A Janusian perspective on the nature, development and structure of schizophrenia and schizotypy

An Overview of the Association between Schizotypy and Dopamine

Schizotypy refers to a constellation of personality traits that are believed to mirror the subclinical expression of schizophrenia in the general population. Evidence from pharmacological studies indicates that dopamine (DA) is involved in the etiology of schizophrenia. Based on the assumption of a continuum between schizophrenia and schizotypy, researchers have begun investigating the association between DA and schizotypy using a wide range of methods. In this article, we review published studies on this association from the following areas of work: (1) experimental investigations of the interactive effects of dopaminergic challenges and schizotypy on cognition, motor control, and behavior (2), dopaminergically supported cognitive functions (3), studies of associations between schizotypy and polymorphisms in genes involved in dopaminergic neurotransmission, and (4) molecular imaging studies of the association between schizotypy and markers of the DA system. Together, data from these lines of evidence suggest that DA is important to the expression and experience of schizotypy and associated behavioral biases. An important observation is that the experimental designs, methods, and manipulations used in this research are highly heterogeneous. Future studies are required to replicate individual observations, to enlighten the link between DA and different schizotypy dimensions (positive, negative, cognitive disorganization), and to guide the search for solid DA-sensitive behavioral markers. Such studies are important in order to clarify inconsistencies between studies. More work is also needed to identify differences between dopaminergic alterations in schizotypy compared to the dysfunctions observed in schizophrenia.

Dopaminergic basis of the psychosis-prone personality investigated with functional magnetic resonance imaging of procedural learning

Previous evidence shows a reliable association between psychosis-prone (especially schizotypal) personality traits and performance on dopamine (DA)-sensitive tasks (e.g., prepulse inhibition and antisaccade). Here, we used blood oxygen level-dependent (BOLD) fMRI and an established procedural learning (PL) task to examine the dopaminergic basis of two aspects of psychosis-proneness (specific schizotypy and general psychoticism). Thirty healthy participants (final N = 26) underwent fMRI during a blocked, periodic sequence-learning task which, in previous studies, has been shown to reveal impaired performance in schizophrenia patients given drugs blocking the DA D2 receptor subtype (DRD2), and to correspond with manipulation of DA activity and elicit fronto-striatal-cerebellar activity in healthy people. Psychosis-proneness was indexed by the Psychoticism (P) scale of the Eysenck Personality Questionnaire-Revised (EPQ-R; 1991) and the Schizotypal Personality Scale (STA; 1984). EPQ-R Extraversion and Neuroticism scores were also examined to establish discriminant validity. We found a positive correlation between the two psychosis-proneness measures (r = 0.43), and a robust and unique positive association between EPQ-R P and BOLD signal in the putamen, caudate, thalamus, insula, and frontal regions. STA schizotypy score correlated positively with activity in the right middle temporal gyrus. As DA is a key transmitter in the basal ganglia, and the thalamus contains the highest levels of DRD2 receptors of all extrastriatal regions, our results support a dopaminergic basis of psychosis-proneness as measured by the EPQ-R Psychoticism.

Abnormal externally guided movement preparation in recent-onset schizophrenia is associated with impaired selective attention to external input

Several theories propose that the primary cognitive impairment in schizophrenia concerns a deficit in the processing of external input information. There is also evidence, however, for impaired motor preparation in schizophrenia. This provokes the question whether the impaired motor preparation in schizophrenia is a secondary consequence of disturbed (selective) processing of the input needed for that preparation, or an independent primary deficit. The aim of the present study was to discriminate between these hypotheses, by investigating externally guided movement preparation in relation to selective stimulus processing. The sample comprised 16 recent-onset schizophrenia patients and 16 controls who performed a movement-precuing task. In this task, a precue delivered information about one, two or no parameters of a movement summoned by a subsequent stimulus. Performance measures and measures derived from the electroencephalogram showed that patients yielded smaller benefits from the precues and showed less cue-based preparatory activity in advance of the imperative stimulus than the controls, suggesting a response preparation deficit. However, patients also showed less activity reflecting selective attention to the precue. We therefore conclude that the existing evidence for an impairment of externally guided motor preparation in schizophrenia is most likely due to a deficit in selective attention to the external input, which lends support to theories proposing that the primary cognitive deficit in schizophrenia concerns the processing of input information.

Startle gating in antipsychotic-naïve first episode schizophrenia patients: one ear is better than two

Prepulse inhibition (PPI) of the startle reflex to binaural prepulse stimuli is reliably reported to be reduced in patients with schizophrenia. Monaural acoustic prestimuli produce more inhibition of the eye blink reflex than binaural prestimuli in healthy people. The effect of monaural prestimulation on reflex inhibition in patients with schizophrenia is not known. In this study, inhibition of the acoustic startle response by monaural and binaural acoustic prestimuli was assessed in 20 antipsychotic-naïve first episode schizophrenia patients and compared with 20 age and sex-matched healthy subjects. The results revealed less PPI, especially with binaural prestimuli, in patients than healthy subjects but both groups showed more PPI with monaural than binaural prestimuli. It is concluded that first episode schizophrenia patients show deficient sensorimotor gating but they are not impaired in the mechanism underlying stronger PPI with monaural than binaural prepulses.

