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Chew QH, Prakash KNB, Koh LY, Chilla G, Yeow LY, Sim K. Neuroanatomical subtypes of schizophrenia and relationship with illness duration and deficit status. Schizophr Res 2022; 248:107-113. [PMID: 36030757 DOI: 10.1016/j.schres.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/21/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND The heterogeneity of schizophrenia (SCZ) regarding psychopathology, illness trajectory and their inter-relationships with underlying neural substrates remain incompletely understood. In a bid to reduce illness heterogeneity using neural substrates, our study aimed to replicate the findings of an earlier study by Chand et al. (2020). We employed brain structural measures for subtyping SCZ patients, and evaluate each subtype's relationship with clinical features such as illness duration, psychotic psychopathology, and additionally deficit status. METHODS Overall, 240 subjects (160 SCZ patients, 80 healthy controls) were recruited for this study. The participants underwent brain structural magnetic resonance imaging scans and clinical rating using the Positive and Negative Syndrome Scale. Neuroanatomical subtypes of SCZ were identified using "Heterogeneity through discriminative analysis" (HYDRA), a clustering technique which accounted for relevant covariates and the inter-group normalized percentage changes in brain volume were also calculated. RESULTS As replicated, two neuroanatomical subtypes (SG-1 and SG-2) were found amongst our patients with SCZ. The subtype SG-1 was associated with enlargements in the third and lateral ventricles, volume increase in the basal ganglia (putamen, caudate, pallidum), longer illness duration, and deficit status. The subtype SG-2 was associated with reductions of cortical and subcortical structures (hippocampus, thalamus, basal ganglia). CONCLUSIONS These replicated findings have clinical implications in the early intervention, response monitoring, and prognostication of SCZ. Future studies may adopt a multi-modal neuroimaging approach to enhance insights into the neurobiological composition of relevant subtypes.
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Affiliation(s)
- Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore
| | - K N Bhanu Prakash
- Biophotonics & Bioimaging, Institute of Bioengineering and Bioimaging, Agency for Science, Technology and Research, Singapore; Clinical Data Analytics & Radiomics, Bioinformatics Institute, Agency for Science, Technology and Research, Singapore
| | - Li Yang Koh
- Biophotonics & Bioimaging, Institute of Bioengineering and Bioimaging, Agency for Science, Technology and Research, Singapore
| | - Geetha Chilla
- Biophotonics & Bioimaging, Institute of Bioengineering and Bioimaging, Agency for Science, Technology and Research, Singapore; Clinical Data Analytics & Radiomics, Bioinformatics Institute, Agency for Science, Technology and Research, Singapore
| | - Ling Yun Yeow
- Biophotonics & Bioimaging, Institute of Bioengineering and Bioimaging, Agency for Science, Technology and Research, Singapore; Clinical Data Analytics & Radiomics, Bioinformatics Institute, Agency for Science, Technology and Research, Singapore
| | - Kang Sim
- West Region, Institute of Mental Health, Singapore.
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Schneider H. Artificial Intelligence in Schizophrenia. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3
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Iliuta FP, Manea MC, Budisteanu M, Ciobanu AM, Manea M. Magnetic resonance imaging in schizophrenia: Luxury or necessity? (Review). Exp Ther Med 2021; 22:765. [PMID: 34055064 PMCID: PMC8145262 DOI: 10.3892/etm.2021.10197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/16/2021] [Indexed: 11/12/2022] Open
Abstract
Schizophrenia, one of the most common psychiatric disorders, with a worldwide annual incidence rate of approximately 0.3-0.7%, known to affect the population below 25 years of age, is persistent throughout lifetime and includes people from all layers of society. With recent technological progress that allows better imaging techniques, such as the ones provided by computed tomography and particularly magnetic resonance imaging (MRI), research on schizophrenia imaging has grown considerably. The purpose of this review is to establish the importance of using imaging techniques in the early detection of brain abnormalities in patients diagnosed with schizophrenia. We reviewed all articles which reported on MRI imaging in schizophrenia. In order to do this, we used the PubMed database, using as search words ‘MRI’ and ‘schizophrenia’. MRI studies of first episode patients and chronic patients, suggest reduction of the whole brain volume. Enlargement of lateral ventricles was described as positive in 15 studies out of 19 and was similar to findings in chronic patients. Moreover, for the first episode patients, all data collected point to important changes in medial temporal lobe structures, diminished hippocampal volume, the whole frontal lobe, asymmetry in prefrontal cortex, diminished volume in cingulate, corpus callosum, and cavum septum pellucidum reported abnormalities. MRI is recommended as an important tool in the follow-up process of patients with schizophrenia. Yet, it is still under debate whether the abnormalities described in this condition are able to be used as diagnostic biomarkers.
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Affiliation(s)
- Floris Petru Iliuta
- Psychiatry Research Laboratory, 'Prof. Dr. Alexandru Obregia' Clinical Hospital of Psychiatry, 041914 Bucharest, Romania.,Department of Psychiatry and Psychology, Faculty of Dental Medicine, 'Carol Davila' University of Medicine and Pharmacy, 010221 Bucharest, Romania
| | - Mihnea Costin Manea
- Psychiatry Research Laboratory, 'Prof. Dr. Alexandru Obregia' Clinical Hospital of Psychiatry, 041914 Bucharest, Romania.,Department of Psychiatry and Psychology, Faculty of Dental Medicine, 'Carol Davila' University of Medicine and Pharmacy, 010221 Bucharest, Romania
| | - Magdalena Budisteanu
- Psychiatry Research Laboratory, 'Prof. Dr. Alexandru Obregia' Clinical Hospital of Psychiatry, 041914 Bucharest, Romania.,Laboratory of Medical Genetics, 'Victor Babes' National Institute of Pathology, 050096 Bucharest, Romania.,Medical Genetics Department, Faculty of Medicine, 'Titu Maiorescu' University, 031593 Bucharest, Romania
| | - Adela Magdalena Ciobanu
- Department of Neuroscience, Discipline of Psychiatry, Faculty of General Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Psychiatry, 'Prof. Dr. Alexandru Obregia' Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
| | - Mirela Manea
- Psychiatry Research Laboratory, 'Prof. Dr. Alexandru Obregia' Clinical Hospital of Psychiatry, 041914 Bucharest, Romania.,Department of Psychiatry and Psychology, Faculty of Dental Medicine, 'Carol Davila' University of Medicine and Pharmacy, 010221 Bucharest, Romania
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4
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Artificial Intelligence in Schizophrenia. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_214-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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5
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van Haren N, Cahn W, Hulshoff Pol H, Kahn R. Schizophrenia as a progressive brain disease. Eur Psychiatry 2020; 23:245-54. [DOI: 10.1016/j.eurpsy.2007.10.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 10/11/2007] [Accepted: 10/18/2007] [Indexed: 01/06/2023] Open
Abstract
AbstractThere is convincing evidence that schizophrenia is characterized by abnormalities in brain volume. At the Department of Psychiatry of the University Medical Centre Utrecht, Netherlands, we have been carrying out neuroimaging studies in schizophrenia since 1995. We focused our research on three main questions. First, are brain volume abnormalities static or progressive in nature? Secondly, can brain volume abnormalities in schizophrenia be explained (in part) by genetic influences? Finally, what environmental factors are associated with the brain volume abnormalities in schizophrenia?Based on our findings we suggest that schizophrenia is a progressive brain disease. We showed different age-related trajectories of brain tissue loss suggesting that brain maturation that occurs in the third and fourth decade of life is abnormal in schizophrenia. Moreover, brain volume has been shown to be a useful phenotype for studying schizophrenia. Brain volume is highly heritable and twin and family studies show that unaffected relatives show abnormalities that are similar, but usually present to a lesser extent, to those found in the patients. However, also environmental factors play a role. Medication intake is indeed a confounding factor when interpreting brain volume (change) abnormalities, while independent of antipsychotic medication intake brain volume abnormalities appear influenced by the outcome of the illness.In conclusion, schizophrenia can be considered as a progressive brain disease with brain volume abnormalities that are for a large part influenced by genetic factors. Whether the progressive volume change is also mediated by genes awaits the results of longitudinal twin analyses. One of the main challenges for the coming years, however, will be the search for gene-by-environment interactions on the progressive brain changes in schizophrenia.
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6
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Katagiri N, Pantelis C, Nemoto T, Tsujino N, Saito J, Hori M, Yamaguchi T, Funatogawa T, Mizuno M. Longitudinal changes in striatum and sub-threshold positive symptoms in individuals with an 'at risk mental state' (ARMS). Psychiatry Res Neuroimaging 2019; 285:25-30. [PMID: 30716687 DOI: 10.1016/j.pscychresns.2019.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/23/2018] [Accepted: 01/26/2019] [Indexed: 10/27/2022]
Abstract
Recent studies have revealed that several psychotic symptom changes observed in the 'at risk mental state' (ARMS) are associated with changes in the striatum. We investigated if structural changes in the striatum are associated with recovery of sub-threshold psychotic symptoms in subjects with an ARMS who did not develop psychosis (ARMS-N). Sixteen healthy controls and 42 subjects with an ARMS participated in this study. Striatal volumes (caudate, putamen, and nucleus accumbens) were analyzed using MRI. The sub-threshold psychotic symptoms of the subjects with an ARMS were measured using the SOPS. Imaging and symptoms were reevaluated after 52 weeks. Significant right putamen volume reduction was observed at the follow-up in ARMS-N subjects. Improvement in sub-threshold positive symptoms significantly correlated with an increase in volume in the right accumbens at follow up. No relationship was found for negative symptoms. From these findings, the association between improvement in sub-threshold positive symptoms and an increase in the volume of the right accumbens may suggest that changes in the accumbens, which is a major site for dopamine innervation, are associated with symptom recovery. These findings may point to neurobiological resilience that may be associated with lower transition to psychosis.
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Affiliation(s)
- Naoyuki Katagiri
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, 143-8541, Tokyo, Japan.
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Carlton South, Victoria, Australia; Centre for Neural Engineering, Department of Electrical and Electronic Engineering, University of Melbourne, Carlton South, Victoritoka, Australia
| | - Takahiro Nemoto
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, 143-8541, Tokyo, Japan
| | - Naohisa Tsujino
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, 143-8541, Tokyo, Japan; Saiseikai Yokohamashi Tobu Hospital Psychiatry, Yokohama-City, Kanagawa, Japan
| | - Junichi Saito
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, 143-8541, Tokyo, Japan; Saiseikai Yokohamashi Tobu Hospital Psychiatry, Yokohama-City, Kanagawa, Japan
| | - Masaaki Hori
- Department of Radiology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Taiju Yamaguchi
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, 143-8541, Tokyo, Japan
| | - Tomoyuki Funatogawa
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, 143-8541, Tokyo, Japan
| | - Masafumi Mizuno
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, 143-8541, Tokyo, Japan
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Cahn W, Hulshoff Pol HE, Bongers M, Schnack HG, Mandl RCW, Van Haren NEM, Durston S, Koning H, Van Der Linden JA, Kahn RS. Brain morphology in antipsychotic-naïve schizophrenia: A study of multiple brain structures. Br J Psychiatry 2018; 43:s66-72. [PMID: 12271803 DOI: 10.1192/bjp.181.43.s66] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BackgroundAlthough brain volume changes are found in schizophrenia, only a limited number of structural magnetic resonance imaging studies have exclusively examined antipsychotic-naïve patients.AimsTo comprehensively investigate multiple brain structures in a single sample of patients who were antipsychotic-naïve.MethodTwenty antipsychotic-naïve patients with first-episode schizophrenia and 20 healthy comparison subjects were included. Intracranial, total brain, frontal lobe, grey and white matter, cerebellar, hippocampal, parahippocampal, thalamic, caudate nucleus and lateral and third ventricular volumes were measured. Repeated-measures analyses of (co)variance were conducted with intracranial volume as covariate.ResultsThird ventricle volume enlargement was found in patients compared with the healthy subjects. No differences were found in other brain regions.ConclusionsThese findings suggest that some brain abnormalities are present in the early stages of schizophrenia. Moreover, it suggests that brain abnormalities reported in patients with chronic schizophrenia develop in a later stage of the disease and/or are medication induced.
