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Reinen JM, Polosecki P, Castro E, Corcoran CM, Cecchi GA, Colibazzi T. Multimodal fusion of brain signals for robust prediction of psychosis transition. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:54. [PMID: 38773120 PMCID: PMC11109212 DOI: 10.1038/s41537-024-00464-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/15/2024] [Indexed: 05/23/2024]
Abstract
The prospective study of youths at clinical high risk (CHR) for psychosis, including neuroimaging, can identify neural signatures predictive of psychosis outcomes using algorithms that integrate complex information. Here, to identify risk and psychosis conversion, we implemented multiple kernel learning (MKL), a multimodal machine learning approach allowing patterns from each modality to inform each other. Baseline multimodal scans (n = 74, 11 converters) included structural, resting-state functional imaging, and diffusion-weighted data. Multimodal MKL outperformed unimodal models (AUC = 0.73 vs. 0.66 in predicting conversion). Moreover, patterns learned by MKL were robust to training set variations, suggesting it can identify cross-modality redundancies and synergies to stabilize the predictive pattern. We identified many predictors consistent with the literature, including frontal cortices, cingulate, thalamus, and striatum. This highlights the advantage of methods that leverage the complex pathophysiology of psychosis.
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Affiliation(s)
- Jenna M Reinen
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA.
| | | | - Eduardo Castro
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Cheryl M Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Tiziano Colibazzi
- Department of Psychiatry, The New York State Psychiatric Institute, Columbia College of Physicians and Surgeons, New York, NY, USA
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Lu J, Gou N, Sun Q, Huang Y, Guo H, Han D, Zhou J, Wang X. Brain structural alterations associated with impulsiveness in male violent patients with schizophrenia. BMC Psychiatry 2024; 24:281. [PMID: 38622613 PMCID: PMC11017613 DOI: 10.1186/s12888-024-05721-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Violence in schizophrenia (SCZ) is a phenomenon associated with neurobiological factors. However, the neural mechanisms of violence in patients with SCZ are not yet sufficiently understood. Thus, this study aimed to explore the structural changes associated with the high risk of violence and its association with impulsiveness in patients with SCZ to reveal the possible neurobiological basis. METHOD The voxel-based morphometry approach and whole-brain analyses were used to measure the alteration of gray matter volume (GMV) for 45 schizophrenia patients with violence (VSC), 45 schizophrenia patients without violence (NSC), and 53 healthy controls (HC). Correlation analyses were used to examine the association of impulsiveness and brain regions associated with violence. RESULTS The results demonstrated reduced GMV in the right insula within the VSC group compared with the NSC group, and decreased GMV in the right temporal pole and left orbital part of superior frontal gyrus only in the VSC group compared to the HC group. Spearman correlation analyses further revealed a positive correlation between impulsiveness and GMV of the left superior temporal gyrus, bilateral insula and left medial orbital part of the superior frontal gyrus in the VSC group. CONCLUSION Our findings have provided further evidence for structural alterations in patients with SCZ who had engaged in severe violence, as well as the relationship between the specific brain alterations and impulsiveness. This work provides neural biomarkers and improves our insight into the neural underpinnings of violence in patients with SCZ.
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Affiliation(s)
- Juntao Lu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Ningzhi Gou
- Department of Psychiatry, the First Affiliated Hospital, Medical College of Xi 'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Qiaoling Sun
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Ying Huang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Huijuan Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Dian Han
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Jiansong Zhou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
| | - Xiaoping Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
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Ku BS, Collins M, Anglin DM, Diomino AM, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Druss BG, Keshavan M, Mathalon DH, Perkins DO, Stone WS, Tsuang MT, Woods SW, Walker EF. Associations between childhood ethnoracial minority density, cortical thickness, and social engagement among minority youth at clinical high-risk for psychosis. Neuropsychopharmacology 2023; 48:1707-1715. [PMID: 37438421 PMCID: PMC10579230 DOI: 10.1038/s41386-023-01649-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/14/2023]
Abstract
An ethnoracial minority density (EMD) effect in studies of psychotic spectrum disorders has been observed, whereby the risk of psychosis in ethnoracial minority group individuals is inversely related to the proportion of minorities in their area of residence. The authors investigated the relationships among area-level EMD during childhood, cortical thickness (CT), and social engagement (SE) in clinical high risk for psychosis (CHR-P) youth. Data were collected as part of the North American Prodrome Longitudinal Study. Participants included 244 ethnoracial minoritized (predominantly Hispanic, Asian and Black) CHR-P youth and ethnoracial minoritized healthy controls. Among youth at CHR-P (n = 164), lower levels of EMD during childhood were associated with reduced CT in the right fusiform gyrus (adjusted β = 0.54; 95% CI 0.17 to 0.91) and right insula (adjusted β = 0.40; 95% CI 0.05 to 0.74). The associations between EMD and CT were significantly moderated by SE: among youth with lower SE (SE at or below the median, n = 122), lower levels of EMD were significantly associated with reduced right fusiform gyrus CT (adjusted β = 0.72; 95% CI 0.29 to 1.14) and reduced right insula CT (adjusted β = 0.57; 95% CI 0.18 to 0.97). However, among those with greater SE (n = 42), the associations between EMD and right insula and fusiform gyrus CT were not significant. We found evidence that lower levels of ethnic density during childhood were associated with reduced cortical thickness in regional brain regions, but this association may be buffered by greater levels of social engagement.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Meghan Collins
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Deidre M Anglin
- Department of Psychology, The City College of New York, City University of New York, New York, NY, USA
- The Graduate Center, City University of New York, New York, NY, USA
| | - Anthony M Diomino
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Kristin S Cadenhead
- Department of Psychology, The City College of New York, City University of New York, New York, NY, USA
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Matcheri Keshavan
- Harvard Medical School, Departments of Psychiatry at Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, and Massachusetts General Hospital, Boston, MA, USA
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - William S Stone
- Harvard Medical School, Departments of Psychiatry at Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, and Massachusetts General Hospital, Boston, MA, USA
| | - Ming T Tsuang
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Scott W Woods
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
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Iftimovici A, Chaumette B, Duchesnay E, Krebs MO. Brain anomalies in early psychosis: From secondary to primary psychosis. Neurosci Biobehav Rev 2022; 138:104716. [PMID: 35661683 DOI: 10.1016/j.neubiorev.2022.104716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/12/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
Abstract
Brain anomalies are frequently found in early psychoses. Although they may remain undetected for many years, their interpretation is critical for differential diagnosis. In secondary psychoses, their identification may allow specific management. They may also shed light on various pathophysiological aspects of primary psychoses. Here we reviewed cases of secondary psychoses associated with brain anomalies, reported over a 20-year period in adolescents and young adults aged 13-30 years old. We considered age at first psychotic symptoms, relevant medical history, the nature of psychiatric symptoms, clinical red flags, the nature of the brain anomaly reported, and the underlying disease. We discuss the relevance of each brain area in light of normal brain function, recent case-control studies, and postulated pathophysiology. We show that anomalies in all regions, whether diffuse, multifocal, or highly localized, may lead to psychosis, without necessarily being associated with non-psychiatric symptoms. This underlines the interest of neuroimaging in the initial workup, and supports the hypothesis of psychosis as a global network dysfunction that involves many different regions.
