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Guo F, Zhu YQ, Li C, Wang XR, Wang HN, Liu WM, Wang LX, Tian P, Kang XW, Cui LB, Xi YB, Yin H. Gray matter volume changes following antipsychotic therapy in first-episode schizophrenia patients: A longitudinal voxel-based morphometric study. J Psychiatr Res 2019; 116:126-132. [PMID: 31233895 DOI: 10.1016/j.jpsychires.2019.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/15/2022]
Abstract
Despite evidence of structural brain abnormalities in schizophrenia, the current study aimed to explore the effects of antipsychotic treatment on gray matter (GM) volume using structural magnetic resonance imaging (MRI) and investigate the relationship between brain structure and treatment response. The GM volumes of 33 patients with first-episode schizophrenia were calculated with voxel-based morphometry (VBM), with 33 matched healthy controls. Longitudinal volume changes within subjects after 4-month antipsychotic treatment were also evaluated. Correlation between volumetric changes and clinical symptoms derived from the Positive and Negative Syndrome Scale (PANSS) were further investigated. Compared with healthy controls, decreased GM volumes in the frontal gyrus were observed in schizophrenia patients. After 4-month treatment, patients showed significantly decreased GM volume primarily in the bilateral frontal, temporal and left parietal brain regions. In addition, the GM volume changes of the left postcentral gyrus was positively correlated with negative symptoms improvement, and the correlation analysis revealed the total PANSS scores changes were associated with GM volume changes in the right inferior frontal gyrus and the right superior temporal gyrus. Besides, non-responders had reduced GM volume in the bilateral middle frontal gyrus and the right superior frontal gyrus compared with responders and healthy controls. Our results suggest that the abnormality in the right frontal gyrus exists in the early stage of schizophrenia. Moreover, the relationship between antipsychotics and structural changes was identified. The GM volume might have the potential to reflect the symptom improvement in schizophrenia patients. And MRI may assist in predicting the antipsychotic treatment response in first-episode schizophrenia patients.
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Affiliation(s)
- Fan Guo
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China; Key Laboratory of Molecular Imaging of the Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Yuan-Qiang Zhu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Chen Li
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Xing-Rui Wang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Hua-Ning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Wen-Ming Liu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Liu-Xian Wang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China; Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Ping Tian
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Xiao-Wei Kang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Long-Biao Cui
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China; Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, 710032, China
| | - Yi-Bin Xi
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
| | - Hong Yin
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
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Lin Y, Li M, Zhou Y, Deng W, Ma X, Wang Q, Guo W, Li Y, Jiang L, Hu X, Zhang N, Li T. Age-Related Reduction in Cortical Thickness in First-Episode Treatment-Naïve Patients with Schizophrenia. Neurosci Bull 2019; 35:688-696. [PMID: 30790217 DOI: 10.1007/s12264-019-00348-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 10/25/2018] [Indexed: 02/05/2023] Open
Abstract
Substantial evidence supports the neurodevelopmental hypothesis of schizophrenia. Meanwhile, progressive neurodegenerative processes have also been reported, leading to the hypothesis that neurodegeneration is a characteristic component in the neuropathology of schizophrenia. However, a major challenge for the neurodegenerative hypothesis is that antipsychotic drugs used by patients have profound impact on brain structures. To clarify this potential confounding factor, we measured the cortical thickness across the whole brain using high-resolution T1-weighted magnetic resonance imaging in 145 first-episode and treatment-naïve patients with schizophrenia and 147 healthy controls. The results showed that, in the patient group, the frontal, temporal, parietal, and cingulate gyri displayed a significant age-related reduction of cortical thickness. In the control group, age-related cortical thickness reduction was mostly located in the frontal, temporal, and cingulate gyri, albeit to a lesser extent. Importantly, relative to healthy controls, patients exhibited a significantly smaller age-related cortical thickness in the anterior cingulate, inferior temporal, and insular gyri in the right hemisphere. These results provide evidence supporting the existence of neurodegenerative processes in schizophrenia and suggest that these processes already occur in the early stage of the illness.
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Affiliation(s)
- Yin Lin
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China.,Department of Psychology, Shenzhen Children's Hospital, Shenzhen, 518038, China
| | - Mingli Li
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yi Zhou
- Department of Radiology, Hospital for Chengdu Office of Tibetan Autonomous Region, Branch Hospital of West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wei Deng
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaohong Ma
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qiang Wang
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wanjun Guo
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yinfei Li
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lijun Jiang
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xun Hu
- Huaxi Biobank, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Nanyin Zhang
- Department of Biomedical Engineering, Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, 16802, USA.
| | - Tao Li
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China. .,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Joo SW, Chon MW, Rathi Y, Shenton ME, Kubicki M, Lee J. Abnormal asymmetry of white matter tracts between ventral posterior cingulate cortex and middle temporal gyrus in recent-onset schizophrenia. Schizophr Res 2018; 192:159-166. [PMID: 28506703 DOI: 10.1016/j.schres.2017.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/04/2017] [Accepted: 05/07/2017] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Previous studies have reported abnormalities in the ventral posterior cingulate cortex (vPCC) and middle temporal gyrus (MTG) in schizophrenia patients. However, it remains unclear whether the white matter tracts connecting these structures are impaired in schizophrenia. Our study investigated the integrity of these white matter tracts (vPCC-MTG tract) and their asymmetry (left versus right side) in patients with recent onset schizophrenia. METHOD Forty-seven patients and 24 age-and sex-matched healthy controls were enrolled in this study. We extracted left and right vPCC-MTG tract on each side from T1W and diffusion MRI (dMRI) at 3T. We then calculated the asymmetry index of diffusion measures of vPCC-MTG tracts as well as volume and thickness of vPCC and MTG using the formula: 2×(right-left)/(right+left). We compared asymmetry indices between patients and controls and evaluated their correlations with the severity of psychiatric symptoms and cognition in patients using the Positive and Negative Syndrome Scale (PANSS), video-based social cognition scale (VISC) and the Wechsler Adult Intelligence Scale (WAIS-III). RESULTS Asymmetry of fractional anisotropy (FA) and radial diffusivity (RD) in the vPCC-MTG tract, while present in healthy controls, was not evident in schizophrenia patients. Also, we observed that patients, not healthy controls, had a significant FA decrease and RD increase in the left vPCC-MTG tract. There was no significant association between the asymmetry indices of dMRI measures and IQ, VISC, or PANSS scores in schizophrenia. CONCLUSION Disruption of asymmetry of the vPCC-MTG tract in schizophrenia may contribute to the pathophysiology of schizophrenia.