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Affiliation(s)
- W Cahn
- Department of Psychiatry, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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8
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Hirjak D, Huber M, Kirchler E, Kubera KM, Karner M, Sambataro F, Freudenmann RW, Wolf RC. Cortical features of distinct developmental trajectories in patients with delusional infestation. Prog Neuropsychopharmacol Biol Psychiatry 2017; 76:72-79. [PMID: 28257853 DOI: 10.1016/j.pnpbp.2017.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Although there is strong neuroimaging evidence that cortical alterations are a core feature of schizophrenia spectrum disorders, it still remains unclear to what extent such abnormalities occur in monothematic delusional disorders. In individuals with delusional infestation (DI), the delusional belief to be infested with pathogens, previous structural MRI studies have shown prefrontal, temporal, parietal, insular, thalamic and striatal gray matter volume changes. Differential contributions of cortical features of evolutionary and genetic origin (such as cortical thickness, area and folding) which may distinctly contribute to DI pathophysiology are unclear at present. METHODS In this study, 18 patients with DI and 20 healthy controls (HC) underwent MRI scanning at 1.0T. Using surface-based analyses we calculated cortical thickness, surface area and local gyrification index (LGI). Whole-brain differences between patients and controls were investigated. RESULTS Surface analyses revealed frontoparietal patterns exhibiting altered cortical thickness, surface area and LGI in DI patients compared to controls. Higher cortical thickness was found in the right medial orbitofrontal cortex (p<0.05, cluster-wise probability [CWP] corrected). Smaller surface area in patients was found in the left inferior temporal gyrus, the precuneus, the pars orbitalis of the right frontal gyrus, and the lingual gyrus (p<0.05, CWP corr.). Lower LGI was found in the left postcentral, bilateral precentral, right middle temporal, inferior parietal, and superior parietal gyri (p<0.01, CWP corr.). CONCLUSION This study lends further support to the hypothesis that cortical features of distinct evolutionary and genetic origin differently contribute to the pathogenesis of delusional disorders. Regions in which atrophy was observed are part of neural circuits associated with perception, visuospatial control and self-awareness. The data are in line with the notion of a content-specific neural signature of DI.
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Affiliation(s)
- Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University Mannheim, Germany.
| | - Markus Huber
- Department of Psychiatry, General Hospital Bruneck, South Tyrol, Italy
| | - Erwin Kirchler
- Department of Psychiatry, General Hospital Bruneck, South Tyrol, Italy
| | - Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Martin Karner
- Department of Radiology, General Hospital Bruneck, South Tyrol, Italy
| | - Fabio Sambataro
- Department of Experimental and Clinical Medical Sciences, Udine University, Italy
| | | | - Robert C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
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9
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Mamah D, Alpert KI, Barch DM, Csernansky JG, Wang L. Subcortical neuromorphometry in schizophrenia spectrum and bipolar disorders. NEUROIMAGE-CLINICAL 2016; 11:276-286. [PMID: 26977397 PMCID: PMC4781974 DOI: 10.1016/j.nicl.2016.02.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 02/17/2016] [Accepted: 02/19/2016] [Indexed: 11/17/2022]
Abstract
Background Disorders within the schizophrenia spectrum genetically overlap with bipolar disorder, yet questions remain about shared biological phenotypes. Investigation of brain structure in disease has been enhanced by developments in shape analysis methods that can identify subtle regional surface deformations. Our study aimed to identify brain structure surface deformations that were common across related psychiatric disorders, and characterize differences. Methods Using the automated FreeSurfer-initiated Large Deformation Diffeomorphic Metric Mapping, we examined volumes and shapes of seven brain structures: hippocampus, amygdala, caudate, nucleus accumbens, putamen, globus pallidus and thalamus. We compared findings in controls (CON; n = 40), and those with schizophrenia (SCZ; n = 52), schizotypal personality disorder (STP; n = 12), psychotic bipolar disorder (P-BP; n = 49) and nonpsychotic bipolar disorder (N-BP; n = 24), aged 15–35. Relationships between morphometric measures and positive, disorganized and negative symptoms were also investigated. Results Inward deformation was present in the posterior thalamus in SCZ, P-BP and N-BP; and in the subiculum of the hippocampus in SCZ and STP. Most brain structures however showed unique shape deformations across groups. Correcting for intracranial size resulted in volumetric group differences for caudate (p < 0.001), putamen (p < 0.01) and globus pallidus (p < 0.001). Shape analysis showed dispersed patterns of expansion on the basal ganglia in SCZ. Significant clinical relationships with hippocampal, amygdalar and thalamic volumes were observed. Conclusions Few similarities in surface deformation patterns were seen across groups, which may reflect differing neuropathologies. Posterior thalamic contraction in SCZ and BP suggest common genetic or environmental antecedents. Surface deformities in SCZ basal ganglia may have been due to antipsychotic drug effects. Shape analysis identified structural abnormalities in psychiatric disorders, where volume analysis did not Few similarities in surface deformation patterns were seen across diagnostic groups Posterior thalamic contraction was seen in both schizophrenia and bipolar patients Expansion of basal ganglia regions were seen in schizophrenia patients
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, United States.
| | - Kathryn I Alpert
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Deanna M Barch
- Department of Psychiatry, Washington University Medical School, St. Louis, United States; Department of Psychology, Washington University Medical School, St. Louis, United States; Department of Radiology, Washington University Medical School, St. Louis, United States
| | - John G Csernansky
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, United States
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Emsley R, Asmal L, du Plessis S, Chiliza B, Kidd M, Carr J, Vink M. Dorsal striatal volumes in never-treated patients with first-episode schizophrenia before and during acute treatment. Schizophr Res 2015; 169:89-94. [PMID: 26441006 DOI: 10.1016/j.schres.2015.09.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/06/2015] [Accepted: 09/08/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Studies of pre-and post-treatment striatal volume in schizophrenia have reported conflicting results. MATERIALS AND METHODS We assessed dorsal striatal (caudate and putamen) volumes bilaterally in 22 never-treated, non-substance-abusing patients with first-episode schizophrenia or schizophreniform disorder and 23 healthy controls matched for age, sex and educational status. Patients received either risperidone or flupenthixol long acting injection and were compared by structural MRI with controls at weeks 0, 4 and 13. T1-weighted data on a 3T MRI scanner were obtained and images were reconstructed using FreeSurfer. Treatment outcome was assessed by changes in psychopathology, insight, functionality, cognitive performance and motor symptoms. RESULTS Caudate, but not putamen volumes was significantly larger in patients bilaterally at baseline (P=0.01). Linear mixed effects repeated measures found no significant group × time interactions for any of the regions. Caudate volume was not significantly associated with improvements in psychotic symptoms. Also, the findings of a regression model were inconsistent insofar as larger caudate volume was associated with less improvement in depression scores, greater improvement in functionality and greater improvement in verbal learning but less improvement in reasoning and problem solving (left caudate) and composite cognitive score (right caudate). CONCLUSIONS The increased caudate volumes prior to treatment are contrary to previous reports in never-treated patients with first-episode schizophrenia, and together with our failure to demonstrate volume changes related to acute treatment, call into question previous proposals that enlarged caudate volume is a consequence of antipsychotic treatment.
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Affiliation(s)
- Robin Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
| | - Laila Asmal
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Stéfan du Plessis
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Bonginkosi Chiliza
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Stellenbosch University, South Africa
| | - Jonathan Carr
- Division of Neurology, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Matthijs Vink
- Department of Psychiatry, University Medical Centre Utrecht, The Netherlands
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Tao H, Wong GHY, Zhang H, Zhou Y, Xue Z, Shan B, Chen EYH, Liu Z. Grey matter morphological anomalies in the caudate head in first-episode psychosis patients with delusions of reference. Psychiatry Res 2015; 233:57-63. [PMID: 26025014 DOI: 10.1016/j.pscychresns.2015.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 11/18/2014] [Accepted: 04/30/2015] [Indexed: 11/26/2022]
Abstract
Delusions of reference (DOR) are theoretically linked with aberrant salience and associative learning. Previous studies have shown that the caudate nucleus plays a critical role in the cognitive circuits of coding prediction errors and associative learning. The current study aimed at testing the hypothesis that abnormalities in the caudate nucleus may be involved in the neuroanatomical substrate of DOR. Structural magnetic resonance imaging of the brain was performed in 44 first-episode psychosis patients (with diagnoses of schizophrenia or schizophreniform disorder) and 25 healthy controls. Patients were divided into three groups according to symptoms: patients with DOR as prominent positive symptom; patients with prominent positive symptoms other than DOR; and patients with minimal positive symptoms. All groups were age-, gender-, and education-matched, and patient groups were matched for diagnosis, duration of illness, and antipsychotic treatment. Voxel-based morphometric analysis was performed to identify group differences in grey matter density. Relationships were explored between grey matter density and DOR. Patients with DOR were found to have reduced grey matter density in the caudate compared with patients without DOR and healthy controls. Grey matter density values of the left and right caudate head were negatively correlated with DOR severity. Decreased grey matter density in the caudate nucleus may underlie DOR in early psychosis.
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Affiliation(s)
- Haojuan Tao
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, China.
| | - Gloria H Y Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong.
| | - Huiran Zhang
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, China
| | - Yuan Zhou
- Key Laboratory of Behavioural Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Zhimin Xue
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, China
| | - Baoci Shan
- Key Laboratory of Nuclear Analysis Techniques, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
| | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Zhening Liu
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, China
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Bernard JA, Orr JM, Mittal VA. Abnormal hippocampal-thalamic white matter tract development and positive symptom course in individuals at ultra-high risk for psychosis. NPJ SCHIZOPHRENIA 2015; 1. [PMID: 26120591 PMCID: PMC4479398 DOI: 10.1038/npjschz.2015.9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background/Objectives: Abnormal development of the hippocampus has been reported in adolescents at ultra-high risk (UHR) for psychosis and thalamic abnormalities have been found. However, the white matter connections between the hippocampus and the thalamus have not been studied. The connections between these regions are of key importance to our understanding of the pathophysiology of psychosis. Methods: Twenty-six UHR and 21 healthy age-matched controls were tested at a baseline assessment and 12 months later. Symptoms were assessed at both the time points and all the participants underwent diffusion tensor imaging scans. We used tractography to trace the white matter connections in each individual between the thalamus and hippocampus and then extracted fractional anisotropy (FA) to assess white matter structural integrity. Results: There was a significant group by time interaction indicating that FA decreased in UHR, and increased in controls over 12 months. Across both groups, baseline FA of the thalamic–hippocampal tract was predictive of positive symptoms at 12-month follow-up. Critically, this pattern remained significant in UHR individual group alone. At baseline, those with higher FA, indicative of abnormal white matter development, show higher positive symptoms 1 year later. Conclusions: Here, we provide evidence to indicate that there are differences in white matter development in hippocampal–thalamic connections, both of which are important nodes in networks associated with schizophrenia. Furthermore, abnormal developmental patterns in UHR individuals are associated with positive symptom course.
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Affiliation(s)
- Jessica A Bernard
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Joseph M Orr
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Vijay A Mittal
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA ; Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA
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Kang JI, Park HJ, Kim SJ, Kim KR, Lee SY, Lee E, An SK, Kwon JS, Lee JD. Reduced binding potential of GABA-A/benzodiazepine receptors in individuals at ultra-high risk for psychosis: an [18F]-fluoroflumazenil positron emission tomography study. Schizophr Bull 2014; 40:548-57. [PMID: 23588475 PMCID: PMC3984508 DOI: 10.1093/schbul/sbt052] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Altered transmission of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter, may contribute to the development of schizophrenia. The purpose of the present study was to investigate the presence of GABA-A/benzodiazepine (BZ) receptor binding abnormalities in individuals at ultra-high risk (UHR) for psychosis in comparison with normal controls using [(18)F]-fluoroflumazenil (FFMZ) positron emission tomography (PET). In particular, we set regions of interest in the striatum (caudate, putamen, and nucleus accumbens) and medial temporal area (hippocampus and parahippocampal gyrus). METHODS Eleven BZ-naive people at UHR and 15 normal controls underwent PET scanning using [(18)F]-FFMZ to measure GABA-A/BZ receptor binding potential. The regional group differences between UHR individuals and normal controls were analyzed using Statistical Parametric Mapping 8 software. Participants were evaluated using the structured interview for prodromal syndromes and neurocognitive function tasks. RESULTS People at UHR demonstrated significantly reduced binding potential of GABA-A/BZ receptors in the right caudate. CONCLUSIONS Altered GABAergic transmission and/or the imbalance of inhibitory and excitatory systems in the striatum may be present at the putative prodromal stage and play a pivotal role in the pathophysiology of psychosis.
