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Long J, Xu J, Wang X, Li J, Rao S, Wu H, Kuang W. Altered Local Gyrification Index and Corresponding Functional Connectivity in Medication Free Major Depressive Disorder. Front Psychiatry 2020; 11:585401. [PMID: 33424661 PMCID: PMC7793885 DOI: 10.3389/fpsyt.2020.585401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/24/2020] [Indexed: 02/05/2023] Open
Abstract
A lot of previous studies have documented that major depressive disorder (MDD) is a developmental disorder. The cortical surface measure, local gyrification index (LGI), can well reflect the fetal and early postnatal neurodevelopmental processes. Thus, LGI may provide new insight for the neuropathology of MDD. The previous studies only focused on the surface structural abnormality, but how the structural abnormality lead to functional connectivity changes is unexplored. In this study, we investigated LGI and corresponding functional connectivity difference in 28 medication-free MDD patients. We found significantly decreased LGI in left lingual gyrus (LING) and right posterior superior temporal sulcus (bSTS), and the changed LGI in bSTS was negatively correlated with disease onset age and anxiety scores. The following functional connectivity analyses identified decreased functional connectivities between LING and right LING, precentral gyrus, and middle temporal gyrus. The decreased functional connectivities were correlated with disease duration, onset, and depression symptoms. Our findings revealed abnormal LGI in LING and bSTS indicating that the abnormal developmental of visual and social cognition related brain areas may be an early biomarker for depression.
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Affiliation(s)
- Jiang Long
- Deparment of Psychiatry, West China Hospital, Sichuan University, Chengdu, China
| | - Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xue Wang
- Deparment of Psychiatry, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Li
- Deparment of Psychiatry, West China Hospital, Sichuan University, Chengdu, China
| | - Shan Rao
- Deparment of Psychiatry, West China Hospital, Sichuan University, Chengdu, China
| | - Huawang Wu
- Department of Radiology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Weihong Kuang
- Department of Psychiatry and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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Schmitgen MM, Depping MS, Bach C, Wolf ND, Kubera KM, Vasic N, Hirjak D, Sambataro F, Wolf RC. Aberrant cortical neurodevelopment in major depressive disorder. J Affect Disord 2019; 243:340-347. [PMID: 30261449 DOI: 10.1016/j.jad.2018.09.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 08/07/2018] [Accepted: 09/10/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is strong neuroimaging evidence that cortical alterations represent a core pathophysiological feature of major depressive disorder (MDD). Differential contributions of cortical features of neurodevelopmental origin, which may distinctly contribute to MDD vulnerability, disease-onset, or symptom expression, are unclear at present. METHODS We investigated distinct markers of cortical neurodevelopment, i.e. local cortical gyrification (LGI) and thickness (CT) in patients with MDD (n = 38) and healthy controls (HC, n = 22) using 3 T structural magnetic resonance imaging data and surface-based data analysis techniques. CT and LGI were computed using the Computational Anatomy Toolbox (CAT12). Analyses were performed for the entire cortical surface followed by a complementary regions-of-interest approach. RESULTS MDD patients showed significantly greater LGI in frontal, cingulate, parietal, temporal, and occipital regions compared to HC (FDR-corrected at p < 0.05 using threshold-free cluster enhancement). No significant differences of CT were found. In the MDD-group, correlations were found between duration of illness in years and number of depressive episodes and LGI of frontal, temporal, and parietal regions (p < 0.05). LIMITATIONS Main limitations are the relatively modest sample size and a cross-sectional study design. We did not control for early environmental factors potentially influencing neurodevelopment, such as childhood trauma. We report associations uncorrected for multiple comparisons. CONCLUSIONS The data suggest different local trajectories of cortical change in MDD. In addition, our data support the notion that aberrant cortical development may serve as a vulnerability marker of MDD, as well as a potential predictor of disease course.
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Affiliation(s)
- Mike M Schmitgen
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115 Heidelberg, Germany
| | - Malte S Depping
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115 Heidelberg, Germany
| | - Claudia Bach
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115 Heidelberg, Germany
| | - Nadine D Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115 Heidelberg, Germany
| | - Katharina M Kubera
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115 Heidelberg, Germany
| | - Nenad Vasic
- Department of Psychiatry and Psychotherapy, Clinical Center Christophsbad, Göppingen, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University Mannheim, Germany
| | - Fabio Sambataro
- Department of Experimental and Clinical Medical Sciences (DISM), University of Udine, Italy
| | - Robert C Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115 Heidelberg, Germany.