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Affiliation(s)
- Sung Woo Joo
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Myong-Wuk Chon
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Brockton Division, Brockton, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marek Kubicki
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jungsun Lee
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea; Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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The Study of the Antisaccade Performance and Contingent Negative Variation Characteristics in First-Episode and Chronic Schizophrenia Patients. SPANISH JOURNAL OF PSYCHOLOGY 2017; 20:E55. [PMID: 29072157 DOI: 10.1017/sjp.2017.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The study tested whether the antisaccade (AS) performance and Contingent Negative Variation (CNV) measures differed between the first-episode and chronic patients to provide the evidence of PFC progressive functional deterioration. Subjects included 15 first-episode and 20 chronic schizophrenic patients (with the duration of illness more than 5 years), and 21 control subjects. The first-episode and chronic patients had significantly elevated error percent (p < .05, effect size 1.10 and p < .001, effect size 1.25), increased AS latencies (p < .01, effect size 1.18 and p < .001, effect size 1.69), and increased latencies variability (p < .01, effect size 1.52 and p < .001, effect size 1.37) compared to controls. Chronic patients had marginally significant increase of the response latency (p = .086, effect size .78) and latency variability (p < .099, effect size .63) compared to first-episode ones. Results of CNV analysis revealed that chronic patients only exhibited robustly declined frontal CNV amplitude at Fz (p < .05, effect size .70), F3 (p < .05, effect size .88), and F4 (p < .05, effect size .71) sites compared to controls. The obtained results might be related to specific changes in prefrontal cortex function over the course of schizophrenia.
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Herold CJ, Schmid LA, Lässer MM, Seidl U, Schröder J. Cognitive Performance in Patients with Chronic Schizophrenia Across the Lifespan. GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2017. [DOI: 10.1024/1662-9647/a000164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Chronic schizophrenia involves neuropsychological deficits that primarily strike executive functions and episodic memory. Our study investigated these deficits throughout the lifespan in patients with chronic schizophrenia and in healthy controls. Important neuropsychological functions were tested in 94 patients and 66 healthy controls, who were assigned to three age groups. Compared with the healthy controls, patients performed significantly poorer on all tests applied. Significant age effects occurred on all tests except the digit span forward, with older subjects scoring well below the younger ones. With respect to cognitive flexibility, age effects were more pronounced in the patients. These findings underline the importance of cognitive deficits in chronic schizophrenia and indicate that diminished cognitive flexibility shows age-associated differences.
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Affiliation(s)
- Christina Josefa Herold
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Lena Anna Schmid
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Marc Montgomery Lässer
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Seidl
- Center for Mental Health, Klinikum Stuttgart, Stuttgart, Germany
| | - Johannes Schröder
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
- Institute of Gerontology, University of Heidelberg, Heidelberg, Germany
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Chaves C, Marque CR, Maia-de-Oliveira JP, Wichert-Ana L, Ferrari TB, Santos AC, Araújo D, Machado-de-Sousa JP, Bressan RA, Elkis H, Crippa JA, Guimarães FS, Zuardi AW, Baker GB, Dursun SM, Hallak JEC. Effects of minocycline add-on treatment on brain morphometry and cerebral perfusion in recent-onset schizophrenia. Schizophr Res 2015; 161:439-45. [PMID: 25497439 DOI: 10.1016/j.schres.2014.11.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 11/14/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
Abstract
Increasing evidence suggests that the tetracycline antibiotic minocycline has neuroprotective effects and is a potential treatment for schizophrenia. However, the mechanisms of action of minocycline in the CNS remain elusive. The aim of this study was to investigate the effects of minocycline on brain morphology and cerebral perfusion in patients with recent-onset schizophrenia after 12months of a randomized double-blind, placebo-controlled clinical trial of minocycline add-on treatment. This study included 24 outpatients with recent-onset schizophrenia randomized for 12months of adjuvant treatment with minocycline (200mg/d) or placebo. MRI (1.5T) and [(99m)Tc]-ECD SPECT brain scans were performed at the end of the 12-month of trial. Between-condition comparisons of SPECT and MRI brain images were performed using statistical parametric mapping and analyzed by voxel-based morphometry (VBM). Minocycline adjuvant treatment significantly reduced positive and negative symptoms when compared with placebo. The VBM analysis of MRI scans showed that the patients in the placebo group had significant lower gray matter volumes in the midposterior cingulate cortex and in the precentral gyrus in comparison with the patients in the minocycline group. In addition, a decreased ECD uptake in the minocycline condition was observed in fronto-temporal areas. These results suggest that minocycline may protect against gray matter loss and modulate fronto-temporal areas involved in the pathophysiology of schizophrenia. Furthermore, minocycline add-on treatment may be a potential treatment in the early stages of schizophrenia and may ameliorate clinical deterioration and brain alterations observed in this period.