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Affiliation(s)
- Jee In Kang
- *To whom correspondence should be addressed; Department of Psychiatry, Severance Mental Health Hospital, Yonsei University Health System, 119, 1926 Beon-gil, Gyeongchung-daero, Gwangju-si, Gyeonggi-do 464-100, South Korea; tel: +82-31-760-9404, fax: +82-31-761-7582, e-mail:
| | - Hae-Jeong Park
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea;,Department of Medical Science, Yonsei University College of Medicine, Seoul, South Korea;,Department of Nuclear Medicine, BK21 Project for Medical Science, and Severance Biomedical Science Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea;,†These two authors contributed equally to this work and should be considered co-first authors
| | - Se Joo Kim
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea;,Clinical and Neurobiological Lab for Obsessive-Compulsive Disorder, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea;,Department of Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Ran Kim
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea;,Section of Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Su Young Lee
- Section of Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea;,Department of Psychiatry, Cheil General Hospital & Women’s Healthcare Center, Kwandong University College of Medicine, Seoul, South Korea
| | - Eun Lee
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea;,Section of Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Suk Kyoon An
- Section of Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea;,Department of Medical Science, Yonsei University College of Medicine, Seoul, South Korea;,Department of Psychiatry, Yonsei University College of Medicine, Severance Mental Health Hospital, Seoul, South Korea;,Graduate Program in Cognitive Science, Yonsei University, Seoul, South Korea;,*To whom correspondence should be addressed; Department of Psychiatry, Severance Mental Health Hospital, Yonsei University Health System, 119, 1926 Beon-gil, Gyeongchung-daero, Gwangju-si, Gyeonggi-do 464-100, South Korea; tel: +82-31-760-9404, fax: +82-31-761-7582, e-mail:
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Jong Doo Lee
- Department of Nuclear Medicine, BK21 Project for Medical Science, and Severance Biomedical Science Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
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14
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Premkumar P, Sharma T. Neuropsychologic functioning and structural MRI of the brain in patients with schizophrenia. Expert Rev Neurother 2014; 5:85-94. [PMID: 15853478 DOI: 10.1586/14737175.5.1.85] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The first episode of schizophrenia represents a transition from a premorbid to a morbid state. Studying the first episode of schizophrenia is useful since it is devoid of the confounds of chronicity and long-term medication. It is also likely to direct us to the core deficits of the illness. Studies on first-episode schizophrenia suggest a generalized neuropsychologic impairment, but that memory, attention and executive function are more severely impaired. Support for a neurodevelopmental model of neuropsychologic impairment in schizophrenia is derived from the findings that much of the neuropsychologic impairment is present by illness onset, that neuropsychologic impairment remains stable over time and that there is a weak relation between duration of untreated psychosis and neuropsychologic impairment. However, neuropsychologic impairment is moderated by neuroleptic treatment, with some evidence that atypical antipsychotics may have some beneficial effects over conventional antipsychotics. The causal mechanisms of brain abnormality in the temporal and frontal lobes appear to be different to that of neuropsychologic impairment in schizophrenia. The observation that there is a brain volume decrement over time and that the rate of change is higher during the first 5 years would be consistent with a neurodegenerative model of schizophrenia. At the same time, the basal ganglia are vulnerable to volumetric increase secondary to neuroleptic medication. Understanding the roles of the neurodevelopmental and neurodegenerative models of schizophrenia is important in deciding intervention strategies.
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15
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Lunsford-Avery JR, Orr JM, Gupta T, Pelletier-Baldelli A, Dean DJ, Smith Watts AK, Bernard J, Millman ZB, Mittal VA. Sleep dysfunction and thalamic abnormalities in adolescents at ultra high-risk for psychosis. Schizophr Res 2013; 151:148-53. [PMID: 24094679 PMCID: PMC3855888 DOI: 10.1016/j.schres.2013.09.015] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 09/15/2013] [Accepted: 09/17/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sleep dysfunction is a pervasive, distressing characteristic of psychosis, yet little is known regarding sleep quality prior to illness onset. At present, it is unclear whether sleep dysfunction precedes the emergence of psychotic symptoms, signifying a core feature of the disorder, or if it represents a consequence of prolonged contact with aspects of schizophrenia and its treatment (e.g., medication use or neurotoxicity) or co-morbid symptoms (e.g., depressive and manic symptomatology). The current study examined sleep dysfunction in adolescents at ultra high-risk (UHR) for psychosis, relationships between sleep disturbances and psychosis symptoms, volume of an integral sleep-structure (thalamus), and associations between thalamic abnormalities and sleep impairment in UHR youth. METHOD Thirty-three UHR youth and 33 healthy controls (HC) participated in a self-assessment of sleep functioning (Pittsburgh Sleep Quality Index; PSQI), self and parent-report clinical interviews, and structural magnetic resonance imaging (MRI). RESULTS UHR adolescents displayed increased latency to sleep onset and greater sleep disturbances/disrupted continuity compared to HC youth, over and above concurrent mood symptoms. Among UHR youth, increased sleep dysfunction was associated with greater negative symptom severity but not positive symptoms. Compared to HC adolescents, UHR participants displayed decreased bilateral thalamus volume, which was associated with increased sleep dysfunction. CONCLUSIONS Sleep dysfunction occurs during the pre-psychotic period, and may play a role in the etiology and pathophysiology of psychosis. In addition, the relationship of disrupted sleep to psychosis symptoms in UHR youth indicates that prevention and intervention strategies may be improved by targeting sleep stabilization in the pre-psychotic period.
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Affiliation(s)
- Jessica R Lunsford-Avery
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
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16
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Xiao Y, Zhang W, Lui S, Yao L, Gong Q. Similar and different gray matter deficits in schizophrenia patients and their unaffected biological relatives. Front Psychiatry 2013; 4:150. [PMID: 24319433 PMCID: PMC3836186 DOI: 10.3389/fpsyt.2013.00150] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/07/2013] [Indexed: 02/05/2023] Open
Abstract
Neuroimaging studies have revealed significant reductions in the gray matter (GM) of several brain regions in patients with schizophrenia, a neuropsychiatric disorder with high hereditability. However, it is unclear whether unaffected relatives have GM abnormalities in common with their affected relatives, which may relate to susceptibility to developing schizophrenia. To address this issue, we conducted two separate meta-analyses of voxel-based morphometry to investigate GM abnormalities in schizophrenia patients and their unaffected relatives. One meta-analysis compared a patient group with healthy controls, whereas the other meta-analysis compared the unaffected relatives with healthy controls. Eight studies comprising 495 patients with schizophrenia, 584 unaffected relatives of patients, and 596 healthy controls were systematically included in the present study. Compared to healthy controls, the patient group showed decreased GM in the right cuneus, the right superior frontal gyrus, the right insula and the left claustrum, and increased GM in the bilateral putamen, the right parahippocampal gyrus, the left precentral gyrus, the left inferior temporal gyri, and the right cerebellar tonsil. The comparison between unaffected relatives and healthy controls showed a GM reduction in the left claustrum, the bilateral parahippocampal gyri, the left fusiform gyrus, the right inferior temporal gyrus, and the bilateral medial prefrontal cortices, whereas increased GM was observed in the right hippocampus, the right fusiform gyrus, the right precentral gyrus, and the right precuneus. Thus, our meta-analyses show that the GM changes in schizophrenia patients and their unaffected relatives are largely different, although there is subtle overlap in some regions.
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Affiliation(s)
- Yuan Xiao
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University , Chengdu , China
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17
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Levitt JJ, Rosow LK, Nestor PG, Pelavin PE, Swisher TM, McCarley RW, Shenton ME. A volumetric MRI study of limbic, associative and sensorimotor striatal subregions in schizophrenia. Schizophr Res 2013; 145:11-9. [PMID: 23380548 DOI: 10.1016/j.schres.2012.08.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/21/2012] [Accepted: 08/28/2012] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Cognitive and emotional functioning is mediated by frontal-subcortical feedback loops. The striatum, a component of this circuitry, thus is a possible neural substrate of schizophrenia. Striatum volume, however, is believed to be differentially influenced by neuroleptic treatment due to an anterior-posterior D2 receptor density gradient. We thus rigorously parcellated it into subregions in order to assess whether neuroleptic effect on group differences is regionally specific. METHODS 29 chronic, male, schizophrenia patients and 28 male, normal controls (NCs), group-matched for handedness, age, and parental SES, underwent structural brain imaging on a 1.5 Tesla GE system. We manually measured the volume, normalized for intracranial contents, of the striatum parcellated into anatomic subregions and their corresponding limbic, associative and sensorimotor functional subregions and performed clinical correlations. RESULTS First, we found a localized bilateral enlargement of the posterior putamen in medicated chronic schizophrenia. Second, we showed associative striatal subregion volumes correlated with executive function in schizophrenia subjects and, to a lesser extent, in NCs. Third, we showed associative striatal subregions inversely correlated with negative symptoms but conversely, the ventral/limbic striatum did not correlate with positive or negative clinical symptoms. DISCUSSION Our novel parcellation strategy, based on rigorous delineation of the ventral striatum, allowed for the demonstration of localized volumetric differences between schizophrenia and NCs. Furthermore, by parcellating the striatum into functional subregions we demonstrated significant positive correlations between the volume of the associative striatum and executive functioning in schizophrenia, adding further support to the importance of its role in the pathophysiology of schizophrenia.
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Affiliation(s)
- James J Levitt
- Clinical Neuroscience Division, Laboratory of Neuroscience, Department of Psychiatry, VA Boston Healthcare System, Brockton Division, Brockton, MA 02301, USA.
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18
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McClure R, Styner M, Maltbie E, Lieberman J, Gouttard S, Gerig G, Shi X, Zhu H. Localized differences in caudate and hippocampal shape are associated with schizophrenia but not antipsychotic type. Psychiatry Res 2013; 211:1-10. [PMID: 23142194 PMCID: PMC3557605 DOI: 10.1016/j.pscychresns.2012.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 06/20/2012] [Accepted: 07/03/2012] [Indexed: 11/20/2022]
Abstract
UNLABELLED Caudate and hippocampal volume differences in patients with schizophrenia are associated with disease and antipsychotic treatment, but local shape alterations have not been thoroughly examined. Schizophrenia patients randomly assigned to haloperidol and olanzapine treatment underwent magnetic resonance imaging (MRI) at 3, 6, and 12 months. The caudate and hippocampus were represented as medial representations (M-reps); mesh structures derived from automatic segmentations of high resolution MRIs. Two quantitative shape measures were examined: local width and local deformation. A novel nonparametric statistical method, adjusted exponentially tilted (ET) likelihood, was used to compare the shape measures across the three groups while controlling for covariates. Longitudinal shape change was not observed in the hippocampus or caudate when the treatment groups and controls were examined in a global analysis, nor when the three groups were examined individually. Both baseline and repeated measures analysis showed differences in local caudate and hippocampal size between patients and controls, while no consistent differences were shown between treatment groups. Regionally specific differences in local hippocampal and caudate shape are present in schizophrenic patients. Treatment-related related longitudinal shape change was not observed within the studied timeframe. Our results provide additional evidence for disrupted cortico-basal ganglia-thalamo-cortical circuits in schizophrenia. CLINICAL TRIAL INFORMATION This longitudinal study was conducted from March 1, 1997 to July 31, 2001 at 14 academic medical centers (11 in the United States, one in Canada, one in the Netherlands, and one in England). This study was performed prior to the establishment of centralized registries of federally and privately supported clinical trials.