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Affiliation(s)
- Anton Iftimovici
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, GDR 3557-Institut de Psychiatrie, Paris, France; NeuroSpin, Atomic Energy Commission, Gif-sur Yvette, France; GHU Paris Psychiatrie et Neurosciences, Paris, France.
| | - Boris Chaumette
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, GDR 3557-Institut de Psychiatrie, Paris, France; GHU Paris Psychiatrie et Neurosciences, Paris, France
| | | | - Marie-Odile Krebs
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, GDR 3557-Institut de Psychiatrie, Paris, France; GHU Paris Psychiatrie et Neurosciences, Paris, France
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Soldevila-Matías P, Albajes-Eizagirre A, Radua J, García-Martí G, Rubio JM, Tordesillas-Gutierrez D, Fuentes-Durá I, Solanes A, Fortea L, Oliver D, Sanjuán J. Precuneus and insular hypoactivation during cognitive processing in first-episode psychosis: Systematic review and meta-analysis of fMRI studies. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022; 15:101-116. [PMID: 35840277 DOI: 10.1016/j.rpsmen.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/09/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The neural correlates of the cognitive dysfunction in first-episode psychosis (FEP) are still unclear. The present review and meta-analysis provide an update of the location of the abnormalities in the fMRI-measured brain response to cognitive processes in individuals with FEP. METHODS Systematic review and voxel-based meta-analysis of cross-sectional fMRI studies comparing neural responses to cognitive tasks between individuals with FEP and healthy controls (HC) according to PRISMA guidelines. RESULTS Twenty-six studies were included, comprising 598 individuals with FEP and 567 HC. Individual studies reported statistically significant hypoactivation in the dorsolateral prefrontal cortex (6 studies), frontal lobe (8 studies), cingulate (6 studies) and insula (5 studies). The meta-analysis showed statistically significant hypoactivation in the left anterior insula, precuneus and bilateral striatum. CONCLUSIONS While the studies tend to highlight frontal hypoactivation during cognitive tasks in FEP, our meta-analytic results show that the left precuneus and insula primarily display aberrant activation in FEP that may be associated with salience attribution to external stimuli and related to deficits in perception and regulation.
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Affiliation(s)
- Pau Soldevila-Matías
- Research Institute of the Hospital Clínic Universitari of Valencia (INCLIVA), Valencia, Spain; Department of Basic Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Anton Albajes-Eizagirre
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; FIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, Barcelona, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; FIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, Barcelona, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Gracián García-Martí
- Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; Biomedical Engineering Unit/Radiology Department, Quirónsalud Hospital, Spain
| | - José M Rubio
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA; The Feinstein Institute, Northwell Health Hospital, New York, USA
| | - Diana Tordesillas-Gutierrez
- Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; University Hospital Marqués de Valdecilla (IDIVAL), Department of Psychiatry, School of Medicine, University of Cantabria, Spain; Neuroimaging Unit, Technological Facilities, Valdecilla Biomedical Research Institute IDIVAL, Santander, Cantabria, Spain
| | - Inmaculada Fuentes-Durá
- Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Aleix Solanes
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Lydia Fortea
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Julio Sanjuán
- Research Institute of the Hospital Clínic Universitari of Valencia (INCLIVA), Valencia, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Psychiatric, University of Valencia, School of Medicine, Valencia, Spain
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Insula volumes in first-episode and chronic psychosis: A longitudinal MRI study. Schizophr Res 2022; 241:14-23. [PMID: 35074528 DOI: 10.1016/j.schres.2021.12.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/21/2021] [Accepted: 12/28/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Alterations in insular grey matter (GM) volume has been consistently reported for affective and non-affective psychoses both in chronic and first-episode patients, ultimately suggesting that the insula might represent a good region to study in order to assess the longitudinal course of psychotic disorders. Therefore, in this longitudinal Magnetic Resonance Imaging (MRI) study, we aimed at further investigating the key role of insular volumes in psychosis. MATERIAL AND METHODS 68 First-Episode Psychosis (FEP) patients, 68 patients with Schizophrenia (SCZ), 47 Bipolar Disorder (BD) patients, and 94 Healthy Controls (HC) were enrolled and underwent a 1.5 T MRI evaluation. A subsample of 99 subjects (10 HC, 23 BD, 29 SCZ, 37 FEP) was rescanned after 2,53 ± 1,68 years. The insular cortex was manually traced and then divided into an anterior and posterior portion. Group and correlation analyses were then performed both at baseline and at follow-up. RESULTS At baseline, greater anterior and lower posterior insular GM volumes were observed in chronic patients. At follow-up, we found that FEP patients had a significant GM volume increase from baseline to follow-up, especially in the posterior insula whereas chronic patients showed a relative stability. Finally, significant negative correlations between illness severity and pharmacological treatment and insular GM volumes were observed in the whole group of psychotic patients. CONCLUSIONS The longitudinal assessment of both chronic and first-episode patients allowed us to detect a complex pattern of GM abnormalities in selective sub-portions of insular volumes, ultimately suggesting that this structure could represent a key biological marker of psychotic disorders.
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Hubl D, Michel C, Schultze-Lutter F, Hauf M, Schimmelmann BG, Kaess M, Kindler J. Basic symptoms and gray matter volumes of patients at clinical high risk for psychosis. Psychol Med 2021; 51:2666-2674. [PMID: 32404212 DOI: 10.1017/s0033291720001282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Clinical high-risk (CHR) for psychosis is indicated by ultra-high risk (UHR) and basic symptom (BS) criteria; however, conversion rates are highest when both UHR and BS criteria are fulfilled (UHR&BS). While BSs are considered the most immediate expression of neurobiological aberrations underlying the development of psychosis, research on neurobiological correlates of BS is scarce. METHODS We investigated gray matter volumes (GMV) of 20 regions of interest (ROI) previously associated with UHR criteria in 90 patients from the Bern early detection service: clinical controls (CC), first-episode psychosis (FEP), UHR, BS and UHR&BS. We expected lowest GMV in FEP and UHR&BS, and highest volume in CC with UHR and BS in-between. RESULTS Significantly, lower GMV was detected in FEP and UHR&BS patients relative to CC with no other significant between-group differences. When ROIs were analyzed separately, seven showed a significant group effect (FDR corrected), with five (inferior parietal, medial orbitofrontal, lateral occipital, middle temporal, precuneus) showing significantly lower GM volume in the FEP and/or UHR&BS groups than in the CC group (Bonferroni corrected). In the CHR group, only COGDIS scores correlated negatively with cortical volumes. CONCLUSIONS This is the first study to demonstrate that patients who fulfill both UHR and BS criteria - a population that has been associated with higher conversion rates - exhibit more severe GMV reductions relative to those who satisfy BS or UHR criteria alone. This result was mediated by the BS in the UHR&BS group, as only the severity of BS was linked to GMV reductions.