Impaired hemispheric communication in schizophrenia: a study using the consonant-vowel-consonant task

The ability of the left and right hemispheres to interact and cooperate in the processing of information is important for normal brain functioning. Some investigators have suggested that this cooperation in functioning occurs through a process called "metacontrol." Because studies have suggested that patients with schizophrenia may have problems with interhemispheric interaction, we considered that it could be informative to study such patients from the viewpoint of interhemispheric cooperation, and more specifically that of metacontrol. To do this we utilized an assessment procedure called the consonant-vowel-consonant (CVC) task, in which nonsense three-letter combinations (trigrams) are presented vertically to the left, right and both visual fields. The pattern of errors can be used to determine the type of processing the hemispheres use under the different conditions of presentation. Previous studies have shown that when trigram information is presented to both hemispheres, the left hemisphere appears to switch into a mode that more resembles right hemisphere processing, and we wished to determine if evidence for this switch in the mode of processing also occurred in a sample of patients with schizophrenia. To determine the specificity of any findings to schizophrenia, we also studied a group of patients with bipolar disorder. For the control and bipolar groups, our results showed the typical finding of superior processing in the right visual field (left hemisphere) over the left visual field, with presentation to both visual fields demonstrating a qualitative error pattern resembling that of the left visual field (right hemisphere). Patients with schizophrenia, however, did not demonstrate this switching into a right hemisphere mode upon bilateral presentation of the trigrams and instead seemed to show no switching, or actually switching into more of a left hemisphere mode. Our results suggest that patients with schizophrenia (but not bipolar disorder) may have abnormalities in the cooperative processing of information when it is presented to both hemispheres, and that this disturbance may reflect problems with metacontrol of hemispheric processing.

Reduced prepulse inhibition in unaffected siblings of schizophrenia patients

We investigated whether prepulse inhibition of the startle response is reduced in siblings of schizophrenia patients compared to age- and sex-matched healthy controls. Nineteen unaffected biological siblings and 19 controls were assessed on prepulse inhibition by monaural and binaural acoustic prepulse stimuli, with the startle stimuli always presented binaurally. There was significantly less prepulse inhibition in siblings, compared to controls, with binaural prepulse stimuli, as also seen previously in schizophrenia patients. The difference between siblings and controls in prepulse inhibition with the left or right ear prepulse stimuli was not significant because of a pronounced increase in prepulse inhibition with monaural, relative to binaural, prepulses in the sibling group. High schizotypal ratings were mildly associated with reduced prepulse inhibition. Prepulse inhibition may provide a useful measure in the search for schizophrenia genes.

Psychobiology of altered states of consciousness

The article reviews the current knowledge regarding altered states of consciousness (ASC) (a) occurring spontaneously, (b) evoked by physical and physiological stimulation, (c) induced by psychological means, and (d) caused by diseases. The emphasis is laid on psychological and neurobiological approaches. The phenomenological analysis of the multiple ASC resulted in 4 dimensions by which they can be characterized: activation, awareness span, self-awareness, and sensory dynamics. The neurophysiological approach revealed that the different states of consciousness are mainly brought about by a compromised brain structure, transient changes in brain dynamics (disconnectivity), and neurochemical and metabolic processes. Besides these severe alterations, environmental stimuli, mental practices, and techniques of self-control can also temporarily alter brain functioning and conscious experience.

EEG microstate duration and syntax in acute, medication-naive, first-episode schizophrenia: a multi-center study

In young, first-episode, productive, medication-naive patients with schizophrenia, EEG microstates (building blocks of mentation) tend to be shortened. Koenig et al. [Koenig, T., Lehmann, D., Merlo, M., Kochi, K., Hell, D., Koukkou, M., 1999. A deviant EEG brain microstate in acute, neuroleptic-naive schizophrenics at rest. European Archives of Psychiatry and Clinical Neuroscience 249, 205-211] suggested that shortening concerned specific microstate classes. Sequence rules (microstate concatenations, syntax) conceivably might also be affected. In 27 patients of the above type and 27 controls, from three centers, multichannel resting EEG was analyzed into microstates using k-means clustering of momentary potential topographies into four microstate classes (A-D). In patients, microstates were shortened in classes B and D (from 80 to 70 ms and from 94 to 82 ms, respectively), occurred more frequently in classes A and C, and covered more time in A and less in B. Topography differed only in class B where LORETA tomography predominantly showed stronger left and anterior activity in patients. Microstate concatenation (syntax) generally were disturbed in patients; specifically, the class sequence A-->C-->D-->A predominated in controls, but was reversed in patients (A-->D-->C-->A). In schizophrenia, information processing in certain classes of mental operations might deviate because of precocious termination. The intermittent occurrence might account for Bleuler's "double bookkeeping." The disturbed microstate syntax opens a novel physiological comparison of mental operations between patients and controls.