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Affiliation(s)
- Robert McClure
- Departments of Psychiatry, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Martin Styner
- Departments of Psychiatry, University of North Carolina, Chapel Hill, NC, 27599, USA
- Computer Science, University of North Carolina, Chapel Hill, NC, 27599, USA
- Corresponding Author: Martin Styner, University of North Carolina, CB 7160, Department of Psychiatry, Chapel Hill, NC 27599, Telephone: (919) 843-1092, Fax: (919) 966- 7225,
| | - Eric Maltbie
- Departments of Psychiatry, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Jeffrey Lieberman
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
| | - Sylvain Gouttard
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Guido Gerig
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Xiaoyan Shi
- Biostatistics, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Hongtu Zhu
- Biostatistics, University of North Carolina, Chapel Hill, NC, 27599, USA
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19
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Chemerinski E, Byne W, Kolaitis JC, Glanton CF, Canfield EL, Newmark RE, Haznedar MM, Novakovic V, Chu KW, Siever LJ, Hazlett EA. Larger putamen size in antipsychotic-naïve individuals with schizotypal personality disorder. Schizophr Res 2013. [PMID: 23187070 PMCID: PMC3634353 DOI: 10.1016/j.schres.2012.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To (a) compare the size of the dorsal and ventral striatum (caudate and putamen) in a large sample of antipsychotic-naïve individuals with schizotypal personality disorder (SPD) and healthy control participants; (b) examine symptom correlates of striatal size in SPD. METHODS The left and right caudate and putamen were hand-traced on structural MRI at five dorsal to ventral slice levels in 76 SPD and 148 healthy control participants. A Group×Region (caudate, putamen)×Slice (1-5: ventral, 2, 3, 4, dorsal)×Hemisphere (left, right) mixed-model MANOVA was conducted on size relative to whole brain. RESULTS Primary results showed that compared with the controls, the SPD group showed (a) larger bilateral putamen size overall and this enlargement was more pronounced at the most ventral and dorsal levels; in contrast, there were no between-group differences in caudate volume; (b) larger bilateral size of the striatum ventrally, averaged across the caudate and putamen. Among the SPD group, larger striatal size ventrally, particularly in the left hemisphere was associated with less severe paranoid symptoms. CONCLUSIONS Striatal size is abnormal in SPD and resembles that of patients with schizophrenia who respond well to antipsychotic treatment. The results suggest that striatal size may be an important endophenotype to consider when developing new pharmacological treatments and when studying factors mitigating psychosis.
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Affiliation(s)
- Eran Chemerinski
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States,Department of Outpatient Psychiatry, James J. Peter Veterans Affairs Medical Center, Psychiatry, Bronx, NY, United States
| | - William Byne
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States,Department of Outpatient Psychiatry, James J. Peter Veterans Affairs Medical Center, Psychiatry, Bronx, NY, United States,Mental Illness Research, Education, and Clinical Center, James J. Peter Veterans Affairs Medical Center, Bronx, NY, United States
| | - Jeanine C. Kolaitis
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States,Research & Development, James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States
| | - Cathryn F. Glanton
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States
| | - Emily L. Canfield
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States
| | - Randall E. Newmark
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States
| | - M. Mehmet Haznedar
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States,Department of Outpatient Psychiatry, James J. Peter Veterans Affairs Medical Center, Psychiatry, Bronx, NY, United States
| | - Vladan Novakovic
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States
| | - King-Wai Chu
- Mental Illness Research, Education, and Clinical Center, James J. Peter Veterans Affairs Medical Center, Bronx, NY, United States
| | - Larry J. Siever
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States,Department of Outpatient Psychiatry, James J. Peter Veterans Affairs Medical Center, Psychiatry, Bronx, NY, United States,Mental Illness Research, Education, and Clinical Center, James J. Peter Veterans Affairs Medical Center, Bronx, NY, United States
| | - Erin A. Hazlett
- Mount Sinai School of Medicine, Department of Psychiatry, New York, NY, United States,Mental Illness Research, Education, and Clinical Center, James J. Peter Veterans Affairs Medical Center, Bronx, NY, United States,Research & Development, James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States,Corresponding author at: Mental Illness Research, Education, and Clinical Center (MIRECC) VISN 3, JJP VA Medical Center, 130 West Kingsbridge Road, Rm 6A-45, Bronx, NY 10468, United States. Tel.: +1 718 584 9000x3701; fax: +1 718 364 3576. (E.A. Hazlett)
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20
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Rais M, Cahn W, Schnack HG, Hulshoff Pol HE, Kahn RS, van Haren NEM. Brain volume reductions in medication-naive patients with schizophrenia in relation to intelligence quotient. Psychol Med 2012; 42:1847-1856. [PMID: 22357376 DOI: 10.1017/s0033291712000098] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Global brain abnormalities such as brain volume loss and grey- and white-matter deficits are consistently reported in first-episode schizophrenia patients and may already be detectable in the very early stages of the illness. Whether these changes are dependent on medication use or related to intelligence quotient (IQ) is still debated. METHOD Magnetic resonance imaging scans were obtained for 20 medication-naive patients with first-episode schizophrenia and 26 matched healthy subjects. Volume measures of total brain grey and white matter, third and lateral ventricles and cortical thickness/surface were obtained. Differences between the groups were investigated, taking into account the effect of intelligence. RESULTS Medication-naive patients showed statistically significant reductions in whole-brain volume and cerebral grey- and white-matter volume together with lateral ventricle enlargement compared to healthy subjects. IQ was significantly lower in patients compared to controls and was positively associated with brain and white-matter volume in the whole group. No significant differences in cortical thickness were found between the groups but medication-naive patients had a significantly smaller surface in the left superior temporal pole, Heschl's gyrus and insula compared to controls. CONCLUSIONS Our findings suggest that brain volume loss is present at illness onset, and can be explained by the reduced surface of the temporal and insular cortex. These abnormalities are not related to medication, but IQ.
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Affiliation(s)
- M Rais
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
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21
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Schaeffer EL, Kühn F, Schmitt A, Gattaz WF, Gruber O, Schneider-Axmann T, Falkai P, Schmitt A. Increased cell proliferation in the rat anterior cingulate cortex following neonatal hypoxia: relevance to schizophrenia. J Neural Transm (Vienna) 2012; 120:187-95. [PMID: 22806004 PMCID: PMC3535379 DOI: 10.1007/s00702-012-0859-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 06/29/2012] [Indexed: 01/20/2023]
Abstract
As a consequence of obstetric complications, neonatal hypoxia has been discussed as an environmental factor in the pathophysiology of schizophrenia. However, the biological consequences of hypoxia are unclear. The neurodevelopmental hypothesis of schizophrenia suggests that the onset of abnormal brain development and neuropathology occurs perinatally, whereas symptoms of the disease appear in early adulthood. In our animal model of chronic neonatal hypoxia, we have detected behavioral alterations resembling those known from schizophrenia. Disturbances in cell proliferation possibly contribute to the pathophysiology of this disease. In the present study, we used postnatal rats to investigate cell proliferation in several brain areas following neonatal hypoxia. Rats were repeatedly exposed to hypoxia (89 % N2, 11 % O2) from postnatal day (PD) 4–8. We then evaluated cell proliferation on PD 13 and 39, respectively. These investigations were performed in the anterior cingulate cortex (ACC), caudate-putamen (CPU), dentate gyrus, and subventricular zone. Rats exposed to hypoxia exhibited increased cell proliferation in the ACC at PD 13, normalizing at PD 39. In other brain regions, no alterations have been detected. Additionally, hypoxia-treated rats showed decreased CPU volume at PD 13. The results of the present study on the one hand support the assumption of chronic hypoxia influencing transient cell proliferation in the ACC, and on the other hand reveal normalization during ageing.
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Affiliation(s)
- Evelin L. Schaeffer
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Franziska Kühn
- Department of Psychiatry and Psychotherapy, Georg-August-University, von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - Angelika Schmitt
- Department of Psychiatry and Psychotherapy, University of Würzburg, Füchsleinstr. 15, 97080 Würzburg, Germany
| | - Wagner F. Gattaz
- Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Oliver Gruber
- Department of Psychiatry and Psychotherapy, Georg-August-University, von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Georg-August-University, von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Georg-August-University, von-Siebold-Str. 5, 37075 Göttingen, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nußbaumstr. 7, 80336 Munich, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, Georg-August-University, von-Siebold-Str. 5, 37075 Göttingen, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nußbaumstr. 7, 80336 Munich, Germany
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Healthy aging: an automatic analysis of global and regional morphological alterations of human brain. Acad Radiol 2012; 19:785-93. [PMID: 22503890 DOI: 10.1016/j.acra.2012.03.006] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/17/2012] [Accepted: 03/02/2012] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES Morphologic changes of the human brain during healthy aging provide useful reference knowledge for age-related brain disorders. The aim of this study was to explore age-related global and regional morphological changes of healthy adult brains. MATERIALS AND METHODS T1-weighted magnetic resonance images covering the entire brain were acquired for 314 subjects. Image processing of registration, segmentation, and surface construction were performed to calculate the volumes of the cerebrum, cerebellum, brain stem, lateral ventricle, and subcortical nuclei, as well as the surface area, mean curvature index, cortical thickness of the cerebral cortex, and subjacent white matter volume using FreeSurfer software. Mean values of each morphologic index were calculated and plotted against age group for sectional analysis. Regression analysis was conducted using SPSS to investigate the age effects on global and regional volumes of human brain. RESULTS Overall global and regional volume loss was observed for the entire brain during healthy aging. Moderate atrophy was observed in subcortical gray matter structures, including the thalamus (R(2) = 0.476, P < .001), nucleus accumbens (R(2) = 0.525, P < .001), pallidum (R(2) = 0.461, P < .001), and putamen (R(2) = 0.533, P < .001). The volume of hippocampus showed a slight increase by 40 years of age, followed by a relatively faster decline after the age of 50 years (R(2) = 0.486, P < .001). Surface area and mean curvature were less affected by aging relative to cortical thickness and subjacent white matter volume. Significant cortical thinning was mainly found in the parietal (R(2) = 0.553, P < .001) and insula regions (R(2) = 0.405, P < .001). CONCLUSIONS Morphologic alterations of human brain manifested regional heterogeneity in the scenario of general volume loss during healthy aging. The age effect on the hippocampus demonstrated a unique evolution. These findings provide informative reference knowledge that may help in identifying and differentiating pathologic aging and other neurologic disorders.
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Kunwar A, Ramanathan S, Nelson J, Antshel KM, Fremont W, Higgins AM, Shprintzen RJ, Kates WR. Cortical gyrification in velo-cardio-facial (22q11.2 deletion) syndrome: a longitudinal study. Schizophr Res 2012; 137:20-5. [PMID: 22365148 PMCID: PMC3414250 DOI: 10.1016/j.schres.2012.01.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 01/21/2012] [Accepted: 01/24/2012] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Velo-cardio-facial syndrome (VCFS) has been identified as an important risk factor for psychoses, with up to 32% of individuals with VCFS developing a psychotic illness. Individuals with VCFS thus form a unique group to identify and explore early symptoms and biological correlates of psychosis. In this study, we examined if cortical gyrification pattern, i.e. gyrification index (GI) can be a potential neurobiological marker for psychosis. METHOD GIs of 91 individuals with VCFS were compared with 29 siblings and 54 controls. Further, 58 participants with VCFS, 21 siblings and 18 normal controls were followed up after 3 years and longitudinal changes in GI were compared. Additionally, we also correlated longitudinal changes in GI in individuals with VCFS with prodromal symptoms of psychosis on the Scale of Prodromal Symptoms (SOPS). RESULT Individuals with VCFS had significantly lower GIs as compared to their siblings and normal controls. Longitudinal examination of GI did not reveal any significant group-time interactions between the three groups. Further, longitudinal change in GI scores in the VCFS group was negatively correlated with positive prodromal symptoms, with the left occipital region reaching statistical significance. CONCLUSION The study confirms previous reports that individuals with VCFS have reduced cortical folding as compared to normal controls. However over a period of three years, there is no difference in the rate of change of GI among both individuals with VCFS and normal controls. Finally, our results suggest that neuroanatomical alterations in areas underlying visual processing may be an early marker for psychosis.