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Pandey GN, Rizavi HS, Zhang H, Ren X. Abnormal gene and protein expression of inflammatory cytokines in the postmortem brain of schizophrenia patients. Schizophr Res 2018; 192:247-254. [PMID: 28476335 PMCID: PMC5668197 DOI: 10.1016/j.schres.2017.04.043] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/20/2017] [Accepted: 04/24/2017] [Indexed: 01/20/2023]
Abstract
Immune function abnormalities have been implicated in the pathophysiology of schizophrenia (SZ). This is primarily based on the observation that the levels of proinflammatory cytokines are significantly increased in the serum of SZ patients compared with normal control (NC) subjects. However, it is not known if similar cytokines abnormalities are also present in the brain of SZ patients. To further examine the involvement of inflammatory cytokines in the brain of SZ patients, we determined the protein and mRNA levels of TNF-α, IL-1β, IL-2, IL-6, IL-8, IL-10, IL-13, LTA and IL-1RA in the prefrontal cortex (PFC, Brodmann area 9) of SZ patients. We found that the protein and mRNA expression levels of the cytokines TNF-α and IL-6 are significantly increased and those of IL-10 are significantly decreased in the PFC of SZ patients. No difference in the protein and mRNA levels of IL-1β, IL-13, and IL-1RA was observed between SZ patients and NC subjects. The protein expression levels of IL-8 were significantly decreased and those of LTA were significantly increased in SZ patients, but no significant difference in the mRNA levels of IL-8 and LTA was observed between SZ patients and NC subjects. The levels of IL-2 were undetectable or very low in the postmortem brain of either SZ or NC subjects. These results suggest abnormalities of specific pro- and anti-inflammatory cytokines in the postmortem brain of SZ patients. These observations may have important implications in understanding the role of inflammatory cytokines in the pathophysiology of SZ.
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Affiliation(s)
- Ghanshyam N Pandey
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL 60612, USA.
| | - Hooriyah S Rizavi
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL 60612, USA
| | - Hui Zhang
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL 60612, USA
| | - Xinguo Ren
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL 60612, USA
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Terzić T, Kastelic M, Dolžan V, Plesničar BK. Genetic variability testing of neurodevelopmental genes in schizophrenic patients. J Mol Neurosci 2014; 56:205-11. [PMID: 25529856 DOI: 10.1007/s12031-014-0482-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 12/14/2014] [Indexed: 10/24/2022]
Abstract
This study investigated the associations between single nucleotide polymorphisms in the neurodevelopmental Disrupted In Schizophrenia 1 (DISC1 ), neuregulin 1 (NRG1), brain-derived neurotrophic factor (BDNF) and NOTCH4 genes and the clinical symptoms and the occurrence of treatment-resistant schizophrenia in the Slovenian population. We included 138 schizophrenia patients, divided into treatment-responsive and treatment-resistant group and 94 healthy blood donors. All subjects were genotyped for eight polymorphisms (DISC1 rs6675281, DISC1 rs821616, NRG1 rs3735781, NRG1 rs3735782, NRG1 rs10503929, NRG1 rs3924999, BDNF rs6265, NOTCH rs367398) and investigated for associations with clinical variables. NOTCH4 rs367398 AA/AG was significantly associated with worse Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression (CGI) score. NOTCH4 rs367398 was not statistically significantly associated with the occurrence of treatment-resistant schizophrenia after the correction for multiple testing. Our data indicate that NOTCH4 polymorphism can influence clinical symptoms in Slovenian patients with schizophrenia.