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Affiliation(s)
- Daniela Hubl
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Martinus Hauf
- Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, University of Bern, Switzerland
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
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Lyu H, Jiao J, Feng G, Wang X, Sun B, Zhao Z, Shang D, Pan F, Xu W, Duan J, Zhou Q, Hu S, Xu Y, Xu D, Huang M. Abnormal causal connectivity of left superior temporal gyrus in drug-naïve first- episode adolescent-onset schizophrenia: A resting-state fMRI study. Psychiatry Res Neuroimaging 2021; 315:111330. [PMID: 34280873 DOI: 10.1016/j.pscychresns.2021.111330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/06/2021] [Accepted: 07/02/2021] [Indexed: 12/19/2022]
Abstract
This study aimed to investigate the alterations of causal connectivity between the brain regions in Adolescent-onset schizophrenia (AOS) patients. Thirty-two first-episode drug-naïve AOS patients and 27 healthy controls (HC) were recruited for resting-state functional MRI scanning. The brain region with the between-group difference in regional homogeneity (ReHo) values was chosen as a seed to perform the Granger causality analysis (GCA) and further detect the alterations of causal connectivity in AOS. AOS patients exhibited increased ReHo values in left superior temporal gyrus (STG) compared with HCs. Significantly decreased values of outgoing Granger causality from left STG to right superior frontal gyrus and right angular gyrus were observed in GC mapping for AOS. Significantly stronger causal outflow from left STG to right insula and stronger causal inflow from right middle occipital gyrus (MOG) to left STG were also observed in AOS patients. Based on assessments of the two strengthened causal connectivity of the left STG with insula and MOG, a discriminant model could identify all patients from controls with 94.9% accuracy. This study indicated that alterations of directional connections in left STG may play an important role in the pathogenesis of AOS and serve as potential biomarkers for the disease.
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Affiliation(s)
- Hailong Lyu
- The First Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Jianping Jiao
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Guoxun Feng
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Ningbo Mental Hospital, Ningbo, Zhejiang, China
| | - Xinxin Wang
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Bin Sun
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Ningbo Mental Hospital, Ningbo, Zhejiang, China
| | - Zhiyong Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China; Columbia University & New York State Psychiatric Institute, New York, United States
| | - Desheng Shang
- The First Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Fen Pan
- The First Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Weijuan Xu
- The First Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Jinfeng Duan
- The First Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, Zhejiang, China
| | | | - Shaohua Hu
- The First Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yi Xu
- The First Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Dongrong Xu
- Columbia University & New York State Psychiatric Institute, New York, United States.
| | - Manli Huang
- The First Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, Zhejiang, China.
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Sheffield JM, Huang AS, Rogers BP, Blackford JU, Heckers S, Woodward ND. Insula sub-regions across the psychosis spectrum: morphology and clinical correlates. Transl Psychiatry 2021; 11:346. [PMID: 34088895 PMCID: PMC8178380 DOI: 10.1038/s41398-021-01461-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/04/2021] [Accepted: 05/14/2021] [Indexed: 02/05/2023] Open
Abstract
The insula is a heterogeneous cortical region, comprised of three cytoarchitecturally distinct sub-regions (agranular, dysgranular, and granular), which traverse the anterior-posterior axis and are differentially involved in affective, cognitive, and somatosensory processing. Smaller insula volume is consistently reported in psychosis-spectrum disorders and is hypothesized to result, in part, from abnormal neurodevelopment. To better understand the regional and diagnostic specificity of insula abnormalities in psychosis, their developmental etiology, and clinical correlates, we characterized insula volume and morphology in a large group of adults with a psychotic disorder (schizophrenia spectrum, psychotic bipolar disorder) and a community-ascertained cohort of psychosis-spectrum youth (age 8-21). Insula volume and morphology (cortical thickness, gyrification, sulcal depth) were quantified from T1-weighted structural brain images using the Computational Anatomy Toolbox (CAT12). Healthy adults (n = 196), people with a psychotic disorder (n = 303), and 1368 individuals from the Philadelphia Neurodevelopmental Cohort (PNC) (381 typically developing (TD), 381 psychosis-spectrum (PS) youth, 606 youth with other psychopathology (OP)), were investigated. Insula volume was significantly reduced in adults with psychotic disorders and psychosis-spectrum youth, following an anterior-posterior gradient across granular sub-regions. Morphological abnormalities were limited to lower gyrification in psychotic disorders, which was specific to schizophrenia and associated with cognitive ability. Insula volume and thickness were associated with cognition, and positive and negative symptoms of psychosis. We conclude that smaller insula volume follows an anterior-posterior gradient in psychosis and confers a broad risk for psychosis-spectrum disorders. Reduced gyrification is specific to schizophrenia and may reflect altered prenatal development that contributes to cognitive impairment.
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Affiliation(s)
- Julia M Sheffield
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Anna S Huang
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Baxter P Rogers
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | | | - Stephan Heckers
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Neil D Woodward
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Fortea A, Batalla A, Radua J, van Eijndhoven P, Baeza I, Albajes-Eizagirre A, Fusar-Poli P, Castro-Fornieles J, De la Serna E, Luna LP, Carvalho AF, Vieta E, Sugranyes G. Cortical gray matter reduction precedes transition to psychosis in individuals at clinical high-risk for psychosis: A voxel-based meta-analysis. Schizophr Res 2021; 232:98-106. [PMID: 34029948 DOI: 10.1016/j.schres.2021.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 01/10/2023]
Abstract
Gray matter and cortical thickness reductions have been documented in individuals at clinical high-risk for psychosis and may be more pronounced in those who transition to psychosis. However, these findings rely on small samples and are inconsistent across studies. In this review and meta-analysis we aimed to investigate neuroanatomical correlates of clinical high-risk for psychosis and potential predictors of transition, using a novel meta-analytic method (Seed-based d Mapping with Permutation of Subject Images) and cortical mask, combining data from surface-based and voxel-based morphometry studies. Individuals at clinical high-risk for psychosis who later transitioned to psychosis were compared to those who did not and to controls, and included three statistical maps. Overall, individuals at clinical high-risk for psychosis did not differ from controls, however, within the clinical high-risk for psychosis group, transition to psychosis was associated with less cortical gray matter in the right temporal lobe (Hedges' g = -0.377), anterior cingulate and paracingulate (Hedges' g = -0.391). These findings have the potential to help refine prognostic and etiopathological research in early psychosis.
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Affiliation(s)
- Adriana Fortea
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Institute of Neuroscience, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain; Fundació Clínic per a la Recerca Biomèdica (FCRB), Esther Koplowitz Centre, Rosselló 153, 08036 Barcelona, Spain; Medicina i Recerca Traslacional, University of Barcelona, Casanova 143, 08036 Barcelona, Spain.
| | - Albert Batalla
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Rosselló 149, 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain; Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Center for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; Donders Institute for Brain Cognition and Behavior, Center for Cognitive Neuroimaging, Nijmegen, the Netherlands.
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Institute of Neuroscience, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain; Medicina i Recerca Traslacional, University of Barcelona, Casanova 143, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Rosselló 149, 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
| | - Anton Albajes-Eizagirre
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Rosselló 149, 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Institute of Neuroscience, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain; Medicina i Recerca Traslacional, University of Barcelona, Casanova 143, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Rosselló 149, 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
| | - Elena De la Serna
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
| | - Licia P Luna
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Division of Neuroradiology, 600 N Wolfe Street Phipps B100F, 21287 Baltimore, MD, USA
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Center of Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Eduard Vieta
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Rosselló 149, 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain; Barcelona Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
| | - Gisela Sugranyes
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Institute of Neuroscience, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain; Fundació Clínic per a la Recerca Biomèdica (FCRB), Esther Koplowitz Centre, Rosselló 153, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Rosselló 149, 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
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11
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Brain structural correlates of functional capacity in first-episode psychosis. Sci Rep 2020; 10:17229. [PMID: 33056996 PMCID: PMC7560620 DOI: 10.1038/s41598-020-73553-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023] Open
Abstract
Impaired functional capacity is a core feature of schizophrenia and presents even in first-episode psychosis (FEP) patients. Impairments in daily functioning tend to persist despite antipsychotic therapy but their neural basis is less clear. Previous studies suggest that volume loss in frontal cortex might be an important contributor, but findings are inconsistent. We aimed to comprehensively investigate the brain structural correlates of functional capacity in FEP using MRI and a reliable objective measure of functioning [University of California, San Diego Performance-Based Skills Assessment (UPSA)]. In a sample of FEP (n = 39) and a well-matched control group (n = 21), we measured cortical thickness, gray matter volume, and white matter tract integrity (fractional anisotropy, FA) within brain regions implicated by previous work. The FEP group had thinner cortex in various frontal regions and fusiform, and reduced FA in inferior longitudinal fasciculus (ILF). In FEP, poorer functional capacity correlated with reduced superior frontal volume and lower FA in left ILF. Importantly, frontal brain volumes and integrity of the ILF were identified as the structural correlates of functional capacity in FEP, controlling for other relevant factors. These findings enhance mechanistic understanding of functional capacity deficits in schizophrenia by specifying the underlying neural correlates. In future, this could help inform intervention strategies.