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Affiliation(s)
- Arun Kunwar
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, New York
| | - Seethalakshmi Ramanathan
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, New York
| | - Joshua Nelson
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, New York
| | - Kevin M. Antshel
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, New York
| | - Wanda Fremont
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, New York
| | - Anne Marie Higgins
- Department of Otolaryngology, State University of New York at Upstate Medical University, Syracuse, New York
| | | | - Wendy R. Kates
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, New York
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Hirjak D, Wolf RC, Stieltjes B, Seidl U, Schröder J, Thomann PA. Neurological soft signs and subcortical brain morphology in recent onset schizophrenia. J Psychiatr Res 2012; 46:533-9. [PMID: 22316638 DOI: 10.1016/j.jpsychires.2012.01.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 01/06/2012] [Accepted: 01/09/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Minor motor and sensory deficits or neurological soft signs (NSS) are frequently found in patients with schizophrenia at any stage of their illness. The thalamus and basal ganglia are accepted as being important for both motor control and integration of sensory input. However, whether NSS are related to alterations of these brain regions remains controversial. METHOD Twenty patients with recent onset schizophrenia were investigated using high-resolution magnetic resonance imaging (MRI) at 3 Tesla. NSS were examined on the Heidelberg Scale after remission of acute symptoms and related to both volumetric and shape measurements of thalamus, caudate nucleus, putamen, and globus pallidus, respectively. Age, education, medication and duration of illness were considered as potential confounders. RESULTS NSS were associated with structural alterations predominantly in the thalamus, the left caudate nucleus, and in the right globus pallidus. According to shape analyses these associations referred to regionally specific morphometric alterations rather than to global atrophy of the respective structures. CONCLUSION Our findings provide new insights into the association of NSS with brain morphometric alterations and lend further support to an involvement of multiple subcortical regions in schizophrenia.
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Affiliation(s)
- Dusan Hirjak
- Structural Neuroimaging Group, Department of General Psychiatry, University of Heidelberg, Germany.
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25
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Watson DR, Anderson JM, Bai F, Barrett SL, McGinnity TM, Mulholland CC, Rushe TM, Cooper SJ. A voxel based morphometry study investigating brain structural changes in first episode psychosis. Behav Brain Res 2012; 227:91-9. [DOI: 10.1016/j.bbr.2011.10.034] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 10/19/2011] [Accepted: 10/21/2011] [Indexed: 01/04/2023]
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High order linguistic features such as ambiguity processing as relevant diagnostic markers for schizophrenia. SCHIZOPHRENIA RESEARCH AND TREATMENT 2012; 2012:825050. [PMID: 23304500 PMCID: PMC3529898 DOI: 10.1155/2012/825050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 04/16/2012] [Accepted: 11/16/2012] [Indexed: 11/17/2022]
Abstract
Due to the deficits of schizophrenic patients regarding the understanding of vague meanings (D. Ketteler and S. Ketteler (2010)) we develop a special test battery called HOLF (high order linguistic function test), which should be able to detect subtle linguistic performance deficits in schizophrenic patients. HOLF was presented to 40 schizophrenic patients and controls, focussing on linguistic features such as ambiguity, synonymy, hypero-/hyponymy, antinomy, and adages. Using the HOLF test battery we found that schizophrenic patients showed significant difficulties in discriminating ambiguities, hypero- and hyponymy, or synonymy compared to healthy controls. Antonyms and adages showed less significant results in comparing both groups. The more difficult a linguistic task was, the more confusion was measured in the schizophrenic group while healthy controls did not show significant problems in processing high order language tasks.
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Varambally S, Venkatasubramanian G, Gangadhar BN. Neurological soft signs in schizophrenia - The past, the present and the future. Indian J Psychiatry 2012; 54:73-80. [PMID: 22556444 PMCID: PMC3339227 DOI: 10.4103/0019-5545.94653] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Clinical neurological abnormalities in patients with schizophrenia have been generally called "Neurological Soft Signs" (NSS). Studies have consistently shown increased NSS in patients with schizophrenia as compared to healthy persons. Early studies were limited by possible confounds of prior neuroleptic medications and illness chronicity. Studies in first episode never treated schizophrenia patients have addressed these confounds. The clinical significance of these findings and the correlation with cognitive dysmetria is the focus of the current review. Relevant literature was obtained using PUBMED and MEDLINE search (1980-2008) and a direct search of reference list of pertinent journal articles. In a 2003 study, neuroleptic-naive schizophrenia patients had significantly more NSS than controls. Patients who were more neurologically impaired had more negative symptoms. Higher NSS scores in treatment-naive schizophrenia patients and the absence of correlation between NSS and illness duration lends support to a neurodevelopmental pathogenesis for schizophrenia. The finding of incoordination and cerebellar signs in most studies also supports the "cognitive dysmetria" explanatory model for schizophrenia. A significant subgroup of patients with schizophrenia may have more neuropathological abnormalities, which predisposes them for a more severe and chronic course of illness. These patients may potentially be identified by clinical neurological examination, which might be very important for prognostication and evolving better methods of treatment for these patients. NSS, by themselves or as a composite index with other neurobiological parameters, hold potential as a candidate endophenotype for schizophrenia.
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Affiliation(s)
- Shivarama Varambally
- Department of Psychiatry, Schizophrenia Clinic, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
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Molina V, Galindo G, Cortés B, de Herrera AGS, Ledo A, Sanz J, Montes C, Hernández-Tamames JA. Different gray matter patterns in chronic schizophrenia and chronic bipolar disorder patients identified using voxel-based morphometry. Eur Arch Psychiatry Clin Neurosci 2011; 261:313-22. [PMID: 21188405 DOI: 10.1007/s00406-010-0183-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
Abstract
Gray matter (GM) volume deficits have been described in patients with schizophrenia (Sz) and bipolar disorder (BD), but to date, few studies have directly compared GM volumes between these syndromes with methods allowing for whole-brain comparisons. We have used structural magnetic resonance imaging (MRI) and voxel-based morphometry (VBM) to compare GM volumes between 38 Sz and 19 BD chronic patients. We also included 24 healthy controls. The results revealed a widespread cortical (dorsolateral and medial prefrontal and precentral) and cerebellar deficit as well as GM deficits in putamen and thalamus in Sz when compared to BD patients. Besides, a subcortical GM deficit was shown by Sz and BD groups when compared to the healthy controls, although a putaminal reduction was only evident in the Sz patients. In this comparison, the BD patients showed a limited cortical and subcortical GM deficit. These results support a partly different pattern of GM deficits associated to chronic Sz and chronic BD, with some degree of overlapping.
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Affiliation(s)
- Vicente Molina
- Department of Psychiatry, Hospital Universitario de Salamanca, Paseo de San Vicente, Spain.
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29
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Hartberg CB, Sundet K, Rimol LM, Haukvik UK, Lange EH, Nesvåg R, Melle I, Andreassen OA, Agartz I. Subcortical brain volumes relate to neurocognition in schizophrenia and bipolar disorder and healthy controls. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1122-30. [PMID: 21457744 DOI: 10.1016/j.pnpbp.2011.03.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 03/09/2011] [Accepted: 03/17/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Similar patterns of subcortical brain abnormalities and neurocognitive dysfunction have been demonstrated in schizophrenia and bipolar disorder, with more extensive findings in schizophrenia. It is unknown whether relationships between subcortical volumes and neurocognitive performance are similar or different between schizophrenia and bipolar disorder. METHODS MRI scans and neuropsychological test performance were obtained from 117 schizophrenia or 121 bipolar spectrum disorder patients and 192 healthy control subjects. Using the FreeSurfer software, volumes of 18 selected subcortical structures were automatically segmented and analyzed for relationships with results from 7 neurocognitive tests. RESULTS In schizophrenia, larger left ventricular volumes were related to poorer motor speed, and bilateral putamen volumes were related to poorer verbal learning, executive functioning and working memory performance. In bipolar disorder, larger left ventricular volumes were related to poorer motor speed and executive functioning. The relationship between left putamen volume and working memory was specific to schizophrenia. The relationships between left inferior lateral ventricles and motor speed and between right putamen volumes and executive functioning were similar in schizophrenia and bipolar disorder, and different from healthy controls. The results remained significant after corrections for use of antipsychotic medication. Significant structure-function relationships were also found when all subjects were combined into one group. CONCLUSION The present findings suggest that there are differences as well as similarities in subcortical structure/function relationships between patients with schizophrenia or bipolar disorder and healthy individuals. The observed differences further suggest that ventricular and putamen volume sizes may reflect severity of cognitive dysfunction in these disorders.
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Affiliation(s)
- Cecilie B Hartberg
- Institute of Clinical Medicine, Psychiatry Section, University of Oslo, Norway.
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30
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Leung M, Cheung C, Yu K, Yip B, Sham P, Li Q, Chua S, McAlonan G. Gray matter in first-episode schizophrenia before and after antipsychotic drug treatment. Anatomical likelihood estimation meta-analyses with sample size weighting. Schizophr Bull 2011; 37:199-211. [PMID: 19759093 PMCID: PMC3004197 DOI: 10.1093/schbul/sbp099] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cerebral morphological abnormalities in schizophrenia may be modulated by treatment, chronicity, and duration of illness. Comparing brain imaging studies of individuals with first-episode schizophrenia and neuroleptic naive (NN-FES) with that of their neuroleptic-treated counterparts (NT-FES) can help to dissect out the effect of these potential confounders. METHODS We used the anatomical likelihood estimation method to compare voxel-based morphometric studies of NN-FES (n = 162 patients) and NT-FES (n = 336 patients) studies. The analysis included a sample size weighting step based on the Liptak-Stouffer method to reflect the greater power of larger studies. RESULTS Patient samples were matched for age, gender, and duration of illness. An extensive network of gray matter deficits in frontal, temporal, insular, striatal, posterior cingulate, and cerebellar regions was detected in the NN-FES samples as compared with healthy controls. Major deficits were detected in the frontal, superior temporal, insular, and parahippocampal regions for the NT-FES group compared with the NN-FES group. In addition, the NT-FES group showed minor deficits in the caudate, cingulate, and inferior temporal regions compared with the NN-FES group. There were no regions with gray matter volumetric excess in the NT-FES group. CONCLUSION Frontal, striato-limbic, and temporal morphological abnormalities are present in the early stage of schizophrenia and are unrelated to the effects of neuroleptic treatment, chronicity, and duration of illness. There may be dynamic effects of treatment on striato-limbic and temporal, but not frontal, regional gray matter volumes of the brain.
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Affiliation(s)
- Meikei Leung
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Charlton Cheung
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kevin Yu
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Benjamin Yip
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Pak Sham
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong,Centre for Reproduction, Development and Growth, The University of Hong Kong
| | - Qi Li
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong,Centre for Reproduction, Development and Growth, The University of Hong Kong
| | - Siew Chua
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong,Centre for Reproduction, Development and Growth, The University of Hong Kong
| | - Grainne McAlonan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong,Centre for Reproduction, Development and Growth, The University of Hong Kong,To whom correspondence should be addressed; tel: +852-28199564, fax: +852-28551345, e-mail:
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Molina V, Hernández JA, Sanz J, Paniagua JC, Hernández AI, Martín C, Matías J, Calama J, Bote B. Subcortical and cortical gray matter differences between Kraepelinian and non-Kraepelinian schizophrenia patients identified using voxel-based morphometry. Psychiatry Res 2010; 184:16-22. [PMID: 20832256 DOI: 10.1016/j.pscychresns.2010.06.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 05/31/2010] [Accepted: 06/10/2010] [Indexed: 11/26/2022]
Abstract
The long-term outcome of schizophrenia patients may differ depending on their brain structure. This would be reflected in significant structural differences between poor-outcome (i.e., Kraepelinian) and non-Kraepelinian patients. To assess this possibility, we have evaluated the degree of deviation in brain structure in Kraepelinian patients with respect to controls and non-Kraepelinian schizophrenia patients. We used voxel-brain morphometry (VBM) to assess the differences in gray matter volume across the brain in the Kraepelinian group with respect to the healthy controls and non-Kraepelinian patients. Twenty-six Kraepelinian and 18 non-Kraepelinian schizophrenia patients and 41 healthy controls were included. With respect to the healthy controls, the Kraepelinian patients showed a very significant decrease in gray matter in the frontal, occipital, and limbic cortices, and, at a subcortical level, bilaterally in the striatum and thalamus. In comparison with the non-Kraepelinian patients, the Kraepelinian individuals continued to show a similar subcortical decrease. Thus, Kraepelinian patients may be characterized by a distinct pattern of brain abnormalities, in particular, in subcortical regions.