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Affiliation(s)
- Cristiano Chaves
- Department of Neuroscience and Behavior, Division of Psychiatry, Ribeirão Preto Medical School, University of São Paulo, Brazil; National Science and Technology Institute for Translational Medicine (INCT-TM), Brazil.
| | - Cristiane R Marque
- Department of Neuroscience and Behavior, Division of Psychiatry, Ribeirão Preto Medical School, University of São Paulo, Brazil; National Science and Technology Institute for Translational Medicine (INCT-TM), Brazil
| | - João P Maia-de-Oliveira
- Department of Neuroscience and Behavior, Division of Psychiatry, Ribeirão Preto Medical School, University of São Paulo, Brazil; National Science and Technology Institute for Translational Medicine (INCT-TM), Brazil; Department of Clinical Medicine, Federal University of Rio Grande do Norte, Brazil
| | - Lauro Wichert-Ana
- Department of Neuroscience and Behavior, Division of Psychiatry, Ribeirão Preto Medical School, University of São Paulo, Brazil; Department of Internal Medicine, Division of Nuclear Medicine, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Thiago B Ferrari
- Department of Neuroscience and Behavior, Division of Psychiatry, Ribeirão Preto Medical School, University of São Paulo, Brazil; National Science and Technology Institute for Translational Medicine (INCT-TM), Brazil
| | - Antonio C Santos
- Department of Neuroscience and Behavior, Division of Psychiatry, Ribeirão Preto Medical School, University of São Paulo, Brazil; Department of Internal Medicine, Division of Radiology, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - David Araújo
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Canada
| | - João P Machado-de-Sousa
- Department of Neuroscience and Behavior, Division of Psychiatry, Ribeirão Preto Medical School, University of São Paulo, Brazil; National Science and Technology Institute for Translational Medicine (INCT-TM), Brazil
| | - Rodrigo A Bressan
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo, Brazil
| | - Helio Elkis
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil
| | - José A Crippa
- Department of Neuroscience and Behavior, Division of Psychiatry, Ribeirão Preto Medical School, University of São Paulo, Brazil; National Science and Technology Institute for Translational Medicine (INCT-TM), Brazil
| | - Francisco S Guimarães
- Department of Neuroscience and Behavior, Division of Psychiatry, Ribeirão Preto Medical School, University of São Paulo, Brazil; Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Antônio W Zuardi
- Department of Neuroscience and Behavior, Division of Psychiatry, Ribeirão Preto Medical School, University of São Paulo, Brazil; National Science and Technology Institute for Translational Medicine (INCT-TM), Brazil
| | - Glen B Baker
- National Science and Technology Institute for Translational Medicine (INCT-TM), Brazil; Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Canada
| | - Serdar M Dursun
- National Science and Technology Institute for Translational Medicine (INCT-TM), Brazil; Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Canada
| | - Jaime E C Hallak
- Department of Neuroscience and Behavior, Division of Psychiatry, Ribeirão Preto Medical School, University of São Paulo, Brazil; National Science and Technology Institute for Translational Medicine (INCT-TM), Brazil
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Asami T, Lee SH, Bouix S, Rathi Y, Whitford TJ, Niznikiewicz M, Nestor P, McCarley RW, Shenton ME, Kubicki M. Cerebral white matter abnormalities and their associations with negative but not positive symptoms of schizophrenia. Psychiatry Res 2014; 222:52-9. [PMID: 24650453 PMCID: PMC4083818 DOI: 10.1016/j.pscychresns.2014.02.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 12/11/2013] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
Abstract
Although diffusion tensor imaging (DTI) studies have reported fractional anisotropy (FA) abnormalities in multiple white matter (WM) regions in schizophrenia, relationship between abnormal FA and negative symptoms has not been fully explored. DTI data were acquired from twenty-four patients with chronic schizophrenia and twenty-five healthy controls. Regional brain abnormalities were evaluated by conducting FA comparisons in the cerebral and each lobar WMs between groups. Focal abnormalities were also evaluated with a voxel-wise tract specific method. Associations between structural WM changes and negative symptoms were assessed using the Scale for the Assessment of Negative Symptoms (SANS). The patient group showed decreased FA in the cerebrum, especially in the frontal lobe, compared with controls. A voxel-wise analysis showed FA decreases in almost all WM tracts in schizophrenia. Correlation analyses demonstrated negative relationships between FA in the cerebrum, particularly in the left hemisphere, and SANS global and global rating scores (Anhedonia-Asociality, Attention, and Affective-Flattening), and also associations between FA of left frontal lobe and SANS global score, Anhedonia-Asociality, and Attention. This study demonstrates that patients with chronic schizophrenia evince widespread cerebral FA abnormalities and that these abnormalities, especially in the left hemisphere, are associated with negative symptoms.
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Affiliation(s)
- Takeshi Asami
- Laboratory of Neuroscience, Clinical Neuroscience Division, Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Harvard Medical School, Brockton, Massachusetts, U.S.A,Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Sang Hyuk Lee
- Laboratory of Neuroscience, Clinical Neuroscience Division, Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Harvard Medical School, Brockton, Massachusetts, U.S.A,Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Thomas J. Whitford
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A,School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Margaret Niznikiewicz
- Laboratory of Neuroscience, Clinical Neuroscience Division, Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Harvard Medical School, Brockton, Massachusetts, U.S.A
| | - Paul Nestor
- Laboratory of Neuroscience, Clinical Neuroscience Division, Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Harvard Medical School, Brockton, Massachusetts, U.S.A
| | - Robert W. McCarley
- Laboratory of Neuroscience, Clinical Neuroscience Division, Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Harvard Medical School, Brockton, Massachusetts, U.S.A
| | - Martha E. Shenton
- Laboratory of Neuroscience, Clinical Neuroscience Division, Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Harvard Medical School, Brockton, Massachusetts, U.S.A,Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A,Surgical Planning Laboratory, MRI Division, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts U.S.A
| | - Marek Kubicki
- Laboratory of Neuroscience, Clinical Neuroscience Division, 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, MRI Division, Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA.