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Affiliation(s)
- Tea Terzić
- University Psychiatric Clinic Ljubljana, Studenec 48, 1260, Ljubljana, Slovenia
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Medium-term course and outcome of schizophrenia depicted by the sixth-month subtype after an acute episode. J Formos Med Assoc 2012; 111:265-74. [DOI: 10.1016/j.jfma.2011.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 11/13/2010] [Accepted: 01/30/2011] [Indexed: 11/22/2022] Open
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Huang GH, Tsai HH, Hwu HG, Chen CH, Liu CC, Hua MS, Chen WJ. Patient subgroups of schizophrenia based on the Positive and Negative Syndrome Scale: composition and transition between acute and subsided disease states. Compr Psychiatry 2011; 52:469-78. [PMID: 21193177 DOI: 10.1016/j.comppsych.2010.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 10/26/2010] [Accepted: 10/27/2010] [Indexed: 10/18/2022] Open
Abstract
The present study focuses on schizophrenia patient subgroups with specific symptom pattern using the Positive and Negative Syndrome Scale (PANSS). In this report, we intend to (1) provide a more appropriate analytic method for exploring the subgroups based on PANSS data, (2) validate identified subgroups with external variables, and (3) estimate probabilities of subgroup changes between 2 disease states. The analyzed data include 219 acute-state patients who had completed the PANSS within 1 week of index admission and 225 subsided-state patients who were living in the community and under family care. Regression extension of latent class analysis was performed. We found that acute schizophrenia can be classified into 4 subgroups--whole syndrome, whole syndrome without hostility, partial syndrome with negative symptoms, and partial syndrome with pure reality distortion--and that subsided schizophrenia can be classified into 3 subgroups--florid symptom, marked negative, and remitted. Patients of the whole syndrome, whole syndrome without hostility, partial syndrome with negative symptoms, and partial syndrome with pure reality distortion subgroups at the acute state were most likely to transit to the florid symptom (61%), florid symptom (48%), marked negative (42%), and remitted (56%) subgroups at the subsided state, respectively. Significant relationships of obtained subgroups with sociodemographic variables and neurocognitive variables were identified. These results of different subgroups will provide the background for facilitating current molecular, genetic, and neurobiological studies of schizophrenia.
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Affiliation(s)
- Guan-Hua Huang
- Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
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Xiong P, Zeng Y, Wan J, Xiaohan DH, Tan D, Lu J, Xu F, Li HY, Zhu Z, Ma M. The role of NGF and IL-2 serum level in assisting the diagnosis in first episode schizophrenia. Psychiatry Res 2011; 189:72-6. [PMID: 21277636 DOI: 10.1016/j.psychres.2010.12.017] [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: 12/03/2009] [Revised: 11/03/2010] [Accepted: 12/08/2010] [Indexed: 10/18/2022]
Abstract
Development of reliable diagnostic bio-markers for schizophrenia remains a diagnostic challenge. Serum NGF and IL-2 were analyzed to examine the diagnostic efficiency and predictive capability of these two biomarkers in relation to schizophrenia diagnosis. Thirty neuroleptic naïve subjects with first-episode schizophrenia, thirty patients with major depressive disorder (MDD) and twenty-eight healthy control subjects participated in the study. One-way ANOVA demonstrated significantly lower serum IL-2 and NGF among schizophrenic patients and patients with MDD compared with healthy controls. Receiver operating characteristic (ROC) curve analysis was used to ascertain diagnostic efficiency of serum IL-2 and NGF levels. Area under the ROC curve (AUC) revealed a high level of differentiation between schizophrenic patients and healthy controls for both IL-2 and NGF serum concentrations. Diagnostic efficiency of combined NGF and IL-2 serum levels was also high in schizophrenic patients compared with healthy controls. Serum NGF and IL-2 are promising as potential screening or diagnostic biomarkers for schizophrenia and may be a useful adjunct for clinical assessment.
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Affiliation(s)
- Peng Xiong
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical College, #295 Xichang Road, Kunming, Yunnan, 650031, China
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Frisoni GB, Prestia A, Adorni A, Rasser PE, Cotelli M, Soricelli A, Bonetti M, Geroldi C, Giannakopoulos P, Thompson PM. In vivo neuropathology of cortical changes in elderly persons with schizophrenia. Biol Psychiatry 2009; 66:578-85. [PMID: 19409532 DOI: 10.1016/j.biopsych.2009.02.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 01/22/2009] [Accepted: 02/19/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Elderly schizophrenia patients frequently develop cognitive impairment of unclear etiology. Magnetic resonance imaging (MRI) studies revealed brain structural abnormalities, but the pattern of cortical gray matter (GM) volume and its relationship with cognitive and behavioral symptoms are unknown. METHODS Magnetic resonance scans were taken from elderly schizophrenia patients (n = 20, age 67 +/- 6 SD, Mini-Mental State Examination [MMSE] 23 +/- 4), Alzheimer's disease (AD) patients (n = 20, age 73 +/- 9, MMSE 22 +/- 4), and healthy elders (n = 20, age 73 +/- 8, MMSE 29 +/- 1). Patients were assessed with a comprehensive neuropsychological and behavioral battery. Cortical pattern matching and a region-of-interest analysis, based on Brodmann areas (BAs), were used to map three-dimensional (3-D) profiles of differences in patterns of gray matter volume among groups. RESULTS Schizophrenia patients had 10% and 11% lower total left and right GM volume than healthy elders (p < .001) and 7% and 5% more than AD patients (p = .06 and ns). Regions that had both significantly less gray matter than control subjects and gray matter volume as low as AD mapped to the cingulate gyrus and orbitofrontal cortex (BA 30, 23, 24, 32, 25, 11). The strongest correlate of gray matter volume in elderly schizophrenia patients, although nonsignificant, was the positive symptom subscale of the Positive and Negative Syndrome Scale, mapping to the right anterior cingulate area (r = .42, p = .06). CONCLUSIONS The orbitofrontal/cingulate region had low gray matter volume in elderly schizophrenia patients. Neither cognitive impairment nor psychiatric symptoms were significantly associated with structural differences, even if positive symptoms tended to be associated with increased gray matter volume in this area.