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Soldevila-Matías P, Albajes-Eizagirre A, Radua J, García-Martí G, Rubio JM, Tordesillas-Gutierrez D, Fuentes-Durá I, Solanes A, Fortea L, Oliver D, Sanjuán J. Precuneus and insular hypoactivation during cognitive processing in first-episode psychosis: Systematic review and meta-analysis of fMRI studies. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 15:S1888-9891(20)30100-2. [PMID: 32988773 DOI: 10.1016/j.rpsm.2020.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/02/2020] [Accepted: 08/09/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The neural correlates of the cognitive dysfunction in first-episode psychosis (FEP) are still unclear. The present review and meta-analysis provide an update of the location of the abnormalities in the fMRI-measured brain response to cognitive processes in individuals with FEP. METHODS Systematic review and voxel-based meta-analysis of cross-sectional fMRI studies comparing neural responses to cognitive tasks between individuals with FEP and healthy controls (HC) according to PRISMA guidelines. RESULTS Twenty-six studies were included, comprising 598 individuals with FEP and 567 HC. Individual studies reported statistically significant hypoactivation in the dorsolateral prefrontal cortex (6 studies), frontal lobe (8 studies), cingulate (6 studies) and insula (5 studies). The meta-analysis showed statistically significant hypoactivation in the left anterior insula, precuneus and bilateral striatum. CONCLUSIONS While the studies tend to highlight frontal hypoactivation during cognitive tasks in FEP, our meta-analytic results show that the left precuneus and insula primarily display aberrant activation in FEP that may be associated with salience attribution to external stimuli and related to deficits in perception and regulation.
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Affiliation(s)
- Pau Soldevila-Matías
- Research Institute of the Hospital Clínic Universitari of Valencia (INCLIVA), Valencia, Spain; Department of Basic Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Anton Albajes-Eizagirre
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; FIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, Barcelona, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; FIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, Barcelona, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Gracián García-Martí
- Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; Biomedical Engineering Unit/Radiology Department, Quirónsalud Hospital, Spain
| | - José M Rubio
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA; The Feinstein Institute, Northwell Health Hospital, New York, USA
| | - Diana Tordesillas-Gutierrez
- Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; University Hospital Marqués de Valdecilla (IDIVAL), Department of Psychiatry, School of Medicine, University of Cantabria, Spain; Neuroimaging Unit, Technological Facilities, Valdecilla Biomedical Research Institute IDIVAL, Santander, Cantabria, Spain
| | - Inmaculada Fuentes-Durá
- Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Aleix Solanes
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Lydia Fortea
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Julio Sanjuán
- Research Institute of the Hospital Clínic Universitari of Valencia (INCLIVA), Valencia, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Psychiatric, University of Valencia, School of Medicine, Valencia, Spain
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13
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Structural and functional imaging markers for susceptibility to psychosis. Mol Psychiatry 2020; 25:2773-2785. [PMID: 32066828 PMCID: PMC7577836 DOI: 10.1038/s41380-020-0679-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/15/2020] [Accepted: 01/31/2020] [Indexed: 12/21/2022]
Abstract
The introduction of clinical criteria for the operationalization of psychosis high risk provided a basis for early detection and treatment of vulnerable individuals. However, about two-thirds of people meeting clinical high-risk (CHR) criteria will never develop a psychotic disorder. In the effort to increase prognostic precision, structural and functional neuroimaging have received growing attention as a potentially useful resource in the prediction of psychotic transition in CHR patients. The present review summarizes current research on neuroimaging biomarkers in the CHR state, with a particular focus on their prognostic utility and limitations. Large, multimodal/multicenter studies are warranted to address issues important for clinical applicability such as generalizability and replicability, standardization of clinical definitions and neuroimaging methods, and consideration of contextual factors (e.g., age, comorbidity).
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Ding Y, Ou Y, Pan P, Shan X, Chen J, Liu F, Zhao J, Guo W. Brain structural abnormalities as potential markers for detecting individuals with ultra-high risk for psychosis: A systematic review and meta-analysis. Schizophr Res 2019; 209:22-31. [PMID: 31104914 DOI: 10.1016/j.schres.2019.05.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 02/28/2019] [Accepted: 05/06/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study aims to determine whether structural alterations can be used as neuroimaging markers to detect individuals with ultra-high risk (UHR) for psychosis for the diagnosis of schizophrenia and improvement of treatment outcomes. METHODS Embase and Pubmed databases were searched for related studies in July 2018. The search was performed without restriction on time and regions or languages. A total of 188 articles on voxel-based morphometry (VBM) and 96 articles on cortical thickness were obtained, and another 6 articles were included after the reference lists were checked. Our researchers assessed and extracted the data in accordance with the PRISMA guideline. The data were processed with a seed-based mapping method. RESULTS Fourteen VBM and nine cortical thickness studies were finally included in our study. In individuals with UHR, the gray matter volumes in the bilateral median cingulate (Z = 1.034), the right fusiform gyrus (Z = 1.051), the left superior temporal gyrus (Z = 1.048), and the right thalamus (Z = 1.039) increased relative to those of healthy controls. By contrast, the gray matter volumes in the right gyrus rectus (Z = -2.109), the right superior frontal gyrus (Z = -2.321), and the left superior frontal gyrus (Z = -2.228) decreased. The robustness of these findings was verified through Jackknife sensitivity analysis, and heterogeneity across studies was low. Typically, cortical thickness alterations were not detected in individuals with UHR. CONCLUSIONS Structural abnormalities of the thalamocortical circuit may underpin the neurophysiology of psychosis and mark the vulnerability of transition to psychosis in UHR subjects.
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Affiliation(s)
- Yudan Ding
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China
| | - Yangpan Ou
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China
| | - Pan Pan
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China
| | - Xiaoxiao Shan
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China
| | - Jindong Chen
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300000, China
| | - Jingping Zhao
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China
| | - Wenbin Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan 410011, China.