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8
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Hippocampal and orbital inferior frontal gray matter volume abnormalities and cognitive deficit in treatment-naive, first-episode patients with schizophrenia. Schizophr Res 2014; 152:339-43. [PMID: 24439000 DOI: 10.1016/j.schres.2013.12.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 12/01/2013] [Accepted: 12/27/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cognitive impairment is a core feature of schizophrenia. Some evidence suggests an association between cognition deficits and gray matter reductions. In this study, we investigated the relationship between cognitive performance and gray matter volumes in patients with treatment-naïve, first-episode schizophrenia. METHOD First-episode patients with treatment-naïve schizophrenia and healthy controls went through brain imaging scan using high resolution magnetic resonance imaging. A neuropsychological battery including 8 neurocognitive tests was used to assess cognitive function. Voxel-based methods were used for volumetric measure in the brain. RESULTS Fifty-one patients and 41 healthy controls were included in the analysis. Patients exhibited a poorer performance on all 7 cognitive function tests compared with healthy controls (ps<0.006). There were significant gray matter volume differences between the two groups in bilateral hippocampus gyri, right superior temporal gyrus, left fusiform gyrus and orbital inferior frontal gyri (FDR, ps<0.05). Within the schizophrenia group, multiple regression analysis demonstrated that poorer performance on the working memory, verbal learning and visual learning was associated with smaller hippocampal gray matter volume, and poorer executive function was associated with smaller left orbital inferior frontal gray matter volume after controlling for potential confounding variables (β ≥ 0.420, ps ≤ 0.010). CONCLUSIONS Our findings suggest that cognitive deficits are associated with hippocampal and orbital inferior frontal gray matter volume abnormalities in treatment-naïve, first-episode patients with schizophrenia.
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Guo X, Li J, Wei Q, Fan X, Kennedy DN, Shen Y, Chen H, Zhao J. Duration of untreated psychosis is associated with temporal and occipitotemporal gray matter volume decrease in treatment naïve schizophrenia. PLoS One 2013; 8:e83679. [PMID: 24391807 PMCID: PMC3877095 DOI: 10.1371/journal.pone.0083679] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 11/15/2013] [Indexed: 11/19/2022] Open
Abstract
Background Long duration of untreated psychosis (DUP) is associated with poor treatment outcome. Whether or not DUP is related to brain gray matter volume abnormalities in antipsychotic medication treatment naïve schizophrenia remains unclear at this time. Methods Patients with treatment-naïve schizophrenia and healthy controls went through brain scan using high resolution Magnetic Resonance Imaging. DUP was evaluated using the Nottingham Onset Schedule (NOS), and dichotomized as short DUP (≤ 26 weeks) or long DUP (>26 weeks). Voxel-based methods were used for volumetric measure in the brain. Results Fifty-seven patients (27 short DUP and 30 long DUP) and 30 healthy controls were included in the analysis. There were significant gray matter volumetric differences among the 3 groups in bilateral parahippocampus gyri, right superior temporal gyrus, left fusiform gyrus, left middle temporal gyrus, and right superior frontal gyrus (p's<0.01). Compared with healthy controls, the long DUP group had significantly smaller volume in all these regions (p's <0.05). Compared with the short-DUP group, the long-DUP group had significantly smaller volume in right superior temporal gyrus, left fusiform gyrus, and left middle temporal gyrus (p's<0.01). Conclusion Our findings suggest that DUP is associated with temporal and occipitotemporal gray matter volume decrease in treatment naïve schizophrenia. The brain structural changes in untreated psychosis might contribute to poor treatment response and long-term prognosis in this patient population.
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Affiliation(s)
- Xiaofeng Guo
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Jun Li
- Key Laboratory for NeuroInformation of the Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Qinling Wei
- Department of Psychiatry, 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoduo Fan
- UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - David N. Kennedy
- UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Yidong Shen
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Huafu Chen
- Key Laboratory for NeuroInformation of the Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
- * E-mail: (JZ); (HC)
| | - Jingping Zhao
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, China
- * E-mail: (JZ); (HC)
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Chiapponi C, Piras F, Fagioli S, Piras F, Caltagirone C, Spalletta G. Age-related brain trajectories in schizophrenia: a systematic review of structural MRI studies. Psychiatry Res 2013; 214:83-93. [PMID: 23972726 DOI: 10.1016/j.pscychresns.2013.05.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/12/2013] [Accepted: 05/19/2013] [Indexed: 12/29/2022]
Abstract
Using the Pubmed database, we performed a detailed literature search for structural magnetic resonance imaging studies on patients with schizophrenia, investigating the relationship between macroscopic and microscopic structural parameters and age, to delineate an age-related trajectory. Twenty-six studies were considered for the review, from January 2000 to June 2012. Research results are heterogeneous because of the multifactorial features of schizophrenia and the multiplicity of the methodological approaches adopted. Some areas, within the amygdala-hippocampus complex, which are affected early in life by schizophrenia, age in a physiological way. Other regions, such as the superior temporal gyrus, appear already impaired at the onset of symptoms, undergo a worsening in the acute phase but later stabilize, progressing physiologically over years. Finally, there are regions, such as the uncinate fasciculus, which are not altered early in life, but are affected around the onset of schizophrenia, with their impairment continuously worsening over time. Further extensive longitudinal studies are needed to understand the timing and the possible degenerative characteristics of structural impairment associated with schizophrenia.
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Affiliation(s)
- Chiara Chiapponi
- Laboratory of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
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11
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Kong L, Bachmann S, Thomann PA, Essig M, Schröder J. Neurological soft signs and gray matter changes: a longitudinal analysis in first-episode schizophrenia. Schizophr Res 2012; 134:27-32. [PMID: 22018942 DOI: 10.1016/j.schres.2011.09.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/27/2011] [Accepted: 09/17/2011] [Indexed: 10/16/2022]
Abstract
Neurological soft signs (NSS) - i.e. discrete deficits of sensory and motor function - are frequently found in schizophrenia and vary with psychopathological symptoms in the course of the disorder. Hence, persistence of NSS herald chronicity in first episode schizophrenia. To investigate the cerebral correlates of persisting NSS over time, 20 patients with first-episode schizophrenia underwent T1 magnetic resonance imaging (MRI) after remission of the acute symptoms and after 1 year of follow-up. NSS were rated on the Heidelberg Scale. Twenty age- and gender-matched control subjects were scanned once. Longitudinal gray matter (GM) changes were measured by using tensor based morphometry (TBM). At follow-up, patients demonstrated significantly decreased NSS scores. For further analysis, the patient sample was dichotomized into patients with decreasing NSS scores and patients with persistently increased scores, respectively. While patients with decreasing NSS exhibited only localized changes within the left frontal lobe, cerebellum, and cingulate gyrus, patients with persistently increased scores showed pronounced GM reductions of the sub-lobar claustrum, cingulate gyrus, cerebellum, frontal lobe, and middle frontal gyrus. Results were confirmed after correction for multiple comparisons. These findings support the hypothesis that persisting NSS refer to progressive cerebral changes in first-episode schizophrenia. Since NSS can be assessed in any clinical environment, this association facilitates the prospect that NSS can help to establish prognosis in first-episode patients with schizophrenia.