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Affiliation(s)
- Giovanni B Frisoni
- LENITEM-Laboratory of Epidemiology Neuroimaging and Telemedicine, IRCCS Centro San Giovanni di Dio FBF, the National Centre for Research and Care of Alzheimer's and Mental Diseases, Brescia, Italy.
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Singh B, Bera NK, Nayak CR, Chaudhuri TK. Decreased serum levels of interleukin-2 and interleukin-6 in Indian Bengalee schizophrenic patients. Cytokine 2009; 47:1-5. [PMID: 19502081 DOI: 10.1016/j.cyto.2009.05.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 05/10/2009] [Accepted: 05/15/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE Autoimmune process is thought to be involved in the pathophysiology in some cases of schizophrenia. Alteration in interleukin (IL) regulation is regarded as additional proof of autoimmunological background in schizophrenia. Most of the research in interleukin activity in schizophrenia has been in Caucasian and some Mongoloid patients. We have studied the serum IL-2 and IL-6 level in psychotropic medication free and antipsychotic medicating schizophrenic patients who are Indian Bengalee by ethnicity. METHOD Twenty psychotropic medication free and 30 antipsychotic medicating schizophrenic patients who fulfilled DSM-IV-TR criteria and 30 of the same age and sex matched controls were recruited. Serum level of IL-2 and IL-6 were measured by enzyme-linked immunosorbent assay (ELISA). RESULT There was a significant decrease of IL-2 and IL-6 in both antipsychotic medicating and psychotropic medication free patients. Further the medicating patients showed lower level of IL-2 and IL-6 than the psychotropic medication free patients. CONCLUSION This is the first study to describe a decrease serum level of IL-6 in schizophrenic patients. The study provides the evidence that some kind of immune dysregulation is involved in pathophysiology of schizophrenia. The study also provides the evidence for the immunosuppressive effect of antipsychotic drugs.
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Affiliation(s)
- Bisu Singh
- Cellular Immunology Laboratory, Department of Zoology, University of North Bengal, Siliguri 734 013, West Bengal, India
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Garver DL, Holcomb JA, Christensen JD. Compromised myelin integrity during psychosis with repair during remission in drug-responding schizophrenia. Int J Neuropsychopharmacol 2008; 11:49-61. [PMID: 17708778 DOI: 10.1017/s1461145707007730] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Functional connection among the information-processing (grey-matter) centres within the CNS are necessary for the coordinated processing of perception, affect, thought and behaviour. Myelinated neuronal bundles provide the links among such processing centres. Magnetic resonance diffusion tensor imaging (DTI) can assess the physical integrity of myelin. Using DTI, the authors assessed diffusivity (Dm) within whole brain in 14 controls and within 13 acutely psychotic, drug-free schizophrenics both before and after 28 d of antipsychotic drug treatment. Drug-responder schizophrenicss (D-RS) (n=8) were differentiated from poor responders (PR) (n=5) according to previously defined criteria. Differences of Dm at both baseline and following treatment were assessed using Dm distributional analyses and Statistical Parametric Software (SPM2). Impaired physical integrity of myelin, demonstrated by an increase (overall p<0.05) of Dm, was found in the D-RS patients, with multiple regions demonstrating p<0.0005 patient-control differences. The pathological increase in Dm was reduced (p<0.03) following treatment-associated reduction of psychotic symptoms by 84%. Dm of PR patients did not differ from controls at baseline or following subacute treatment. While the pathophysiology(ies) underlying psychosis in poorly responsive (PR) schizophrenics does not appear to be related to a disordered myelin, the findings are consistent with a partially reversible disorder of myelin integrity, and may underlie a dys-synchrony of information processing in a major subgroup of drug-responsive patients with schizophrenia. An antipsychotic drug-induced cascade may partially restore myelin integrity and functional connectivity concomitant with antipsychotic effects in such D-RS patients.
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Affiliation(s)
- David L Garver
- Seven Counties Services, Inc., Louisville, KY 4022, USA.
