSM-III-R (SCID I and II). Event-related potentials were recorded during an auditory oddball task. Smaller P300 amplitude and prolonged P300 latency were found in SPD subjects as compared with controls. Our findings indicate that such individuals do have deficits in information processing similar to that found in schizophrenia. We can conclude that P300 abnormalities may not be specific for SPD but that abnormalities shown in SPD are possibly a vulnerability marker for developing schizophrenia.

Event-related potentials and genetic risk for schizophrenia

BACKGROUND

Event-related potentials (ERPs) during an auditory oddball task were investigated in patients with schizophrenia and in their healthy siblings to explore the question of whether abnormalities of two-dimensional topographic scalp-distribution of P300 amplitude and latency relate to genetic risk for schizophrenia. We also examined the P50, N100, and P200-waves, elicited during the same task.

METHODS

We investigated 42 schizophrenic patients, 62 of their healthy siblings, and 34 unrelated normal control subjects with a standard auditory oddball paradigm and 16 electroencephalogram electrodes. Amplitudes and latencies of the ERPs P50, N100, P200, and P300 were topographically analyzed.

RESULTS

In the patients, P300 amplitude was significantly decreased in the range of 54%-58% over the left parietotemporal area. Siblings did not show decreased P300 amplitudes when compared with normal subjects. P300 latencies were unchanged in both groups. No significant group differences were observed for the other event-related potentials.

CONCLUSIONS

In line with previous studies, the P300 amplitude in schizophrenic patients was decreased over the left temporoparietal area; however, we found no evidence for a genetic trait effect in the event-related potential abnormality. Possible reasons for these largely negative findings are discussed.

P300 amplitude as a possible correlate of frontal degeneration in schizophrenia

The existence of neurodegeneration is a debated issue in schizophrenia research. The P300 component of event-related electrical potentials (ERP) has been related to the different degree of damage to gray and white matter. This study explores the possible relationship between P300 amplitude and/or latency and the existence of degenerative processes in schizophrenia, by assessing its correlation with volume of sulcal CSF and duration of illness, as transversal indicators of neurodegeneration. Nineteen patients (14 males, 5 females) and 13 controls (6 males, 7 females) were studied with MRI and electrophysiological records (P300). The possible influence of sex and age at the time of the exploration was statistically controlled in both groups. The results show a significant negative correlation between P300 amplitude and prefrontal CSF volume in the patient group. A lower though still significant correlation was also found between P300 amplitude and duration of illness, whereas no correlation was found in the control group. These results support the hypothesis that P300 amplitude may be interpreted as a marker of neurodegeneration in schizophrenia.