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15
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Rollins CP, Garrison JR, Simons JS, Rowe JB, O'Callaghan C, Murray GK, Suckling J. Meta-analytic Evidence for the Plurality of Mechanisms in Transdiagnostic Structural MRI Studies of Hallucination Status. EClinicalMedicine 2019; 8:57-71. [PMID: 31193632 PMCID: PMC6537703 DOI: 10.1016/j.eclinm.2019.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/15/2019] [Accepted: 01/27/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hallucinations are transmodal and transdiagnostic phenomena, occurring across sensory modalities and presenting in psychiatric, neurodegenerative, neurological, and non-clinical populations. Despite their cross-category occurrence, little empirical work has directly compared between-group neural correlates of hallucinations. METHODS We performed whole-brain voxelwise meta-analyses of hallucination status across diagnoses using anisotropic effect-size seed-based d mapping (AES-SDM), and conducted a comprehensive systematic review in PubMed and Web of Science until May 2018 on other structural correlates of hallucinations, including cortical thickness and gyrification. FINDINGS 3214 abstracts were identified. Patients with psychiatric disorders and hallucinations (eight studies) exhibited reduced gray matter (GM) in the left insula, right inferior frontal gyrus, left anterior cingulate/paracingulate gyrus, left middle temporal gyrus, and increased in the bilateral fusiform gyrus, while patients with neurodegenerative disorders with hallucinations (eight studies) showed GM decreases in the left lingual gyrus, right supramarginal gyrus/parietal operculum, left parahippocampal gyrus, left fusiform gyrus, right thalamus, and right lateral occipital gyrus. Group differences between psychiatric and neurodegenerative hallucination meta-analyses were formally confirmed using Monte Carlo randomizations to determine statistical significance, and a jackknife sensitivity analysis established the reproducibility of results across nearly all study combinations. For other structural measures (28 studies), the most consistent findings associated with hallucination status were reduced cortical thickness in temporal gyri in schizophrenia and altered hippocampal volume in Parkinson's disease and dementia. Additionally, increased severity of hallucinations in schizophrenia correlated with GM reductions within the left superior temporal gyrus, right middle temporal gyrus, bilateral supramarginal and angular gyri. INTERPRETATION Distinct patterns of neuroanatomical alteration characterize hallucination status in patients with psychiatric and neurodegenerative diseases, suggesting a plurality of anatomical signatures. This approach has implications for treatment, theoretical frameworks, and generates refutable predictions for hallucinations in other diseases and their occurrence within the general population. FUNDING None.
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Affiliation(s)
- Colleen P.E. Rollins
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Corresponding author at: Department of Psychiatry, University of Cambridge, Cambridge CB2 0SP, UK
| | - Jane R. Garrison
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychology and Behavioural & Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Jon S. Simons
- Department of Psychology and Behavioural & Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - James B. Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Graham K. Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Voxel-Based Morphometry Correlates of an Agitated-Aggressive Syndrome in the At-Risk Mental State for Psychosis and First Episode Psychosis. Sci Rep 2018; 8:16516. [PMID: 30409978 PMCID: PMC6224526 DOI: 10.1038/s41598-018-33770-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/06/2018] [Indexed: 12/29/2022] Open
Abstract
There are mixed reports on structural neuroimaging correlates of aggression in schizophrenia with weak evidence due to cohort overlaps and lack of replications. To our knowledge, no study examined volumetric neuroimaging correlates of aggression in early stages of psychosis. An agitated-aggressive syndrome is present in at-risk mental state (ARMS) and in first-episode psychosis (FEP) - it is unclear whether this syndrome is associated with structural brain abnormalities in early stages of psychosis. Using three-dimensional magnetic resonance imaging and a whole brain voxel-based morphometry approach, we examined 56 ARMS patients, 55 FEP patients and 25 healthy controls. We operationalized aggression using the Excited Component of the Brief Psychiatric Rating Scale (BPRS-EC) and dichotomized our patient group by median split into "BPRS-EC high" (n = 49) and "BPRS-EC low" groups (n = 62). The "BPRS-EC high" group had significantly smaller left lingual gyrus volume than HC. This finding was not present in the "BPRS-EC low" group. In addition, grey matter volume in the left lingual gyrus showed a negative linear correlation with BPRS-EC over all subjects (ρ = -0.318; p = 0.0001) and in the patient group (ρ = -0.202; p = 0.033). These findings provide first hints on structural brain abnormalities associated with an agitated-aggressive syndrome in ARMS and FEP patients.
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17
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Egloff L, Lenz C, Studerus E, Harrisberger F, Smieskova R, Schmidt A, Huber C, Simon A, Lang UE, Riecher-Rössler A, Borgwardt S. Sexually dimorphic subcortical brain volumes in emerging psychosis. Schizophr Res 2018; 199:257-265. [PMID: 29605160 DOI: 10.1016/j.schres.2018.03.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/27/2018] [Accepted: 03/18/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND In schizophrenic psychoses, the normal sexual dimorphism of the brain has been shown to be disrupted or even reversed. Little is known, however, at what time point in emerging psychosis this occurs. We have therefore examined, if these alterations are already present in the at-risk mental state (ARMS) for psychosis and in first episode psychosis (FEP) patients. METHODS Data from 65 ARMS (48 (73.8%) male; age=25.1±6.32) and 50 FEP (37 (74%) male; age=27±6.56) patients were compared to those of 70 healthy controls (HC; 27 (38.6%) male; age=26±4.97). Structural T1-weighted images were acquired using a 3 Tesla magnetic resonance imaging (MRI) scanner. Linear mixed effects models were used to investigate whether subcortical brain volumes are dependent on sex. RESULTS We found men to have larger total brain volumes (p<0.001), and smaller bilateral caudate (p=0.008) and hippocampus volume (p<0.001) than women across all three groups. Older subjects had more GM and WM volume than younger subjects. No significant sex×group interaction was found. CONCLUSIONS In emerging psychosis there still seem to exist patterns of normal sexual dimorphism in total brain and caudate volume. The only structure affected by reversed sexual dimorphism was the hippocampus, with women showing larger volumes than men even in HC. Thus, we conclude that subcortical volumes may not be primarily affected by disrupted sexual dimorphism in emerging psychosis.
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Affiliation(s)
- Laura Egloff
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland; University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Basel, Switzerland
| | - Claudia Lenz
- University of Basel, Institute of Forensic Medicine, Basel, Switzerland
| | - Erich Studerus
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland
| | - Fabienne Harrisberger
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland
| | - Renata Smieskova
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland
| | - André Schmidt
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland
| | - Christian Huber
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland
| | - Andor Simon
- University Hospital of Bern, University Hospital of Psychiatry, Bern, Switzerland; Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, Bruderholz, Switzerland
| | - Undine E Lang
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland
| | - Anita Riecher-Rössler
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland
| | - Stefan Borgwardt
- University of Basel Psychiatric Hospital, Department of Psychiatry, Basel, Switzerland.
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Dukart J, Smieskova R, Harrisberger F, Lenz C, Schmidt A, Walter A, Huber C, Riecher-Rössler A, Simon A, Lang UE, Fusar-Poli P, Borgwardt S. Age-related brain structural alterations as an intermediate phenotype of psychosis. J Psychiatry Neurosci 2017; 42:307-319. [PMID: 28459416 PMCID: PMC5573573 DOI: 10.1503/jpn.160179] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is only limited agreement with respect to location, directionality and functional implications of brain structural alterations observed in patients with schizophrenia. Additionally, their link to occurrence of psychotic symptoms remains unclear. A viable way of addressing these questions is to examine populations in an at-risk mental state (ARMS) before the transition to psychosis. METHODS We tested for structural brain alterations in individuals in an ARMS compared with healthy controls and patients with first-episode psychosis (FEP) using voxel-based morphometry and measures of cortical thickness. Furthermore, we evaluated if these alterations were modified by age and whether they were linked to the observed clinical symptoms. RESULTS Our sample included 59 individuals with ARMS, 26 healthy controls and 59 patients with FEP. We found increased grey matter volume and cortical thickness in individuals with ARMS and a similar pattern of structural alterations in patients with FEP. We further found stronger age-related reductions in grey matter volume and cortical thickness in both patients with FEP and individuals with ARMS, linking these alterations to observed clinical symptoms. LIMITATIONS The ARMS group comprised subgroups with heterogeneous levels of psychosis risk and medication status. Furthermore, the cross-sectional nature of our study and the reduced number of older patients limit conclusions with respect to observed interactions with age. CONCLUSION Our findings on consistent structural alterations in individuals with ARMS and patients with FEP and their link to clinical symptoms have major implications for understanding their time of occurrence and relevance to psychotic symptoms. Interactions with age found for these alterations may explain the heterogeneity of findings reported in the literature.