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Osuji IJ, McGarrahan A, Mihalakos P, Garver D, Kingsbury S, Cullum CM. Neuropsychological functioning in MRI-derived subgroups of schizophrenia. Schizophr Res 2007; 92:189-96. [PMID: 17363218 DOI: 10.1016/j.schres.2006.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Revised: 12/02/2006] [Accepted: 12/07/2006] [Indexed: 11/16/2022]
Abstract
This study examined neuropsychological functioning in two subgroups of patients with familial schizophrenia. Those who showed evidence of progressive ventricular enlargement observed across serial MRI scans (n=6) were compared with subjects whose ventricular volume remained static (n=10) over an average of 28 months. No differences were found in terms of age, education, ethnicity, level of psychotic symptomatology, DSM-IV subtype, age of onset, or duration of illness. Neurocognitively, the static ventricle group was impaired across more cognitive domains and had a larger percentage of subjects falling into the impaired range on a majority of measures, with the greatest differences on measures of attention (p<0.02) and nonverbal memory (p<0.07). These results suggest that clinically meaningful differences between these two MRI-derived subgroups of patients with schizophrenia may exist, and further underscore the heterogeneity of the illness.
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Affiliation(s)
- I J Osuji
- The University of Texas Southwestern Medical Center, Department of Psychiatry, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
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12
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Schmael C, Georgi A, Krumm B, Buerger C, Deschner M, Nöthen MM, Schulze TG, Rietschel M. Premorbid adjustment in schizophrenia--an important aspect of phenotype definition. Schizophr Res 2007; 92:50-62. [PMID: 17369026 DOI: 10.1016/j.schres.2007.01.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Revised: 01/30/2007] [Accepted: 01/30/2007] [Indexed: 10/23/2022]
Abstract
UNLABELLED Schizophrenia is a heterogeneous disorder, and early signs of disorder such as poor premorbid adjustment (PMA) are often present before the onset of diagnosable illness. Differences in PMA between patients may be suggestive of differing aetiological pathways. Poor PMA in schizophrenia has repeatedly been reported to be associated with male sex, earlier age at onset, illness severity, negative symptoms, and poor outcome. Studies of schizophrenia patients systematically assessed for PMA have used small patient samples and have rarely used controls. OBJECTIVE To investigate possible correlations of PMA, as measured with the Cannon-Spoor Premorbid Adjustment Scale (PAS), with such meaningful clinical characteristics as sex, age at onset, negative symptoms etc. using one of the largest samples of schizophrenia inpatients as well as controls characterised for PMA to date. METHOD PMA, diagnosis and lifetime symptoms were assessed in 316 inpatients with schizophrenia and 137 population based controls using the PAS and the Structured Clinical Interview for DSM. RESULTS Controls demonstrated better PAS scores than inpatients with schizophrenia. Earlier age at onset and negative symptoms were found to be associated with poorer PAS scores. There was no difference in PAS ratings between males and females in patients with schizophrenia. Among the control probands, females showed significantly better PAS scores than males. CONCLUSION PAS scores are worse in individuals who eventually develop schizophrenia, and the distribution of these scores among schizophrenia inpatients is correlated with specific clinical features. Earlier findings, which had reported an association with age at onset and negative symptoms in small patient samples, were substantiated. The widely reported association of poor PMA with male sex, if genuinely present, does not appear to be disease specific. Our findings suggest that PMA is in itself a valuable phenotype characteristic and that it may represent a specific biological phenotype which may be of value in sub-sample selection.
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Affiliation(s)
- Christine Schmael
- Central Institute of Mental Health, Division of Genetic Epidemiology in Psychiatry, J5, D-68159 Mannheim, Germany
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Abstract
The idea that some phenotypes bear a closer relationship to the biological processes that give rise to psychiatric illness than diagnostic categories has attracted considerable interest. Much effort has been devoted to finding such endophenotypes, partly because it is believed that the genetic basis of endophenotypes will be easier to analyse than that of psychiatric disease. This belief depends in part on the assumption that the effect sizes of genetic loci contributing to endophenotypes are larger than those contributing to disease susceptibility, hence increasing the chance that genetic linkage and association tests will detect them. We examine this assumption by applying meta-analytical techniques to genetic association studies of endophenotypes. We find that the genetic effect sizes of the loci examined to date are no larger than those reported for other phenotypes. A review of the genetic architecture of traits in model organisms also provides no support for the view that the effect sizes of loci contributing to phenotypes closer to the biological basis of disease is any larger than those contributing to disease itself. While endophenotype measures may afford greater reliability, it should not be assumed that they will also demonstrate simpler genetic architecture.