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Affiliation(s)
- Li Kong
- Section of Geriatric Psychiatry, Department of Psychiatry, University of Heidelberg, Germany
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12
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Chong SA, Campbell A, Chee M, Liu J, Marx C, McGorry P, Subramaniam M, Yung A, Keefe RSE. The Singapore flagship programme in translational and clinical research in psychosis. Early Interv Psychiatry 2011; 5:290-300. [PMID: 22032547 DOI: 10.1111/j.1751-7893.2011.00304.x] [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] [Indexed: 01/24/2023]
Abstract
AIM This paper describes the rationale, aims and development of the Singapore Translational and Clinical Research in Psychosis, which is a 5-year programme. METHODS The authors provide a selective review of the pertinent findings from the clinical, neuropsychological, genetics and neuroimaging studies on high-risk population and how they were factored in the hypotheses and design of this translational clinical research programme. RESULTS This programme, which draws upon the previous work of various groups and the experience of the investigators of this consortium, comprises three interlinked studies. The first is a genome-wide association and copy number variation analysis using the diagnostic phenotype of schizophrenia and cognitive phenotypes, and a joint genome-wide analysis performed by combining our data with other datasets to increase the power to detect genetic risk factors. The second is a prospective study of a large group of individuals who are assessed to be at ultra-high risk of psychosis, and the third is a randomized controlled trial to improve neurocognition in patients with schizophrenia. CONCLUSION The convergence of various factors including the unique structured characteristics of the Singaporean society, the presence of political will with availability of funding and the established research infrastructure make it possible to accrue the sample size for adequate power to elucidate biomarkers of disease risk and resilience.
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Affiliation(s)
- Siow-Ann Chong
- Research Division, Institute of Mental Health (Singapore),Buangkok Medical Park, 10 Buangkok View, Singapore.
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Bachmann S, Haffer S, Beschoner P, Viviani R. Imputation techniques for the detection of microstructural changes in schizophrenia, with an application to magnetization transfer imaging. Schizophr Res 2011; 132:91-6. [PMID: 21820874 DOI: 10.1016/j.schres.2011.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 07/09/2011] [Accepted: 07/14/2011] [Indexed: 12/11/2022]
Abstract
Neuroimaging techniques such as magnetization transfer imaging allow the detection of microstructural alterations of tissue, and for this reason have been applied to the study of disorders such as schizophrenia. However, they are also sensitive to partial volume effects arising from mixed compartments, such as those comprising cerebral spinal fluid, which makes separate evaluation of volumetric and structural alterations difficult. Ensuing regional differences in the distribution of data and signal-to-noise ratio add further potential bias to their assessment. In the present study we simultaneously applied tissue segmentation, statistical imputation, and nonparametric inference to address these issues and improve the validity of statistical inference. In a case study of N=32 schizophrenic patients matched to the same number of controls, we compared a standard voxel-based analysis with one supplemented by the imputation technique. We were able to replicate significant results in the imputed analysis and even extend them in the areas not excluded by excessive partial volume effects. Application of segmentation algorithms in this dataset also suggested that partial volume effects from spinal fluid potentially affect inference in most cortical gray matter, unless remedial steps are undertaken. Refined imputation methods may be particularly attractive in future research settings characterized by large samples and the availability of adequate computational resources.
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Affiliation(s)
- Silke Bachmann
- Dept. of Psychiatry, Psychotherapy, and Psychosomatics, University of Halle (Saale), Germany
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14
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Asami T, Bouix S, Whitford TJ, Shenton ME, Salisbury DF, McCarley RW. Longitudinal loss of gray matter volume in patients with first-episode schizophrenia: DARTEL automated analysis and ROI validation. Neuroimage 2011; 59:986-96. [PMID: 21924364 DOI: 10.1016/j.neuroimage.2011.08.066] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 08/07/2011] [Accepted: 08/21/2011] [Indexed: 11/25/2022] Open
Abstract
Region of Interest (ROI) longitudinal studies have detected progressive gray matter (GM) volume reductions in patients with first-episode schizophrenia (FESZ). However, there are only a few longitudinal voxel-based morphometry (VBM) studies, and these have been limited in ability to detect relationships between volume loss and symptoms, perhaps because of methodologic issues. Nor have previous studies compared and validated VBM results with manual Region of Interest (ROI) analysis. In the present VBM study, high-dimensional warping and individualized baseline-rescan templates were used to evaluate longitudinal volume changes within subjects and compared with longitudinal manual ROI analysis on the same subjects. VBM evaluated thirty-three FESZ and thirty-six matched healthy control subjects (HC) at baseline (cross-sectionally) and longitudinally evaluated 21 FESZ and 23 HC after an average of 1.5 years from baseline scans. Correlation analyses detected the relationship between changes in regional GM volumes in FESZ and clinical symptoms derived from the Brief Psychiatric Rating Scale, as well as cognitive function as assessed by the Mini-Mental State Examination. At baseline, patients with FESZ had significantly smaller GM volume compared to HC in some regions including the left superior temporal gyrus (STG). On rescan after 1.5 years, patients showed significant GM volume reductions compared with HC in the left STG including Heschl's gyrus, and in widespread brain neocortical regions of frontal, parietal, and limbic regions including the cingulate gyrus. FESZ showed an association of positive symptoms and volume loss in temporal (especially STG) and frontal regions, and negative symptoms and volume loss in STG and frontal regions. Worse cognitive function was linked to widespread volume reduction, in frontal, temporal and parietal regions. The validation VBM analyses showed results similar to our previous ROI findings for STG and cingulate gyrus. We conclude FESZ show widespread, progressive GM volume reductions in many brain regions. Importantly, these reductions are directly associated with a worse clinical course. Congruence with ROI analyses suggests the promise of this longitudinal VBM methodology.