Saccadic eye movements, schizotypy, and the role of neuroticism

We investigated the relationships of anti- and prosaccades with psychometric schizotypy. One aim was to estimate the role of negative emotionality and general psychopathology (i.e. neuroticism) in this relationship. 115 non-clinical volunteers underwent infrared oculographic assessment of antisaccades and prosaccades. Schizotypy was assessed with the Personality Syndrome Questionnaire (PSQ-80), the Rust Inventory of Schizotypal Cognitions (RISC), and Eysenck Personality Questionnaire-Revised (EPQ-R) Psychoticism. Higher positive schizotypy scores predicted increased antisaccade errors (RISC) and greater prosaccade spatial error (PSQ-80 Unreality). Greater thought disorder (PSQ-80 Activity) predicted shorter prosaccade latencies. EPQ-R Neuroticism was substantially correlated with schizotypy but was not related to saccadic measures and did not account for their relationship with schizotypy. We conclude that saccadic performance patterns in schizotypy are not due to negative emotionality or general psychopathology, but specific to schizophrenia spectrum signs and symptoms.

Correlation between P50 suppression and psychometric schizotypy among non-clinical Japanese subjects

The link between P50 suppression and psychometric schizotypy was previously reported in non-clinical English-speaking subjects; however, whether a similar relationship exists within a different ethnic sample is unknown. Furthermore, whether such a relationship can also be accounted for by such basic personality characteristics as extraversion or neuroticism has not yet been reported. In the present study, we investigated the correlations of P50 suppression with psychometric schizotypy, and with extraversion or neuroticism among non-clinical Japanese. Subjects were 34 healthy volunteers. The auditory P50 potential was obtained using a paired stimulus paradigm. Psychometric schizotypy was assessed using schizotypal personality questionnaire (SPQ). Extraversion and neuroticism were assessed using Maudsley personality inventory (MPI). P50 suppression correlated not only with total SPQ score, but also with extraversion and with neuroticism. However, the partial correlation analysis revealed a significant partial correlation of P50 suppression with SPQ when controlled for extraversion or neuroticism, and a non-significant partial correlation of P50 suppression with extraversion or neuroticism when controlled for SPQ. When subjects were divided into two subgroups according to the mean SPQ score, the degree of P50 suppression was lower in the high than in the low SPQ scorers. Our results indicate that P50 suppression is one of the neurobiological substrates underlying psychometric schizotypy, and that this relationship cannot be accounted for by measures of extraversion or neuroticism.

Slow habituation of induced gamma and beta oscillations in association with unreality experiences in schizotypy

Highly schizotypal individuals exhibit deficits in attentional processing, in particular dysfunctional habituation. This has led to the suggestion that abnormal habituation may represent a trait marker of psychotic vulnerability. This study examined the difference between high- and low-schizotypal individuals' habituation of nonphase-locked gamma and beta-1 oscillations, with and without attention. Measures of schizotypy were obtained from 40 participants and habituation to different tones was examined over trials of three interval lengths, under conditions of attention and inattention. The data showed that all participants habituated over trials with long intervals when attending to the stimuli. However, those participants who scored high on the unreality subscale exhibited significantly less habituation relative to those with low unreality scores for the short-interval trials. Furthermore, there was no difference in the orienting response to the initial stimuli between these subgroups. These results are discussed in terms of a dysfunctional rehearsal process influencing habituation for those with high-unreality scores.

Theory, methods and new directions in the psychophysiology of the schizophrenic process and schizotypy

Theoretical and methodological issues in the psychophysiology of the schizophrenic process are reviewed. These include the importance of schizotypy with its compensatory abilities as well as deficits for elucidating the processes of development and prevention of schizophrenia. The importance of individual differences, syndromes and single case studies. The recognition that this is a dynamic and fluctuating illness and hence the relevance of functional neurophysiology, including the role of imbalances in hemispheric activation in ontogeny, developmental course, expression of symptoms, the effects of neuroleptics and recovery process, and the influence of stress a precipitant of breakdown. The role of thalamo-cortical activation systems. The particular value of electrocortical measures including the interrelations of electroencephalographic rhythms throughout the spectrum, and relations of gamma, dynamic core neuronal complexity, connectivity and sensory gating with experiences of unreality and disturbances of consciousness.

Schizophrenia and schizotypal personality: a tribute to Peter H. Venables

Peter Venables made multiple contributions to the field of schizophrenia and schizotypy, most notably in the areas of psychophysiology, neurocognition, and assessment. On the 50th anniversary of the start of his research career in 1951, a conference on schizophrenia and schizotypy was held in his honor in Tuscany, Italy. This special edition encapsulates many of the presentations given at that meeting, covering the areas of neurodevelopment, assessment, genetics, psychophysiology, neurocognition, brain imaging, psychopharmacology, intervention, and prevention. A key theme of this special edition concerns the integration of schizophrenia and schizotypy research in a manner that will allow for a more comprehensive understanding of both of these disorders.