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Affiliation(s)
- Vicente Molina
- Servicio de Psiquiatría, Hospital Universitario de Salamanca, Salamanca, Spain.
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32
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Yu K, Cheung C, Leung M, Li Q, Chua S, McAlonan G. Are Bipolar Disorder and Schizophrenia Neuroanatomically Distinct? An Anatomical Likelihood Meta-analysis. Front Hum Neurosci 2010; 4:189. [PMID: 21103008 PMCID: PMC2987512 DOI: 10.3389/fnhum.2010.00189] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 09/22/2010] [Indexed: 11/13/2022] Open
Abstract
Objective: There is renewed debate on whether modern diagnostic classification should adopt a dichotomous or dimensional approach to schizophrenia and bipolar disorder. This study synthesizes data from voxel-based studies of schizophrenia and bipolar disorder to estimate the extent to which these conditions have a common neuroanatomical phenotype. Methods: A post-hoc meta-analytic estimation of the extent to which bipolar disorder, schizophrenia, or both conditions contribute to brain gray matter differences compared to controls was achieved using a novel application of the conventional anatomical likelihood estimation (ALE) method. 19 schizophrenia studies (651 patients and 693 controls) were matched as closely as possible to 19 bipolar studies (540 patients and 745 controls). Result: Substantial overlaps in the regions affected by schizophrenia and bipolar disorder included regions in prefrontal cortex, thalamus, left caudate, left medial temporal lobe, and right insula. Bipolar disorder and schizophrenia jointly contributed to clusters in the right hemisphere, but schizophrenia was almost exclusively associated with additional gray matter deficits (left insula and amygdala) in the left hemisphere. Limitation: The current meta-analytic method has a number of constraints. Importantly, only studies identifying differences between controls and patient groups could be included in this analysis. Conclusion: Bipolar disorder shares many of the same brain regions as schizophrenia. However, relative to neurotypical controls, lower gray matter volume in schizophrenia is more extensive and includes the amygdala. This fresh application of ALE accommodates multiple studies in a relatively unbiased comparison. Common biological mechanisms may explain the neuroanatomical overlap between these major disorders, but explaining why brain differences are more extensive in schizophrenia remains challenging.
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Affiliation(s)
- Kevin Yu
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong Pokfulam, Hong Kong
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Ellman LM, Deicken RF, Vinogradov S, Kremen WS, Poole JH, Kern DM, Tsai WY, Schaefer CA, Brown AS. Structural brain alterations in schizophrenia following fetal exposure to the inflammatory cytokine interleukin-8. Schizophr Res 2010; 121:46-54. [PMID: 20553865 PMCID: PMC2910151 DOI: 10.1016/j.schres.2010.05.014] [Citation(s) in RCA: 176] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 05/11/2010] [Accepted: 05/12/2010] [Indexed: 12/24/2022]
Abstract
BACKGROUND Maternal infection during pregnancy has been repeatedly associated with increased risk for schizophrenia. Nevertheless, most viruses do not cross the placenta; therefore, the damaging effects to the fetus appear to be related to maternal antiviral responses to infection (e.g. proinflammatory cytokines). Fetal exposure to the proinflammatory cytokine interleukin-8 (IL-8) has been significantly associated with risk of schizophrenia in offspring. This study sought to determine the association between fetal exposure to IL-8 and structural brain changes among schizophrenia cases and controls. METHODS Subjects were 17 cases diagnosed with schizophrenia from the Developmental Insult and Brain Anomaly in Schizophrenia (DIBS) study. Psychiatric diagnoses were determined among offspring with semi-structured interviews and medical records review. IL-8 was determined from assays in archived prenatal sera and volumetric analyses of neuroanatomical regions were obtained from T1-weighted magnetic resonance imaging in adulthood. Eight controls were included for exploratory purposes. RESULTS Among cases, fetal exposure to increases in IL-8 was associated with significant increases in ventricular cerebrospinal fluid, significant decreases in left entorhinal cortex volumes and significant decreases in right posterior cingulate volumes. Decreases that approached significance also were found in volumes of the right caudate, the putamen (bilaterally), and the right superior temporal gyrus. No significant associations were observed among controls. CONCLUSION Fetal exposure to elevations in maternal IL-8 led to structural neuroanatomic alterations among cases in regions of the brain consistently implicated in schizophrenia research. In utero exposure to elevations in IL-8 may partially account for brain disturbances commonly found in schizophrenia.
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Affiliation(s)
| | - Raymond F. Deicken
- Department of Psychiatry, University of California-San Francisco, San Francisco, CA
| | - Sophia Vinogradov
- Department of Psychiatry, University of California-San Francisco, San Francisco, CA,Mental Health Service, San Francisco Department of Veteran Affairs Medical Center, San Francisco, CA
| | - William S. Kremen
- Department of Psychiatry, Center for Behavioral Genomics, University of California-San Diego, and Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA
| | - John H. Poole
- Department of Neuropsychology, Defense & Veterans Brain Injury Center, Veterans Affairs Health Care System, Palo Alto, CA
| | - David M. Kern
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Wei Yann Tsai
- Department of Biostatistics, Mailman School of Public Health, Columbia University
| | | | - Alan S. Brown
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Meduri M, Bramanti P, Ielitro G, Favaloro A, Milardi D, Cutroneo G, Muscatello MRA, Bruno A, Micò U, Pandolfo G, La Torre D, Vaccarino G, Anastasi G. Morphometrical and morphological analysis of lateral ventricles in schizophrenia patients versus healthy controls. Psychiatry Res 2010; 183:52-8. [PMID: 20538436 DOI: 10.1016/j.pscychresns.2010.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 09/08/2009] [Accepted: 01/28/2010] [Indexed: 11/25/2022]
Abstract
The goal of this report was to highlight lateral ventricle morphology and volume differences between schizophrenia patients and matched controls. Subjects identified as suitable for analysis comprised 15 schizophrenia patients and 15 healthy subjects. The method applied is three-dimensional (3D) volume rendering starting from structural magnetic resonance imaging (MRI) studies of selected ventricular regions. Differences between groups relative to the global ventricular system and its subdivisions were found. Total lateral ventricle volume, right ventricle volume and left ventricle volume were all higher in schizophrenia patients than in controls; unilateral differences between the two groups were also outlined (right ventricle volume>left ventricle volume in schizophrenia patients vs. healthy subjects). Furthermore, occipital and frontal horn enlargement was found in schizophrenia patients compared with normal controls, but the difference in the temporal horn was not statistically significant. A substantial difference was noted in lateral ventricle morphology between the two groups. Our findings were consistent with the literature and may shed light on some of the discrepancies in previous reports on differences in lateral ventricle volume enlargement.
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Affiliation(s)
- Mario Meduri
- Unit of Psychiatry, Department of Neurosciences, University of Messina, Italy
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Caudate nucleus volume in individuals at ultra-high risk of psychosis: a cross-sectional magnetic resonance imaging study. Psychiatry Res 2010; 182:223-30. [PMID: 20488675 DOI: 10.1016/j.pscychresns.2010.02.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Revised: 12/24/2009] [Accepted: 02/11/2010] [Indexed: 11/24/2022]
Abstract
The aim of the present study was to investigate whether volumetric abnormalities of the caudate nuclei predate the onset of psychotic illness. Caudate nuclei volume (CNVs), excluding the tail, were measured using region-of-interest (ROI) tracing of magnetic resonance imaging (MRI) scans acquired on a 1.5T scanner. Subjects included 39 individuals deemed at ultra-high risk of psychosis who converted to psychosis (UHR-P) after initial MRI scanning; 39 matched individuals at ultra-high risk who did not convert to psychosis (UHR-NP); and 39 matched healthy controls. All subjects were neuroleptic-naïve. After adjusting CNVs for intracranial volume (ICV), univariate analyses of variance and repeated measures analyses of variance were undertaken to examine the relationship of CNVs to psychosis transition and to family history of psychosis. Pearson's correlations were used to investigate the relationship of psychopathological scores to CNVs. CNVs did not differ significantly between UHR individuals and healthy controls, and there was no significant difference between converters and non-converters to psychosis. In the UHR group, presence of family history of psychosis was not related to CNVs. There was no correlation between CNVs and either positive or negative symptoms of schizophrenia. Significant associations were found between larger CNV and increased errors on a spatial working memory task but better verbal fluency performance. These data suggest that the caudate is macroscopically normal prior to illness onset, while the relationship to tasks of executive function may implicate the caudate together with its connections to prefrontal regions. Future research should examine changes longitudinally together with analysis of shape to assess subregions of the caudate that connect with prefrontal cortex.
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36
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Molina V, Sanz J, Villa R, Pérez J, González D, Sarramea F, Ballesteros A, Galindo G, Hernández JA. Voxel-based morphometry comparison between first episodes of psychosis with and without evolution to schizophrenia. Psychiatry Res 2010; 181:204-10. [PMID: 20153145 DOI: 10.1016/j.pscychresns.2009.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 08/20/2009] [Accepted: 09/13/2009] [Indexed: 10/19/2022]
Abstract
First episodes (FE) of psychosis may evolve or not to schizophrenia in ensuing years, but there is a lack of reliable predictors of which patients will have to face such an unfavorable outcome. Given the replicated structural alterations of the brain in schizophrenia, it seems advisable to assess whether the alterations of this kind that can be detected at the time of an initial psychotic episode are different depending on the outcome of the patients. To this end, here we applied voxel-based morphometry to assess whether the degree of cerebral abnormalities differ between 30 FE patients who evolved to schizophrenia in the ensuing 2years and another 14 FE patients who could not be diagnosed as such during that period. Forty-one controls were also included in the study. We found that the FE patients who evolved to schizophrenia had a significantly lower GM value than the controls bilaterally in the left dorsolateral prefrontal (BA 9) and in left anterior cingulate (BA 33) regions while the FE patients who did not develop schizophrenia showed a distinct, right-sided pattern of deviation (visual cortex, superior temporal gyrus and inferior frontal). The direct comparison between FE patients who evolved or not evolved to schizophrenia did not reveal significant differences. Taken together, our results support the notion that brain abnormalities may be different in psychotic FE patients depending on their evolution in the medium term.
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Affiliation(s)
- Vicente Molina
- Hospital Universitario de Salamanca, Servicio de Psiquiatría, Spain.
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Kaspárek T, Prikryl R, Schwarz D, Tronerová S, Cesková E, Mikl M, Vanícek J. Movement sequencing abilities and basal ganglia morphology in first-episode schizophrenia. World J Biol Psychiatry 2010; 10:752-62. [PMID: 18609414 DOI: 10.1080/15622970701882433] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Studies of brain morphology suggest a link between movement sequencing ability and basal ganglia dysfunction. Unfortunately, relevant studies have provided inconsistent data, which may be the result of differences in the methods of brain morphology assessment, statistical analysis or heterogeneity of the populations studied. AIM To test the hypothesis of a link between the dysfunction of movement sequencing and basal ganglia morphology in a homogenous sample of first-episode schizophrenia patients. METHOD Thirty-seven first-episode schizophrenia patients underwent an assessment of movement sequencing abilities using the NES scale and basal ganglia morphology from MR images. The data were compared with a group of 19 age- and sex-matched healthy controls. RESULTS The group of first-episode patients had a higher concentration of gray matter than healthy controls in the putamen and pallidum in both hemispheres. Patients with abnormal sequencing of movements had lower gray matter concentration than patients without such abnormalities in the left putamen, and no differences were found between the symptomatic group and healthy controls. SUMMARY AND CONCLUSION Our study suggests the involvement of the left putamen in the movement sequencing abnormalities in schizophrenia. Because of the potential confounding effect of medication, the lack of support from external evidence and the low power to perform the whole-brain analysis the results should be considered as preliminary. Further studies, especially with antipsychotic-naive first-episode schizophrenia patients are needed to solve these issues.