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Affiliation(s)
- Takeshi Asami
- Laboratory of Neuroscience, Clinical Neuroscience Division, Department of Psychiatry, Boston Veterans Affairs Healthcare System, Brockton Division, Harvard Medical School, Brockton, Massachusetts, USA
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Waters-Metenier S, Toulopoulou T. Putative structural neuroimaging endophenotypes in schizophrenia: a comprehensive review of the current evidence. FUTURE NEUROLOGY 2011. [DOI: 10.2217/fnl.11.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The genetic contribution to schizophrenia etiopathogenesis is underscored by the fact that the best predictor of developing schizophrenia is having an affected first-degree relative, which increases lifetime risk by tenfold, as well as the observation that when both parents are affected, the risk of schizophrenia increases to approximately 50%, compared with 1% in the general population. The search to elucidate the complex genetic architecture of schizophrenia has employed various approaches, including twin and family studies to examine co-aggregation of brain abnormalities, studies on genetic linkage and studies using genome-wide association to identify genetic variations associated with schizophrenia. ‘Endophenotypes’, or ‘intermediate phenotypes’, are potentially narrower constructs of genetic risk. Hypothetically, they are intermediate in the pathway between genetic variation and clinical phenotypes and can supposedly be implemented to assist in the identification of genetic diathesis for schizophrenia and, possibly, in redefining clinical phenomenology.
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Affiliation(s)
- Sheena Waters-Metenier
- Department of Psychosis Studies, King’s College London, King’s Health Partners, Institute of Psychiatry, London, UK
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Heuser M, Thomann PA, Essig M, Bachmann S, Schröder J. Neurological signs and morphological cerebral changes in schizophrenia: An analysis of NSS subscales in patients with first episode psychosis. Psychiatry Res 2011; 192:69-76. [PMID: 21498055 DOI: 10.1016/j.pscychresns.2010.11.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 11/23/2010] [Accepted: 11/23/2010] [Indexed: 11/19/2022]
Abstract
Neurological soft signs (NSS) comprise a broad range of minor motor and sensory deficits which are frequently found in schizophrenia. However, the cerebral changes underlying NSS are only partly understood. We therefore investigated the cerebral correlates of NSS by using magnetic resonance imaging (MRI) in 102 patients with first episode schizophrenia. NSS were assessed after remission of acute psychotic symptoms using the Heidelberg scale (HS), which consists of five NSS subscales ("motor coordination", "complex motor tasks", "orientation", "integrative functions", and "hard signs"). Correlations between NSS scores and cerebral changes were established by optimized voxel-based morphometry. NSS total scores were significantly associated with reduced gray matter densities in the precentral and postcentral gyri, the inferior parietal lobule and the inferior occipital gyrus. Both of the NSS subscales "motor coordination" and "complex motor tasks", referred to motor strip changes but showed differential correlations with parietal, insular, cerebellar or frontal sites, respectively. The NSS subscales "orientation" and "integrative functions" were associated with left frontal, parietal, and occipital changes or bihemispheric frontal changes, respectively. The NSS subscale "hard signs" was associated with deficits in the right cerebellum and right parastriate cortex. Repeated analyses for white matter changes revealed similar results. These findings confirm the associations between NSS and cerebral changes in areas important for motor and sensory functioning. This variety of cerebral sites corresponds to the heterogeneity of NSS and are consistent with the hypothesis that NSS reflect both a rather generalized cerebral dysfunction and localized deficits specific for particular signs.
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Affiliation(s)
- Mark Heuser
- Section of Geriatric Psychiatry, University of Heidelberg, Germany
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17
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Abstract
BACKGROUND People with schizophrenia are often found to have smaller brains and larger brain ventricles than normal, but the role of antipsychotic medication remains unclear. METHOD We conducted a systematic review of magnetic resonance imaging (MRI) studies. We included longitudinal studies of brain changes in patients taking antipsychotic drugs and we examined studies of antipsychotic-naive patients for comparison purposes. RESULTS Fourteen out of 26 longitudinal studies showed a decline in global brain or grey-matter volume or an increase in ventricular or cerebrospinal fluid (CSF) volume during the course of drug treatment, including the largest studies conducted. The frontal lobe was most consistently affected, but overall changes were diffuse. One large study found different degrees of volume loss with different antipsychotics, and another found that volume changes were associated with taking medication compared with taking none. Analyses of linear associations between drug exposure and brain volume changes produced mixed results. Five out of 21 studies of patients who were drug naive, or had only minimal prior treatment, showed some differences from controls in volumes of interest. No global differences were reported in three studies of drug-naive patients with long-term illness. Studies of high-risk groups have not demonstrated differences from controls in global or lobar brain volumes. CONCLUSIONS Some evidence points towards the possibility that antipsychotic drugs reduce the volume of brain matter and increase ventricular or fluid volume. Antipsychotics may contribute to the genesis of some of the abnormalities usually attributed to schizophrenia.
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Affiliation(s)
- J Moncrieff
- Department of Mental Health Sciences, University College London, UK.