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Affiliation(s)
- JONATHAN FLINT
- Wellcome Trust Centre for Human Genetics, University of
Oxford, Oxford, UK
| | - MARCUS R. MUNAFÒ
- Department of Experimental Psychology, University of
Bristol, Bristol, UK
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14
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Abstract
Phenotypic variability and likely extensive genetic heterogeneity have been confounding the search for the causes of schizophrenia since the inception of the diagnostic category. The inconsistent results of genetic linkage and association studies using the diagnostic category as the sole schizophrenia phenotype suggest that the current broad concept of schizophrenia does not demarcate a homogeneous disease entity. Approaches involving subtyping and stratification by covariates to reduce heterogeneity have been successful in the genetic study of other complex disorders, but rarely applied in schizophrenia research. This article reviews past and present attempts at delineating schizophrenia subtypes based on clinical features, statistically derived measures, putative genetic indicators, and intermediate phenotypes, highlighting the potential utility of multidomain neurocognitive endophenotypes.
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Affiliation(s)
- A Jablensky
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, WA, Australia.
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Cerdán LF, Guevara MA, Sanz A, Amezcua C, Ramos-Loyo J. Brain electrical activity changes in treatment refractory schizophrenics after olanzapine treatment. Int J Psychophysiol 2005; 56:237-47. [PMID: 15866327 DOI: 10.1016/j.ijpsycho.2004.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Revised: 12/14/2004] [Accepted: 12/17/2004] [Indexed: 10/25/2022]
Abstract
The aim of the present study was to identify brain electrical activity changes generated by olanzapine (OLZ) in treatment refractory schizophrenics (TRS). 14 paranoid TRS (31.5+/-8.39 years old) were evaluated before and after 8 weeks of OLZ treatment. Psychopathology was evaluated by means of total BPRS and PANSS scores. Resting EEG was recorded in the pre (under typical neuroleptics) and post (under OLZ) sessions. A good response to OLZ was observed in 57% of TRS. A significant reduction in positive and negative symptoms scales of PANSS was found. Absolute power of theta1, theta2, alpha1 bands increased after treatment, while beta2 power showed a decrease. Intrahemispheric correlation increased between different zones of the frontal areas and between frontal and posterior areas, while interhemispheric correlation decreased in theta2. EEG changes were more evident in those patients who had a better response to OLZ. OLZ showed to be effective in TRS, improving psychiatric symptoms and increasing activity synchronization between different areas within each hemisphere that may indicate a functional reorganization, particularly in good responders.
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Affiliation(s)
- Luis F Cerdán
- Centro Comunitario de Salud Mental No. 1, Instituto Mexicano del Seguro Social, Mexico
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Buchsbaum MS, Shihabuddin L, Brickman AM, Miozzo R, Prikryl R, Shaw R, Davis K. Caudate and putamen volumes in good and poor outcome patients with schizophrenia. Schizophr Res 2003; 64:53-62. [PMID: 14511801 DOI: 10.1016/s0920-9964(02)00526-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Magnetic resonance images of 37 patients with schizophrenia and 37 age- and sex-matched volunteers were acquired. The caudate nucleus and putamen were traced on axial slices from the most superior extent of the caudate to the most inferior point where the caudate and putamen merge. Two subtypes of schizophrenia were compared, the Kraepelinian subtype (n=13), characterized by an unremitting and severe course, and the non-Kraepelinian subtype (n=24), characterized by a remitting course and some periods of self-care. Patients with good outcome schizophrenia had larger relative mean putamen size (0.0129) than poor outcome patients (0.0123) or normal controls (0.0121), but not caudate size. This enlargement was most marked for the dorsal putamen and right hemisphere. Striatal size was not related to whether patients were currently being treated with atypical or typical neuroleptics or whether they had been predominantly treated with typical or atypical neuroleptics over the past 3 years. This suggests the possibility that the expansion of putamen size may be a physiological correlate of neuroleptic responsiveness or that small putamen size at disease onset may be a predictor of outcome.
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Affiliation(s)
- Monte S Buchsbaum
- Department of Psychiatry, Mount Sinai School of Medicine, Box 1505, 1 Gustave L. Levy Place, New York, NY 10029-6574, USA.