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Affiliation(s)
- Tomás Kaspárek
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Ebdrup BH, Glenthøj B, Rasmussen H, Aggernaes B, Langkilde AR, Paulson OB, Lublin H, Skimminge A, Baaré W. Hippocampal and caudate volume reductions in antipsychotic-naive first-episode schizophrenia. J Psychiatry Neurosci 2010; 35:95-104. [PMID: 20184807 PMCID: PMC2834791 DOI: 10.1503/jpn.090049] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Enlarged ventricles and reduced hippocampal volume are consistently found in patients with first-episode schizophrenia. Studies investigating brain structure in antipsychotic-naive patients have generally focused on the striatum. In this study, we examined whether ventricular enlargement and hippocampal and caudate volume reductions are morphological traits of antipsychotic-naive first-episode schizophrenia. METHODS We obtained high-resolution 3-dimensional T1-weighted magnetic resonance imaging scans for 38 antipsychotic-naive first-episode schizophrenia patients and 43 matched healthy controls by use of a 3-T scanner. We warped the brain images to each other by use of a high-dimensional intersubject registration algorithm. We performed voxel-wise group comparisons with permutation tests. We performed small volume correction for the hippocampus, caudate and ventricles by use of a false discovery rate correction (p < 0.05) to control for multiple comparisons. We derived and analyzed estimates of brain structure volumes. We grouped patients as those with (n = 9) or without (n = 29) any lifetime substance abuse to examine the possible effects of substance abuse. RESULTS We found that hippocampal and caudate volumes were decreased in patients with first-episode schizophrenia. We found no ventricular enlargement, differences in global volume or significant associations between tissue volume and duration of untreated illness or psychopathology. The hippocampal volume reductions appeared to be influenced by a history of substance abuse. Exploratory analyses indicated reduced volume of the nucleus accumbens in patients with first-episode schizophrenia. LIMITATIONS This study was not a priori designed to test for differences between schizophrenia patients with or without lifetime substance abuse, and this subgroup was small. CONCLUSION Reductions in hippocampal and caudate volume may constitute morphological traits in antipsychotic-naive first-episode schizophrenia patients. However, the clinical implications of these findings are unclear. Moreover, past substance abuse may accentuate hippocampal volume reduction. Magnetic resonance imaging studies addressing the potential effects of substance abuse in antipsychotic-naive first-episode schizophrenia patients are warranted.
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Affiliation(s)
- Bjørn H. Ebdrup
- Correspondence to: Dr. B.H. Ebdrup, Center for Neuropsychiatric Schizophrenia Research, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Psychiatric Center Glostrup, University Hospital Glostrup, DK-2600 Glostrup, Denmark; fax 45 4323 4653;
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Abstract
Schizophrenia (SZ) is a complex, heterogeneous, and disabling psychiatric disorder that impairs multiple aspects of human cognitive, perceptual, emotional, and behavioral functioning. SZ is relatively frequent (prevalence around 1%), with onset usually during adolescence or early adulthood, and has a deteriorating course. The rapidly growing area of neuroimaging research has has found clear evidence of many cortical and subcortical abnormalities in individuals with SZ. In this article the most recent findings from multiple studies on neurological disorders in SZ are reviewed, and the authors make a strong argument for a neurological basis of the schizophrenic process.
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Affiliation(s)
- Arman Danielyan
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45244, USA
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40
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Crespo-Facorro B, Roiz-Santiáñez R, Pérez-Iglesias R, Tordesillas-Gutiérrez D, Mata I, Rodríguez-Sánchez JM, de Lucas EM, Vázquez-Barquero JL. Specific brain structural abnormalities in first-episode schizophrenia. A comparative study with patients with schizophreniform disorder, non-schizophrenic non-affective psychoses and healthy volunteers. Schizophr Res 2009; 115:191-201. [PMID: 19796919 DOI: 10.1016/j.schres.2009.09.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 08/26/2009] [Accepted: 09/07/2009] [Indexed: 12/31/2022]
Abstract
Evidence so far indicates the consistent association between brain structural abnormalities and schizophrenia already present at the early phases of the illness. This study investigates the specificity of brain structural abnormalities in schizophrenia by using region-of-interest method of volumetric analysis in a heterogeneous sample of schizophrenia spectrum patients at their first break of the illness. 225 subjects, comprising 82 schizophrenia patients, 36 schizophreniform disorder patients and 24 patients with non-schizophrenic non-affective psychoses, and 83 healthy individuals underwent a magnetic resonance imaging brain scan. Quantitative brain morphometric variables were assessed: cortical CSF, lateral ventricle, total brain tissue, white matter and cortical and subcortical gray matter volumes. The contribution of sociodemographic, cognitive and clinical characteristics was controlled. Compared with controls, schizophrenia (P=0.017) and schizophreniform disorder (P=0.023) patients showed an increase in cortical CSF volume. Schizophrenia patients had also markedly enlarged lateral ventricle volume compared to controls (P=0.026). The patients with non-schizophrenic non-affective psychoses did not significantly differ in lateral ventricle and cortical CSF volumes from controls. Compared with controls, schizophrenia and schizophreniform disorder patients demonstrated a significant decrease in total brain tissue (-1.30% and -1.12% respectively). Thalamic volume was reduced (-3.84%) in schizophrenia patients compared to controls (P=0.040). Clinical and cognitive variables were not significantly related with morphological changes. The brain changes found in patients with a first episode of schizophrenia spectrum disorders are robustly associated with the diagnoses of schizophrenia and schizophreniform disorder and are independent of relevant intervening variables.
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Affiliation(s)
- Benedicto Crespo-Facorro
- Department of Psychiatry, University Hospital Marqués de Valdecilla, CIBERSAM, School of Medicine, University of Cantabria, Santander, Spain.
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Navari S, Dazzan P. Do antipsychotic drugs affect brain structure? A systematic and critical review of MRI findings. Psychol Med 2009; 39:1763-1777. [PMID: 19338710 DOI: 10.1017/s0033291709005315] [Citation(s) in RCA: 257] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The potential effects of antipsychotic drugs on brain structure represent a key factor in understanding neuroanatomical changes in psychosis. This review addresses two issues: (1) do antipsychotic medications induce changes in total or regional human brain volumes and (2) do such effects depend on antipsychotic type? METHOD A systematic review of studies reporting structural brain magnetic resonance imaging (MRI) measures: (1) directly in association with antipsychotic use; and (2) in patients receiving lifetime treatment with antipsychotics in comparison with drug-naive patients or healthy controls. We searched Medline and EMBASE databases using the medical subject heading terms: 'antipsychotics' AND 'brain' AND (MRI NOT functional). The search included studies published up to 31 January 2007. Wherever possible, we reported the effect size of the difference observed. RESULTS Thirty-three studies met our inclusion criteria. The results suggest that antipsychotics act regionally rather than globally on the brain. These volumetric changes are of a greater magnitude in association with typical than with atypical antipsychotic use. Indeed, there is evidence of a specific effect of antipsychotic type on the basal ganglia, with typicals specifically increasing the volume of these structures. Differential effects of antipsychotic type may also be present on the thalamus and the cortex, but data on these and other brain areas are more equivocal. CONCLUSIONS Antipsychotic treatment potentially contributes to the brain structural changes observed in psychosis. Future research should take into account these potential effects, and use adequate sample sizes, to allow improved interpretation of neuroimaging findings in these disorders.
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Affiliation(s)
- S Navari
- Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, UK.
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Deng MY, McAlonan GM, Cheung C, Chiu CPY, Law CW, Cheung V, Sham PC, Chen EYH, Chua SE. A naturalistic study of grey matter volume increase after early treatment in anti-psychotic naïve, newly diagnosed schizophrenia. Psychopharmacology (Berl) 2009; 206:437-46. [PMID: 19641900 DOI: 10.1007/s00213-009-1619-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Accepted: 07/10/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Anti-psychotic treatment appears to be associated with striatal volume increase, but how early this change occurs is still unknown. METHODS A single prospective cohort of 20 anti-psychotic-naïve patients, newly diagnosed with schizophrenia, underwent magnetic resonance imaging brain scan at baseline. This was repeated following up to 8 weeks of anti-psychotic treatment. Ten patients had repeat scan within only 3 weeks. The choice of anti-psychotic medication was naturalistic, i.e., clinician-led. Well-matched healthy individuals were also scanned to control for non-specific changes over a 3-week period. RESULTS After 3 weeks of anti-psychotic treatment, significant grey matter volume increase in the right caudate, superior and inferior frontal gyrus, precentral gyrus, and left inferior parietal lobule was noted. However, after 8 weeks of anti-psychotic treatment, volume increase in the right thalamus and bilateral cerebellum was observed. Significant grey matter reduction was detected in the left medial frontal gyrus at both 3- and 8-week intervals. CONCLUSIONS Early increase in striatal volume change occurs as early as 3 weeks after anti-psychotic treatment, whilst thalamic volume increase is apparent later, by 8 weeks of treatment. We speculate that drug-mediated neuroplasticity may provide a biomarker for clinical recovery.
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Affiliation(s)
- Michelle Y Deng
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, Hong Kong
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43
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Levitt JJ, Styner M, Niethammer M, Bouix S, Koo MS, Voglmaier MM, Dickey CC, Niznikiewicz MA, Kikinis R, Robert WM, Shenton ME. Shape abnormalities of caudate nucleus in schizotypal personality disorder. Schizophr Res 2009; 110:127-39. [PMID: 19328654 PMCID: PMC2756791 DOI: 10.1016/j.schres.2008.11.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2008] [Revised: 11/01/2008] [Accepted: 11/04/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Previously, we reported abnormal volume and global shape in the caudate nucleus in schizotypal personality disorder (SPD). Here, we use a new shape measure which importantly permits local in addition to global shape analysis, as well as local correlations with behavioral measures. METHODS Thirty-two female and 15 male SPDs, and 29 female and 14 male normal controls (NCLs), underwent brain magnetic resonance imaging (MRI). We assessed caudate shape measures using spherical harmonic-point distribution model (SPHARM-PDM) methodology. RESULTS We found more pronounced global shape differences in the right caudate in male and female SPD, compared with NCLs. Local shape differences, principally in the caudate head, survived statistical correction on the right. Also, we performed correlations between local surface deformations with clinical measures and found significant correlations between local shape deflated deformations in the anterior medial surface of the caudate with verbal learning capacity in female SPD. CONCLUSIONS Using SPHARM-PDM methodology, we found both global and local caudate shape abnormalities in male and female SPD, particularly right-sided, and largely restricted to limbic and cognitive anterior caudate. The most important and novel findings were bilateral statistically significant correlations between local surface deflations in the anterior medial surface of the head of the caudate and verbal learning capacity in female SPD. By extension, these local caudate correlation findings implicate the ventromedial prefrontal cortex (vmPFC), which innervates that area of the caudate, and demonstrate the utility of local shape analysis to investigate the relationship between specific subcortical and cortical brain structures in neuropsychiatric conditions.