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18
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Elsabagh S, Premkumar P, Anilkumar AP, Kumari V. A longer duration of schizophrenic illness has sex-specific associations within the working memory neural network in schizophrenia. Behav Brain Res 2009; 201:41-7. [DOI: 10.1016/j.bbr.2009.01.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2008] [Revised: 01/15/2009] [Accepted: 01/19/2009] [Indexed: 10/21/2022]
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Follow-up MRI study of the insular cortex in first-episode psychosis and chronic schizophrenia. Schizophr Res 2009; 108:49-56. [PMID: 19171466 DOI: 10.1016/j.schres.2008.12.029] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 12/16/2008] [Accepted: 12/24/2008] [Indexed: 11/24/2022]
Abstract
Morphologic abnormalities of the insular cortex have been described in psychotic disorders such as schizophrenia, but it remains unknown whether these abnormalities develop progressively over the course of the illness. In the current study, longitudinal magnetic resonance imaging data were obtained from 23 patients with first-episode psychosis (FEP), 11 patients with chronic schizophrenia, and 26 healthy controls. The volumes of the short (anterior) and long (posterior) insular cortices were measured on baseline and follow-up (between 1 and 4 years later) scans and were compared across groups. In cross-sectional comparison at baseline, the FEP and chronic schizophrenia patients had significantly smaller short insular cortex than did controls. In longitudinal comparison, the FEP patients showed significant gray matter reduction of the insular cortex over time (-4.3%/2.0 years) compared with controls (0.3%/2.2 years) without significant subregional effects, but there was no difference between chronic schizophrenia patients (-1.7%/2.4 years) and controls. The gray matter loss of the left insular cortex over time in FEP patients was correlated with the severity of positive and negative symptoms at follow-up. These findings indicate that patients with psychotic disorders have smaller gray matter volume of the insular cortex especially for its anterior portion (short insula) at first expression of overt psychosis, but also exhibit a regional progressive pathological process of the insular cortex during the early phase after the onset, which seems to reflect the subsequent symptomatology.
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20
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Premkumar P, Fannon D, Kuipers E, Cooke MA, Simmons A, Kumari V. Association between a longer duration of illness, age and lower frontal lobe grey matter volume in schizophrenia. Behav Brain Res 2008; 193:132-9. [PMID: 18586335 DOI: 10.1016/j.bbr.2008.05.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 05/07/2008] [Accepted: 05/10/2008] [Indexed: 11/19/2022]
Abstract
The frontal lobe has an extended maturation period and may be vulnerable to the long-term effects of schizophrenia. We tested this hypothesis by studying the relationship between duration of illness (DoI), grey matter (GM) and cerebro-spinal fluid (CSF) volume across the whole brain. Sixty-four patients with schizophrenia and 25 healthy controls underwent structural MRI scanning and neuropsychological assessment. We performed regression analyses in patients to examine the relationship between DoI and GM and CSF volumes across the whole brain, and correlations in controls between age and GM or CSF volume of the regions where GM or CSF volumes were associated with DoI in patients. Correlations were also performed between GM volume in the regions associated with DoI and neuropsychological performance. A longer DoI was associated with lower GM volume in the left dorsomedial prefrontal cortex (PFC), right middle frontal cortex, left fusiform gyrus (FG) and left cerebellum (lobule III). Additionally, age was inversely associated with GM volume in the left dorsomedial PFC in patients, and in the left FG and CSF excess near the left cerebellum in healthy controls. Greater GM volume in the left dorsomedial PFC was associated with better working memory, attention and psychomotor speed in patients. Our findings suggest that the right middle frontal cortex is particularly vulnerable to the long-term effect of schizophrenia illness whereas the dorsomedial PFC, FG and cerebellum are affected by both a long DoI and aging. The effect of illness chronicity on GM volume in the left dorsomedial PFC may be extended to brain structure-neuropsychological function relationships.
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Affiliation(s)
- Preethi Premkumar
- Department of Psychology, Institute of Psychiatry, De Crespigny Park, King's College London, London SE5 8AF, United Kingdom.
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21
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Neuropsychological function-brain structure relationships and stage of illness: an investigation into chronic and first-episode schizophrenia. Psychiatry Res 2008; 162:195-204. [PMID: 18226505 DOI: 10.1016/j.pscychresns.2007.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 08/23/2007] [Indexed: 11/22/2022]
Abstract
Neuropsychological function-brain structure relationships may differ as a function of illness stage because of progressive brain matter loss through the course of schizophrenia. In this study, we tested whether neuropsychological function-brain structure relationships differed as a function of illness stage. In addition, we tested whether these relationships differed between older and young healthy controls. Function-structure relationships were examined in 35 first-episode patients (31 with schizophrenia, 4 with schizoaffective disorder), 54 chronic schizophrenia patients, 21 older healthy controls and 20 young healthy controls. MRI volumes of frontal and temporal lobe structures, as well as the whole brain, were estimated using a region-of-interest approach. Hierarchical multiple regression analyses were performed between the MRI and neuropsychological measures. Stronger relationships of immediate memory-total prefrontal cortex (PFC) volume in chronic than first-episode patients, and in older than young controls were observed. The abstract reasoning (WCST perseverative errors)-total temporal lobe volume relationship was stronger in older than young controls. These function-structure relationships appeared unexplained by whole brain volume or age in chronic patients. A similar dissociation between young and older subjects of both healthy and patient groups suggests that a 'bigger-is-better' relationship style is present in older individuals regardless of a diagnosis of schizophrenia.