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Affiliation(s)
- Juergen Dukart
- Correspondence to: J. Dukart, Biomarkers & Clinical Imaging, NORD DTA, F. Hoffmann-La Roche, Grenzacherstrasse 170, 4070 Basel, Switzerland;
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Progressive cortical reorganisation: A framework for investigating structural changes in schizophrenia. Neurosci Biobehav Rev 2017; 79:1-13. [DOI: 10.1016/j.neubiorev.2017.04.028] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/26/2017] [Accepted: 04/26/2017] [Indexed: 12/27/2022]
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20
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Walter A, Suenderhauf C, Smieskova R, Lenz C, Harrisberger F, Schmidt A, Vogel T, Lang UE, Riecher-Rössler A, Eckert A, Borgwardt S. Altered Insular Function during Aberrant Salience Processing in Relation to the Severity of Psychotic Symptoms. Front Psychiatry 2016; 7:189. [PMID: 27933003 PMCID: PMC5120113 DOI: 10.3389/fpsyt.2016.00189] [Citation(s) in RCA: 14] [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: 07/19/2016] [Accepted: 11/09/2016] [Indexed: 12/31/2022] Open
Abstract
There is strong evidence for abnormal salience processing in patients with psychotic experiences. In particular, there are indications that the degree of aberrant salience processing increases with the severity of positive symptoms. The aim of the present study was to elucidate this relationship by means of brain imaging. Functional magnetic resonance imaging was acquired to assess hemodynamic responses during the Salience Attribution Test, a paradigm for reaction time that measures aberrant salience to irrelevant stimulus features. We included 42 patients who were diagnosed as having a psychotic disorder and divided them into two groups according to the severity of their positive symptoms. Whole brain analysis was performed using Statistical Parametric Mapping. We found no significant behavioral differences with respect to task performance. Patients with more positive symptoms showed increased hemodynamic responses in the left insula corresponding to aberrant salience than in patients with less positive symptoms. In addition, left insula activation correlated negatively with cumulative antipsychotic medication. Aberrant salience processing in the insula may be increased in psychosis, depending on the severity of positive symptoms. This study indicates that clinically similar psychosis manifestations share the same functional characteristics. In addition, our results suggest that antipsychotic medication can modulate insular function.
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Affiliation(s)
- Anna Walter
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | | | - Renata Smieskova
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Claudia Lenz
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | | | - André Schmidt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Tobias Vogel
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Undine E. Lang
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | | | - Anne Eckert
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
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21
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Torres US, Duran FLS, Schaufelberger MS, Crippa JAS, Louzã MR, Sallet PC, Kanegusuku CYO, Elkis H, Gattaz WF, Bassitt DP, Zuardi AW, Hallak JEC, Leite CC, Castro CC, Santos AC, Murray RM, Busatto GF. Patterns of regional gray matter loss at different stages of schizophrenia: A multisite, cross-sectional VBM study in first-episode and chronic illness. NEUROIMAGE-CLINICAL 2016; 12:1-15. [PMID: 27354958 PMCID: PMC4910144 DOI: 10.1016/j.nicl.2016.06.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/27/2016] [Accepted: 06/02/2016] [Indexed: 12/17/2022]
Abstract
Background: Structural brain abnormalities in schizophrenia have been repeatedly demonstrated in magnetic resonance imaging (MRI) studies, but it remains unclear whether these are static or progressive in nature. While longitudinal MRI studies have been traditionally used to assess the issue of progression of brain abnormalities in schizophrenia, information from cross-sectional neuroimaging studies directly comparing first-episode and chronic schizophrenia patients to healthy controls may also be useful to further clarify this issue. With the recent interest in multisite mega-analyses combining structural MRI data from multiple centers aiming at increased statistical power, the present multisite voxel-based morphometry (VBM) study was carried out to examine patterns of brain structural changes according to the different stages of illness and to ascertain which (if any) of such structural abnormalities would be specifically correlated to potential clinical moderators, including cumulative exposure to antipsychotics, age of onset, illness duration and overall illness severity. Methods: We gathered a large sample of schizophrenia patients (161, being 99 chronic and 62 first-episode) and controls (151) from four previous morphometric MRI studies (1.5 T) carried out in the same geographical region of Brazil. Image processing and analyses were conducted using Statistical Parametric Mapping (SPM8) software with the diffeomorphic anatomical registration through exponentiated Lie algebra (DARTEL) algorithm. Group effects on regional gray matter (GM) volumes were investigated through whole-brain voxel-wise comparisons using General Linear Model Analysis of Co-variance (ANCOVA), always including total GM volume, scan protocol, age and gender as nuisance variables. Finally, correlation analyses were performed between the aforementioned clinical moderators and regional and global brain volumes. Results: First-episode schizophrenia subjects displayed subtle volumetric deficits relative to controls in a circumscribed brain regional network identified only in small volume-corrected (SVC) analyses (p < 0.05, FWE-corrected), including the insula, temporolimbic structures and striatum. Chronic schizophrenia patients, on the other hand, demonstrated an extensive pattern of regional GM volume decreases relative to controls, involving bilateral superior, inferior and orbital frontal cortices, right middle frontal cortex, bilateral anterior cingulate cortices, bilateral insulae and right superior and middle temporal cortices (p < 0.05, FWE-corrected over the whole brain). GM volumes in several of those brain regions were directly correlated with age of disease onset on SVC analyses for conjoined (first-episode and chronic) schizophrenia groups. There were also widespread foci of significant negative correlation between duration of illness and relative GM volumes, but such findings remained significant only for the right dorsolateral prefrontal cortex after accounting for the influence of age of disease onset. Finally, significant negative correlations were detected between life-time cumulative exposure to antipsychotics and total GM and white matter volumes in schizophrenia patients, but no significant relationship was found between indices of antipsychotic usage and relative GM volume in any specific brain region. Conclusion: The above data indicate that brain changes associated with the diagnosis of schizophrenia are more widespread in chronic schizophrenia compared to first-episode patients. Our findings also suggest that relative GM volume deficits may be greater in (presumably more severe) cases with earlier age of onset, as well as varying as a function of illness duration in specific frontal brain regions. Finally, our results highlight the potentially complex effects of the continued use of antipsychotic drugs on structural brain abnormalities in schizophrenia, as we found that cumulative doses of antipsychotics affected brain volumes globally rather than selectively on frontal-temporal regions. Structural brain changes are more widespread in chronic than first-episode schizophrenia. Regional GM deficits may be greater in cases with earlier age of onset. Illness duration seems to impact in some specific frontal structural brain changes. Antipsychotics seem to affect brain volumes globally rather than regionally.