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Affiliation(s)
- James J. Levitt
- Laboratory of Neuroscience, Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Harvard Medical School, Brockton, MA, USA, Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Corresponding author. Department of Psychiatry-116A, VA Boston Healthcare System, Brockton Division, Harvard Medical School, 940 Belmont Street, Brockton, MA 02301, USA. (J.J. Levitt)
| | - Martin Styner
- Department of Computer Science and Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Marc Niethammer
- Department of Computer Science and Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Min-Seong Koo
- College of Medicine, Kwandong University, Seoul, Korea
| | - Martina M. Voglmaier
- Laboratory of Neuroscience, Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Harvard Medical School, Brockton, MA, USA, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
| | - Chandlee C. Dickey
- Laboratory of Neuroscience, Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Harvard Medical School, Brockton, MA, USA, Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Margaret A. Niznikiewicz
- Laboratory of Neuroscience, Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Harvard Medical School, Brockton, MA, USA, Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ron Kikinis
- Surgical Planning Laboratory, Magnetic Resonance Imaging Division, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - W. McCarley Robert
- Laboratory of Neuroscience, Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Harvard Medical School, Brockton, MA, USA
| | - Martha E. Shenton
- Laboratory of Neuroscience, Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Harvard Medical School, Brockton, MA, USA, Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA, Surgical Planning Laboratory, Magnetic Resonance Imaging Division, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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44
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Chua SE, Deng Y, Chen EYH, Law CW, Chiu CPY, Cheung C, Wong JCH, Lienenkaëmper N, Cheung V, Suckling J, McAlonan GM. Early striatal hypertrophy in first-episode psychosis within 3 weeks of initiating antipsychotic drug treatment. Psychol Med 2009; 39:793-800. [PMID: 18713487 DOI: 10.1017/s0033291708004212] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We and others have reported that patients experiencing their first episode of psychosis already have significant structural brain abnormalities. Antipsychotics seem to reverse subcortical volume deficits after months of treatment. However, the early impact of medication on brain morphology is not known. METHOD Forty-eight individuals in their first episode of psychosis underwent magnetic resonance imaging (MRI) brain scanning. Twenty-six were antipsychotic naive and 22 were newly treated with antipsychotic medication for a median period of 3 weeks. In each group, 80% of subjects received a diagnosis of schizophrenia. The two groups were balanced for age, sex, handedness, ethnicity, height, years of education, paternal socio-economic status (SES) and Positive and Negative Syndrome Scale (PANSS) score. Group differences in whole-brain grey matter were compared voxel by voxel, using Brain Activation and Morphological Mapping (BAMM) software. We also conducted testing of group differences with region-of-interest (ROI) measurements of the caudate nucleus. RESULTS Relative to the untreated group, those receiving antipsychotic medication for 3-4 weeks had significantly greater grey-matter volumes in the bilateral caudate and cingulate gyri, extending to the left medial frontal gyrus. ROI analysis confirmed that, in treated patients, the right and left caudate nuclei were significantly larger by 10% (p<0.039, two-tailed) and 9% (p<0.048, two-tailed) respectively. CONCLUSIONS Early striatal grey-matter enlargement may occur within the first 3-4 weeks of antipsychotic treatment. Possible reasons for putative striatal hypertrophy and its implications are discussed.
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Affiliation(s)
- S E Chua
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, S.A.R. China
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Ballmaier M, Schlagenhauf F, Toga AW, Gallinat J, Koslowski M, Zoli M, Hojatkashani C, Narr KL, Heinz A. Regional patterns and clinical correlates of basal ganglia morphology in non-medicated schizophrenia. Schizophr Res 2008; 106:140-7. [PMID: 18818054 PMCID: PMC2709178 DOI: 10.1016/j.schres.2008.08.025] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2008] [Revised: 08/02/2008] [Accepted: 08/07/2008] [Indexed: 10/21/2022]
Abstract
Although structural changes of the basal ganglia are widely implicated in schizophrenia, prior findings in chronically medicated patients show that these changes relate to particular antipsychotic treatments. In unmedicated schizophrenia, local alterations in morphological parameters and their relationships with clinical measures remain unknown. Novel surface-based anatomical modelling methods were applied to magnetic resonance imaging data to examine regional changes in the shape and volume of the caudate, the putamen and the nucleus accumbens in 21 patients (19 males/2 females; mean age=30.7+/-7.3) who were either antipsychotic-naïve or antipsychotic-free for at least 1 year and 21 healthy comparison subjects (19 males/2 females; mean age=31.1+/-8.2). Clinical relationships of striatal morphology were based on exploratory analyses. Left and right global putamen volumes were significantly smaller in patients than controls; no significant global volume effects were observed for the caudate and the nucleus accumbens. However, surface deformation mapping results showed localized volume changes prominent bilaterally in medial/lateral anterior regions of the caudate, as well as in anterior and midposterior regions of the putamen, pronounced on the medial surface. A significant positive correlation was observed between right anterior putamen surface contractions and affective flattening, a core negative symptom of schizophrenia. The diagnostic effects of local surface deformations mostly pronounced in the associative striatum, as well as the correlation between anterior putamen morphology and affective flattening in unmedicated schizophrenia suggest disease-specific neuroanatomical abnormalities and distinct cortical-striatal dysconnectivity patterns relevant to altered executive control, motor planning, along with abnormalities of emotional processing.
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Affiliation(s)
- Martina Ballmaier
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.
| | - Florian Schlagenhauf
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Arthur W. Toga
- Laboratory of Neuro Imaging, Department of Neurology, University of California at Los Angeles, USA
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Michael Koslowski
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Michele Zoli
- Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Cornelius Hojatkashani
- Laboratory of Neuro Imaging, Department of Neurology, University of California at Los Angeles, USA
| | - Katherine L. Narr
- Laboratory of Neuro Imaging, Department of Neurology, University of California at Los Angeles, USA
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
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46
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Horan WP, Green MF, Knowlton BJ, Wynn JK, Mintz J, Nuechterlein KH. Impaired implicit learning in schizophrenia. Neuropsychology 2008; 22:606-17. [PMID: 18763880 DOI: 10.1037/a0012602] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Schizophrenia patients consistently show deficits on tasks of explicit learning and memory. In contrast, their performance on implicit processing tasks often appears to be relatively intact, although most studies have focused on implicit learning of motor skills. This study evaluated implicit learning in 59 medicated schizophrenia outpatients and 43 controls using 2 different cognitive skill tasks. Participants completed a probabilistic classification task to assess procedural habit learning and an artificial grammar task to assess incidental learning of complex rule-based knowledge, as well as an explicit verbal learning and memory task. In addition to performing worse than controls on the explicit learning task, patients showed worse overall performance on the probabilistic classification task, which involves gradual learning through trial-by-trial performance feedback. However, patients and controls showed similar levels of learning on the artificial grammar task, suggesting a preserved ability to acquire complex rule-based knowledge in the absence of performance feedback. Discussion focuses on possible explanations for schizophrenia patients' poor probabilistic classification task performance.
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Affiliation(s)
- William P Horan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
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Brandt GN, Bonelli RM. Structural neuroimaging of the basal ganglia in schizophrenic patients: a review. Wien Med Wochenschr 2008; 158:84-90. [DOI: 10.1007/s10354-007-0478-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 08/09/2007] [Indexed: 10/22/2022]
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Paradiso S, Turner BM, Paulsen JS, Jorge R, Ponto LLB, Robinson RG. Neural bases of dysphoria in early Huntington's disease. Psychiatry Res 2008; 162:73-87. [PMID: 18068955 PMCID: PMC3348657 DOI: 10.1016/j.pscychresns.2007.04.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 03/12/2007] [Accepted: 04/08/2007] [Indexed: 11/27/2022]
Abstract
Psychiatric disorders, including disorders of emotion control, are common in Huntington's disease. The neurobiological mechanism of the increased rate of disorders of emotion control are not known. Emotion perception deficits have been reported in Huntington's disease, but studies of emotional experience have been limited. In the present study we aim to expand the research in emotion in Huntington's disease by examining the neural bases of induced dysphoria at an early stage of Huntington's disease. Ten Huntington's disease patients and 12 demographically matched healthy volunteers underwent [(15)O] water positron emission tomography while in a transient state of dysphoria induced by viewing negatively charged affect-laden stimuli. Both groups experienced dysphoric mood, but Huntington's disease patients responded to the stimuli with greater arousal, anger and fear than healthy controls. Induced dysphoric mood was associated with a widespread reduction of activity within the frontal and parietal lobes, thalamus, and cerebellum. These differences could not be explained based on the smaller gray matter volumes of the corresponding regions, although in Huntington's disease patients smaller caudate nucleus volumes predicted lower dorsal-lateral prefrontal activity. Areas of increased activity included the striate and extrastriate cortex, the left thalamus, the transverse temporal gyrus, and the posterior hippocampus. This study elucidates possible mechanisms contributing to psychiatric disturbances of emotion often found in patients with Huntington's disease.
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Affiliation(s)
- Sergio Paradiso
- Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA.
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49
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Gunduz-Bruce H, Szeszko PR, Gueorguieva R, Ashtari M, Robinson DG, Kane JM, Bilder RM. Cortisol levels in relation to hippocampal sub-regions in subjects with first episode schizophrenia. Schizophr Res 2007; 94:281-7. [PMID: 17490857 DOI: 10.1016/j.schres.2007.03.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2006] [Revised: 03/22/2007] [Accepted: 03/26/2007] [Indexed: 11/22/2022]
Abstract
The etiology of hippocampal volumetric reductions in schizophrenia is largely unknown. In addition to genetic factors, environmental factors might also play a role. High levels of glucocorticoids are known to affect hippocampal volume in disorders such as Cushing's syndrome, but the relationship between cortisol and hippocampal volumes has not been studied in schizophrenia. We obtained diurnal salivary cortisol levels and MRI images to explore the link between cortisol levels and regional hippocampal volumes in healthy controls (N=29) and subjects with first episode schizophrenia (N=16) at the time of first admission. T1-weighted coronal MR images (slice thickness=1.5 mm) were acquired through the whole head using a 3D Fast SPGR IR Prep sequence on a 1.5 T GE imaging system. Using ANOVA, cumulative daily cortisol exposure calculated as area under the curve for each subject revealed significantly higher cortisol levels in the patient group [F(1,43)=4.4 p=0.04]. However, there were no statistically significant associations between the cortisol measures and regional hippocampal volumes in the subjects, except a trend level link between anterior hippocampal volume and cortisol in the positive direction, in parallel to previous findings in healthy adolescents. Our findings do not suggest a robust association between cortisol levels and hippocampal volumes in a first episode schizophrenia sample. Larger scale studies are needed to conclude a link between the two measures, yet it is possible that the negative association that was previously shown in other disorders may not apply to schizophrenia.
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Affiliation(s)
- Handan Gunduz-Bruce
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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50
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Glenthoj A, Glenthoj BY, Mackeprang T, Pagsberg AK, Hemmingsen RP, Jernigan TL, Baaré WFC. Basal ganglia volumes in drug-naive first-episode schizophrenia patients before and after short-term treatment with either a typical or an atypical antipsychotic drug. Psychiatry Res 2007; 154:199-208. [PMID: 17360162 DOI: 10.1016/j.pscychresns.2006.10.002] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Revised: 09/19/2006] [Accepted: 10/20/2006] [Indexed: 10/23/2022]
Abstract
The present study examined basal ganglia volumes in drug-naive first-episode schizophrenic patients before and after treatment with either a specific typical or atypical antipsychotic compound. Sixteen antipsychotic drug-naive and three minimally medicated first-episode schizophrenic patients and 19 matched controls participated. Patients were randomly assigned to treatment with either low doses of the typical antipsychotic drug, zuclopenthixol, or the atypical compound, risperidone. High-resolution magnetic resonance imaging (MRI) scans were obtained in patients before and after 12 weeks of exposure to medication and in controls at baseline. Caudate nucleus, nucleus accumbens, and putamen volumes were measured. Compared with controls, absolute volumes of interest (VOIs) were smaller in patients at baseline and increased after treatment. However, with controls for age, gender and whole brain or intracranial volume, the only significant difference between patients and controls was a Hemisphere x Group interaction for the caudate nucleus at baseline, with controls having larger left than right caudate nuclei and patients having marginally larger right than left caudate volumes. Within patients, the two medication groups did not differ significantly with respect to volume changes after 3 months of low dose treatment in any of the VOIs. Nevertheless, when medication groups were examined separately, a significant volume increase in the putamen was evidenced in the risperidone group. The altered asymmetry in caudate volume in patients suggests intrinsic basal ganglia pathology in schizophrenia, most likely of neurodevelopmental origin.
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Affiliation(s)
- Andreas Glenthoj
- Danish Research Centre for Magnetic Resonance Imaging, University of Copenhagen, Hvidovre Hospital, Denmark
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