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Garver DL, Tamas RL, Holcomb JA. Elevated interleukin-6 in the cerebrospinal fluid of a previously delineated schizophrenia subtype. Neuropsychopharmacology 2003; 28:1515-20. [PMID: 12799618 DOI: 10.1038/sj.npp.1300217] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evidence of immune activation has occasionally, but not consistently, been reported in schizophrenia. Investigations of cytokine abnormalities in serum, and occasionally in CSF, have yielded inconsistent results, which have been difficult to resolve. In such studies, schizophrenia has been assumed to consist of a single process rather than a group of disorders. This study assesses differences in the pro-inflammatory cytokine, interleukin-6 (IL-6) in the cerebrospinal fluid (CSF) in two previously delineated subtypes of schizophrenics ("delayed-responders"(DR) (n=23) and "poor-responders" (PR) (n=8)) during periods of neuroleptic-free psychotic exacerbation, and in a comparison group of normal controls (n=14). The two response subtypes were separated by subsequent treatment response (greater/less than 60% reduction of SAPS scores from baseline during 6 months of systematic treatment). The IL-6 assay, a sandwich enzyme-linked immunosorbent assay, was sensitive and reliable to detect IL-6 levels in the CSF of all subjects. CSF IL-6 was found to be significantly higher in the DR than the PR (P=0.017) and the controls (P=0.013). In addition to supporting the concept of heterogeneity in schizophrenia, this study also provides evidence that a central immune process may be occurring centrally in one subtype of schizophrenia.
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Affiliation(s)
- David L Garver
- Department of Psychiatry and Behavioral Science, University of Louisville School of Medicine, 500 S. Preston Street, Bldg. A Room 210, Louisville, KY 40202, USA.
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Schmauss C, Howe JR. RNA editing of neurotransmitter receptors in the mammalian brain. SCIENCE'S STKE : SIGNAL TRANSDUCTION KNOWLEDGE ENVIRONMENT 2002; 2002:pe26. [PMID: 12023441 DOI: 10.1126/stke.2002.133.pe26] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
RNA editing refers to various posttranscriptional mechanisms that alter the nucleotide sequence of RNA. In the mammalian brain, RNA editing results in significant changes in the functional properties of receptors for the important neurotransmitters glutamate and serotonin. These changes result from site-specific deamination of single adenosines in the pre-messenger RNA encoding these receptors. Here, we review what is known about the mechanisms underlying this editing, the consequences of RNA editing for glutamate and serotonin receptor function, and recent studies on transgenic mice and human post-mortem tissue that have begun to elucidate the role of RNA editing in the intact mammalian brain.
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Affiliation(s)
- Claudia Schmauss
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY 10032, USA
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Waddington JL, Scully PJ, Quinn JF, Meagher DJ, Morgan MG. The origin and course of schizophrenia: implications for clinical practice. J Psychiatr Pract 2001; 7:247-52. [PMID: 15990531 DOI: 10.1097/00131746-200107000-00005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The authors first review current evidence concerning abnormalities of brain structure and function in schizophrenia and interpret them within a "network" pathophysiological model of the disorder. This information is then placed within a contemporary neurodevelopmental framework that "roots" the illness in adverse events during early pregnancy, which result in a developmentally compromised nervous system. They then consider the controversy as to whether the subsequent expression of psychosis reflects an active morbid process and, in a more general sense, whether the disorder is characterized by subsequent progression and clinical deterioration. The authors argue that the developmental and progressive models should not be considered in an either-or manner, since this perspective is not logical and favors nihilistic approaches to intervention and treatment, but rather should be integrated within a lifetime trajectory model. Finally, implications for current psychiatric practice are considered.
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Affiliation(s)
- J L Waddington
- Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Aso M, Suzuki M, Kawasaki Y, Matsui M, Hagino H, Kurokawa K, Seto H, Kurachi M. Sylvian fissure and medial temporal lobe structures in patients with schizophrenia: a magnetic resonance imaging study. Psychiatry Clin Neurosci 2001; 55:49-56. [PMID: 11235858 DOI: 10.1046/j.1440-1819.2001.00784.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Volumes of the medial temporal lobe structures (i.e. the amygdala, hippocampus, and parahippocampal gyrus), Sylvian fissure, and inferior horn of the lateral ventricle relative to the cerebral hemisphere were measured in 24 patients with schizophrenia and 23 normal controls using magnetic resonance imaging. The patients had significantly larger Sylvian fissures and inferior horns bilaterally than the controls. In the patients the right Sylvian fissure size showed a significant positive correlation with the duration of illness. Moreover, earlier onset of illness was significantly correlated with decreased volume of the left medial temporal lobe structures. These results replicate previous finding of inferior horn enlargement and suggest the significance of the Sylvian fissure and the medial temporal lobe structures in pathophysiology of schizophrenia.