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Affiliation(s)
- Ulysses S Torres
- Post-Graduation Program in Radiology, Institute of Radiology (INRAD), Faculty of Medicine, University of São Paulo, Brazil; Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil
| | - Fabio L S Duran
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil
| | - Maristela S Schaufelberger
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Department of Neuroscience and Behaviour, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - José A S Crippa
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Department of Neuroscience and Behaviour, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Mario R Louzã
- Department and Institute of Psychiatry, University of Sao Paulo Medical School, Brazil
| | - Paulo C Sallet
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Department and Institute of Psychiatry, University of Sao Paulo Medical School, Brazil
| | | | - Helio Elkis
- Department and Institute of Psychiatry, University of Sao Paulo Medical School, Brazil
| | - Wagner F Gattaz
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Department and Institute of Psychiatry, University of Sao Paulo Medical School, Brazil; Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil
| | - Débora P Bassitt
- Department and Institute of Psychiatry, University of Sao Paulo Medical School, Brazil
| | - Antonio W Zuardi
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Department of Neuroscience and Behaviour, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Jaime Eduardo C Hallak
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Department of Neuroscience and Behaviour, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Claudia C Leite
- Post-Graduation Program in Radiology, Institute of Radiology (INRAD), Faculty of Medicine, University of São Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil
| | - Claudio C Castro
- Post-Graduation Program in Radiology, Institute of Radiology (INRAD), Faculty of Medicine, University of São Paulo, Brazil; Department of Diagnostic Imaging, Heart Institute (InCor), Faculty of Medicine, University of São Paulo, Brazil
| | - Antonio Carlos Santos
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Department of Internal Medicine - Radiology Division, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - Geraldo F Busatto
- Post-Graduation Program in Radiology, Institute of Radiology (INRAD), Faculty of Medicine, University of São Paulo, Brazil; Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Department and Institute of Psychiatry, University of Sao Paulo Medical School, Brazil
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22
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Suenderhauf C, Walter A, Lenz C, Lang UE, Borgwardt S. Counter striking psychosis: Commercial video games as potential treatment in schizophrenia? A systematic review of neuroimaging studies. Neurosci Biobehav Rev 2016; 68:20-36. [PMID: 27090742 DOI: 10.1016/j.neubiorev.2016.03.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/19/2016] [Accepted: 03/16/2016] [Indexed: 01/01/2023]
Abstract
Schizophrenia is a severe, chronic, and strongly disabling neuropsychiatric disorder, characterized by cognitive decline, positive and negative symptoms. Positive symptoms respond well to antipsychotic medication and psycho-social interventions, in contrast to negative symptoms and neurocognitive impairments. Cognitive deficits have been linked to a poorer outcome and hence specific cognitive remediation therapies have been proposed. Their effectiveness is nowadays approved and neurobiological correlates have been reconfirmed by brain imaging studies. Interestingly, recent MRI work showed that commercial video games modified similar brain areas as these specialized training programs. If gray matter increases and functional brain modulations would translate in better cognitive and every day functioning, commercial video game training could be an enjoyable and economically interesting treatment option for patients with neuropsychiatric disorders. This systematic review summarizes advances in the area with emphasis on imaging studies dealing with brain changes upon video game training and contrasts them to conventional cognitive remediation. Moreover, we discuss potential challenges therapeutic video game development and research would have to face in future treatment of schizophrenia.
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Affiliation(s)
- Claudia Suenderhauf
- Neuropsychiatry and Brain Imaging Group, Department of Psychiatry (UPK), Department of Clinical Research (DKF), Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland.
| | - Anna Walter
- Neuropsychiatry and Brain Imaging Group, Department of Psychiatry (UPK), Department of Clinical Research (DKF), Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland
| | - Claudia Lenz
- Neuropsychiatry and Brain Imaging Group, Department of Psychiatry (UPK), Department of Clinical Research (DKF), Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland
| | - Undine E Lang
- Neuropsychiatry and Brain Imaging Group, Department of Psychiatry (UPK), Department of Clinical Research (DKF), Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland
| | - Stefan Borgwardt
- Neuropsychiatry and Brain Imaging Group, Department of Psychiatry (UPK), Department of Clinical Research (DKF), Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland
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23
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Abstract
UNLABELLED Deficits in auditory emotion recognition (AER) are a core feature of schizophrenia and a key component of social cognitive impairment. AER deficits are tied behaviorally to impaired ability to interpret tonal ("prosodic") features of speech that normally convey emotion, such as modulations in base pitch (F0M) and pitch variability (F0SD). These modulations can be recreated using synthetic frequency modulated (FM) tones that mimic the prosodic contours of specific emotional stimuli. The present study investigates neural mechanisms underlying impaired AER using a combined event-related potential/resting-state functional connectivity (rsfMRI) approach in 84 schizophrenia/schizoaffective disorder patients and 66 healthy comparison subjects. Mismatch negativity (MMN) to FM tones was assessed in 43 patients/36 controls. rsfMRI between auditory cortex and medial temporal (insula) regions was assessed in 55 patients/51 controls. The relationship between AER, MMN to FM tones, and rsfMRI was assessed in the subset who performed all assessments (14 patients, 21 controls). As predicted, patients showed robust reductions in MMN across FM stimulus type (p = 0.005), particularly to modulations in F0M, along with impairments in AER and FM tone discrimination. MMN source analysis indicated dipoles in both auditory cortex and anterior insula, whereas rsfMRI analyses showed reduced auditory-insula connectivity. MMN to FM tones and functional connectivity together accounted for ∼50% of the variance in AER performance across individuals. These findings demonstrate that impaired preattentive processing of tonal information and reduced auditory-insula connectivity are critical determinants of social cognitive dysfunction in schizophrenia, and thus represent key targets for future research and clinical intervention. SIGNIFICANCE STATEMENT Schizophrenia patients show deficits in the ability to infer emotion based upon tone of voice [auditory emotion recognition (AER)] that drive impairments in social cognition and global functional outcome. This study evaluated neural substrates of impaired AER in schizophrenia using a combined event-related potential/resting-state fMRI approach. Patients showed impaired mismatch negativity response to emotionally relevant frequency modulated tones along with impaired functional connectivity between auditory and medial temporal (anterior insula) cortex. These deficits contributed in parallel to impaired AER and accounted for ∼50% of variance in AER performance. Overall, these findings demonstrate the importance of both auditory-level dysfunction and impaired auditory/insula connectivity in the pathophysiology of social cognitive dysfunction in schizophrenia.
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24
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Gong Q, Dazzan P, Scarpazza C, Kasai K, Hu X, Marques TR, Iwashiro N, Huang X, Murray RM, Koike S, David AS, Yamasue H, Lui S, Mechelli A. A Neuroanatomical Signature for Schizophrenia Across Different Ethnic Groups. Schizophr Bull 2015; 41:1266-75. [PMID: 26264820 PMCID: PMC4601715 DOI: 10.1093/schbul/sbv109] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Schizophrenia is a disabling clinical syndrome found across the world. While the incidence and clinical expression of this illness are strongly influenced by ethnic factors, it is unclear whether patients from different ethnicities show distinct brain deficits. In this multicentre study, we used structural Magnetic Resonance Imaging to investigate neuroanatomy in 126 patients with first episode schizophrenia who came from 4 ethnically distinct cohorts (White Caucasians, African-Caribbeans, Japanese, and Chinese). Each patient was individually matched with a healthy control of the same ethnicity, gender, and age (±1 year). We report a reduction in the gray matter volume of the right anterior insula in patients relative to controls (P < .05 corrected); this reduction was detected in all 4 ethnic groups despite differences in psychopathology, exposure to antipsychotic medication and image acquisition sequence. This finding provides evidence for a neuroanatomical signature of schizophrenia expressed above and beyond ethnic variations in incidence and clinical expression. In light of the existing literature, implicating the right anterior insula in bipolar disorder, depression, addiction, obsessive-compulsive disorder, and anxiety, we speculate that the neuroanatomical deficit reported here may represent a transdiagnostic feature of Axis I disorders.