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Liu Y, Liang M, Zhou Y, He Y, Hao Y, Song M, Yu C, Liu H, Liu Z, Jiang T. Disrupted small-world networks in schizophrenia. Brain 2008; 131:945-61. [PMID: 18299296 DOI: 10.1093/brain/awn018] [Citation(s) in RCA: 751] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yong Liu
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100080, China
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Salisbury DF, Kuroki N, Kasai K, Shenton ME, McCarley RW. Progressive and interrelated functional and structural evidence of post-onset brain reduction in schizophrenia. ACTA ACUST UNITED AC 2007; 64:521-9. [PMID: 17485604 PMCID: PMC2903200 DOI: 10.1001/archpsyc.64.5.521] [Citation(s) in RCA: 289] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Progressive brain abnormalities in schizophrenia remain controversial. Evidence of interrelated progressive functional impairment would buttress the case for structural progression. Mismatch negativity (MMN) is reduced in chronic but not first-hospitalized schizophrenia and may index progressive structural changes. OBJECTIVE To determine whether MMN shows associations with underlying auditory cortex gray matter at first hospitalization and progressive reduction longitudinally. DESIGN Cross-sectional (first hospitalization) and longitudinal (1.5-year follow-up). SETTING A private psychiatric hospital. PARTICIPANTS Protocol entrance: MMN and magnetic resonance imaging at first hospitalization in 20 subjects with schizophrenia, 21 subjects with bipolar disorder with psychosis, and 32 control subjects. Longitudinal electrophysiologic testing: MMN in 16 subjects with schizophrenia, 17 subjects with bipolar disorder, and 20 control subjects. Longitudinal electrophysiologic testing and magnetic resonance imaging: MMN and magnetic resonance imaging in 11 subjects with schizophrenia, 13 subjects with bipolar disorder, and 13 control subjects. At each time point, reported samples were group matched for age, handedness, and parental socioeconomic status. INTERVENTIONS Electrophysiologic testing and high-resolution structural magnetic resonance imaging. MAIN OUTCOME MEASURES Mismatch negativity amplitude and Heschl gyrus and planum temporale gray matter volumes. RESULTS Initially, groups did not differ in MMN amplitude. Subjects with schizophrenia showed associations between MMN and Heschl gyrus (r=-0.52; P=.02) not present in the other groups. At longitudinal MMN testing, schizophrenia showed MMN reduction (P=.004). Only schizophrenia evinced longitudinal left hemisphere Heschl gyrus reduction (P=.003), highly correlated with MMN reduction (r=0.6; P=.04). CONCLUSIONS At first hospitalization for schizophrenia, MMN indexed left hemisphere Heschl gyrus gray matter volume, consistent with variable progression of pre-hospitalization cortical reduction. Longitudinally, the interrelated progressive reduction of functional and structural measures suggests progressive pathologic processes early in schizophrenia. An active process of progressive cortical reduction presents a potential therapeutic target. Mismatch negativity may be a simple, sensitive, and inexpensive index not only of this progressive pathologic process but also of successful intervention.
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Affiliation(s)
- Dean F Salisbury
- Veterans Affairs Boston Healthcare System, Brockton Division, Brockton, Boston, MA, USA.
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Vita A, De Peri L, Silenzi C, Dieci M. Brain morphology in first-episode schizophrenia: a meta-analysis of quantitative magnetic resonance imaging studies. Schizophr Res 2006; 82:75-88. [PMID: 16377156 DOI: 10.1016/j.schres.2005.11.004] [Citation(s) in RCA: 278] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Revised: 11/01/2005] [Accepted: 11/05/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND A number of meta-analytic reviews of structural brain imaging studies have shown that multiple subtle brain abnormalities are consistently found in schizophrenia. However, quantitative reviews till now published have included mainly studies performed on chronic schizophrenic patients but have failed to provide clear information on specific, possibly different, findings in first-episode schizophrenia. METHODS We performed a systematic search for MRI studies that reported quantitative measurements of volumes of brain regions in first-episode schizophrenic patients and in healthy controls. Twelve meta-analyses were performed for 6 cerebral regions. RESULTS Twenty-one studies were identified as suitable for analysis. Significant overall effect sizes were demonstrated for lateral and third ventricular volume increase, and for volume reduction of whole brain and hippocampus, but not for temporal lobe, amygdala and total intracranial volumes. CONCLUSIONS The available literature data strongly indicate that some brain abnormalities are already present in first-episode schizophrenic patients. However, unlike the results of published meta-analyses conducted primarily on samples of chronic schizophrenic patients, the present study did not confirm a significant reduction of temporal lobe or amygdala volumes in first-episode schizophrenia. These findings support the hypothesis of different patterns of involvement of various cerebral areas over the time course of schizophrenia.
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Affiliation(s)
- A Vita
- Department of Mental Health, University of Brescia, Italy.
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25
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Whitworth AB, Kemmler G, Honeder M, Kremser C, Felber S, Hausmann A, Walch T, Wanko C, Weiss EM, Stuppaeck CH, Fleischhacker WW. Longitudinal volumetric MRI study in first- and multiple-episode male schizophrenia patients. Psychiatry Res 2005; 140:225-37. [PMID: 16275040 DOI: 10.1016/j.pscychresns.2005.07.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2005] [Revised: 06/20/2005] [Accepted: 07/20/2005] [Indexed: 11/28/2022]
Abstract
In this longitudinal study we compared brain volume changes in first- and multiple-episode patients with schizophrenia to normal aging changes observed in healthy control subjects scanned at comparable times. Two to four years after an initial examination including MRI volumetry, we followed up 21 first episode patients, 17 patients after multiple episodes of schizophrenia, and 20 healthy controls. Volumetric measurements of left and right hemispheres, total brain volume, lateral ventricles, hippocampus and amygdala as well as a clinical evaluation were performed. Patients with schizophrenia showed significant ventricular enlargement and volume reduction of the hippocampus-amygdala complex compared with healthy control subjects both at baseline and follow-up. While there were no differences between patients and controls with respect to mean annual volume changes in the measured regions, patients with schizophrenia showed higher between-subject variability in ventricular volume change. These data are consistent with cross-sectional studies demonstrating ventricular enlargement and hippocampal volume deficits in schizophrenia. However, we were not able to demonstrate a difference in the rate of volume changes over time that distinguished patients with schizophrenia from healthy controls for any of the brain structures measured. Drawbacks of the study are that the follow-up was done after a relatively short interval and that there was a difference in time to follow-up and age between patients and controls. Our results do not support the hypothesis that schizophrenia leads to progressive volume reduction in these areas, although there may be a subset of patients with morphologically visible disease progression.
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