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Affiliation(s)
- M Aso
- Department of Neuropsychiatry, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Japan
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Abstract
For over a century, postmortem studies have played a central part in the search for the structural and biochemical pathology of schizophrenia. However, for most of this time, little progress has been made. Recently, the situation has begun to change, helped by the emergence of more powerful methodologies and research designs, and by the availability of brain imaging to provide complementary information. As a result, it can now be clearly concluded that there are structural cerebral abnormalities in schizophrenia that are intrinsic to the disorder. The neuropathological process is not primarily degenerative, but involves a change in the normal cytoarchitecture of the brain, probably originating in development. Neurochemically, there is postmortem evidence for alterations in several transmitter systems including dopamine, glutamate, serotonin, and γ-aminobutyric acid (GABA). The cardinal findings are reviewed here, together with a consideration of the conceptual and methodological issues that face postmortem studies of schizophrenia.
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Affiliation(s)
- P J Harrison
- Department of Psychiatry, University of Oxford, Oxford, UK
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Abstract
Cell adhesion molecule proteins play a diverse role in neural development, signal transduction, structural linkages to extracellular and intracellular proteins, synaptic stabilization, neurogenesis, and learning. Three basic mRNA isoforms and potent posttranslational modifications differentially regulate these neurobiological properties of the neural cell adhesion molecule (N-CAM). Abnormal concentrations of N-CAM 105-115 kDa (cN-CAM), N-CAM variable alternative spliced exon (VASE), and N-CAM secreted exon (SEC) are related to schizophrenia and bipolar neuropsychiatric disorders. These N-CAM isoforms provide potential mechanisms for expression of multiple neurobiological alterations between controls and individuals with schizophrenia or bipolar illness. Multiple processes can trigger the dysregulation of N-CAM isoforms. Differences in neuropil volume, neuronal diameter, gray matter thickness, and ventricular size can be related to N-CAM neurobiological properties in neuropsychiatric disorders. Potential test of the N-CAM dysregulation hypothesis of neuropsychiatric disorder is whether ongoing dysregulation of N-CAM would cause cognitive impairments, increased lateral ventricle volume, and decreased hippocampal volume observed in schizophrenia and to a lesser extent in bipolar disorder. An indirect test of this theory conducted in animal experiments lend support to this N-CAM hypothesis. N-CAM dysregulation is consistent with a synaptic abnormality that could underlie the disconnection between brain regions consistent with neuroimaging reports. Synapse stability and plasticity may be part of the molecular neuropathology of these disorders.
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Affiliation(s)
- M P Vawter
- National Institute on Drug Abuse-IRP (NIDA-IRP), Addiction Research Center, Section on Development and Plasticity, Baltimore, MD 21224, USA.
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Garver DL, Nair TR, Christensen JD, Holcomb JA, Kingsbury SJ. Brain and ventricle instability during psychotic episodes of the schizophrenias. Schizophr Res 2000; 44:11-23. [PMID: 10867308 DOI: 10.1016/s0920-9964(00)00015-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Recent reports from serial brain scans suggest that the rate of ventricular expansion and/or brain atrophy may be accelerated in at least some schizophrenics. The authors assessed the effect of state changes upon such findings.Within-subject 3D MRIs were assessed for ventricular and brain volumes during periods of [partial] remission and of exacerbation of psychosis. Additional scans at comparable within-subject SAPS were used to assess rates of change in volumes that were independent of SAPS changes. Correlations of changes of ventricle and brain volumes vs. change of SAPS cores between scans revealed that ventricle volumes decreased during a period of psychotic exacerbation and increased at a time of [partial] remission (r(p)=-0.666; P<0.0005); conversely, brain volumes increased during psychotic exacerbation and decreased at [partial] remission (r(p)=+0.448; P=0.032). Scans at comparable SAPS scores suggested that the majority of patients had rates of ventricular expansion comparable to controls (0.9+/-0.6 cc/year), though two patients appeared to have rates of ventricular increase of 4.5+/-2. 1 cc/year (Lilliefores P=0.036; K-means clustering F=17.75). Exacerbation of psychosis in schizophrenia is accompanied by evidence of brain swelling, especially of periventricular brain, with encroachment of brain substance upon ventricular volumes. Controlled for state changes, the majority of schizophrenics show rates of ventricular expansion or brain atrophy indistinguishable from controls.
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Affiliation(s)
- D L Garver
- University of Louisville School of Medicine, Department of Psychiatry and Behavioral Sciences, Louisville, KY 40222, USA.
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