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Affiliation(s)
- Qiyong Gong
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China;,These authors contributed equally to the article
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK;,These authors contributed equally to the article
| | - Cristina Scarpazza
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Kyioto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Xinyu Hu
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Tiago R. Marques
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Norichika Iwashiro
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Xiaoqi Huang
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Shinsuke Koike
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;,MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Anthony S. David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Hidenori Yamasue
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Su Lui
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Andrea Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK;
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25
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Klauser P, Zhou J, Lim JK, Poh JS, Zheng H, Tng HY, Krishnan R, Lee J, Keefe RS, Adcock RA, Wood SJ, Fornito A, Chee MW. Lack of Evidence for Regional Brain Volume or Cortical Thickness Abnormalities in Youths at Clinical High Risk for Psychosis: Findings From the Longitudinal Youth at Risk Study. Schizophr Bull 2015; 41:1285-93. [PMID: 25745033 PMCID: PMC4601700 DOI: 10.1093/schbul/sbv012] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
There is cumulative evidence that young people in an "at-risk mental state" (ARMS) for psychosis show structural brain abnormalities in frontolimbic areas, comparable to, but less extensive than those reported in established schizophrenia. However, most available data come from ARMS samples from Australia, Europe, and North America while large studies from other populations are missing. We conducted a structural brain magnetic resonance imaging study from a relatively large sample of 69 ARMS individuals and 32 matched healthy controls (HC) recruited from Singapore as part of the Longitudinal Youth At-Risk Study (LYRIKS). We used 2 complementary approaches: a voxel-based morphometry and a surface-based morphometry analysis to extract regional gray and white matter volumes (GMV and WMV) and cortical thickness (CT). At the whole-brain level, we did not find any statistically significant difference between ARMS and HC groups concerning total GMV and WMV or regional GMV, WMV, and CT. The additional comparison of 2 regions of interest, hippocampal, and ventricular volumes, did not return any significant difference either. Several characteristics of the LYRIKS sample like Asian origins or the absence of current illicit drug use could explain, alone or in conjunction, the negative findings and suggest that there may be no dramatic volumetric or CT abnormalities in ARMS.
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Affiliation(s)
- Paul Klauser
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Australia;,Monash Clinical and Imaging Neuroscience, School of Psychological Sciences & Monash Biomedical Imaging, Monash University, Clayton, Australia;,These authors contributed equally to the article
| | - Juan Zhou
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore;
| | - Joseph K.W. Lim
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Joann S. Poh
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Hui Zheng
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Han Ying Tng
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Ranga Krishnan
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Jimmy Lee
- Department of General Psychiatry 1 and Research Division, Institute of Mental Health, Singapore, Singapore;,Office of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Richard S.E. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC
| | - R. Alison Adcock
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC;,Center for Cognitive Neuroscience, Duke University, Durham, NC
| | - Stephen J. Wood
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Australia;,School of Psychology, University of Birmingham, Edgbaston, UK
| | - Alex Fornito
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Australia;,Monash Clinical and Imaging Neuroscience, School of Psychological Sciences & Monash Biomedical Imaging, Monash University, Clayton, Australia
| | - Michael W.L. Chee
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
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26
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Bendfeldt K, Smieskova R, Koutsouleris N, Klöppel S, Schmidt A, Walter A, Harrisberger F, Wrege J, Simon A, Taschler B, Nichols T, Riecher-Rössler A, Lang UE, Radue EW, Borgwardt S. Classifying individuals at high-risk for psychosis based on functional brain activity during working memory processing. NEUROIMAGE-CLINICAL 2015; 9:555-63. [PMID: 26640767 PMCID: PMC4625212 DOI: 10.1016/j.nicl.2015.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 11/04/2022]
Abstract
The psychosis high-risk state is accompanied by alterations in functional brain activity during working memory processing. We used binary automatic pattern-classification to discriminate between the at-risk mental state (ARMS), first episode psychosis (FEP) and healthy controls (HCs) based on n-back WM-induced brain activity. Linear support vector machines and leave-one-out-cross-validation were applied to fMRI data of matched ARMS, FEP and HC (19 subjects/group). The HC and ARMS were correctly classified, with an accuracy of 76.2% (sensitivity 89.5%, specificity 63.2%, p = 0.01) using a verbal working memory network mask. Only 50% and 47.4% of individuals were classified correctly for HC vs. FEP (p = 0.46) or ARMS vs. FEP (p = 0.62), respectively. Without mask, accuracy was 65.8% for HC vs. ARMS (p = 0.03) and 65.8% for HC vs. FEP (p = 0.0047), and 57.9% for ARMS vs. FEP (p = 0.18). Regions in the medial frontal, paracingulate, cingulate, inferior frontal and superior frontal gyri, inferior and superior parietal lobules, and precuneus were particularly important for group separation. These results suggest that FEP and HC or FEP and ARMS cannot be accurately separated in small samples under these conditions. However, ARMS can be identified with very high sensitivity in comparison to HC. This might aid classification and help to predict transition in the ARMS. The ARMS was accurately identified based on an individual patient's response within a WM network. Regional cortical activations were particularly important for group separation. Based on WM alterations, FEP and HC or FEP and ARMS could not be accurately separated in small samples.
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Affiliation(s)
- Kerstin Bendfeldt
- Medical Image Analysis Centre, University Hospital Basel, Mittlere Strasse 83, Basel 4031, Switzerland
| | - Renata Smieskova
- Medical Image Analysis Centre, University Hospital Basel, Mittlere Strasse 83, Basel 4031, Switzerland ; Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse, 27, Basel 4056, Switzerland
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Nussbaumstr. 7, Munich 80336, Germany
| | - Stefan Klöppel
- Department of Psychiatry and Psychotherapy, University Medical Center, Freiburg, Freiburg, Germany
| | - André Schmidt
- Medical Image Analysis Centre, University Hospital Basel, Mittlere Strasse 83, Basel 4031, Switzerland ; Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse, 27, Basel 4056, Switzerland
| | - Anna Walter
- Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse, 27, Basel 4056, Switzerland
| | - Fabienne Harrisberger
- Medical Image Analysis Centre, University Hospital Basel, Mittlere Strasse 83, Basel 4031, Switzerland ; Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse, 27, Basel 4056, Switzerland
| | - Johannes Wrege
- Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse, 27, Basel 4056, Switzerland
| | - Andor Simon
- University Hospital of Psychiatry, University of Bern, Bern 3010, Switzerland
| | - Bernd Taschler
- Dept. of Statistics, University of Warwick, Coventry, UK
| | - Thomas Nichols
- Dept. of Statistics, University of Warwick, Coventry, UK
| | - Anita Riecher-Rössler
- Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse, 27, Basel 4056, Switzerland
| | - Undine E Lang
- Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse, 27, Basel 4056, Switzerland
| | - Ernst-Wilhelm Radue
- Medical Image Analysis Centre, University Hospital Basel, Mittlere Strasse 83, Basel 4031, Switzerland
| | - Stefan Borgwardt
- Medical Image Analysis Centre, University Hospital Basel, Mittlere Strasse 83, Basel 4031, Switzerland ; Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse, 27, Basel 4056, Switzerland ; Department of Psychosis Studies, King's College London, Institute of Psychiatry, De Crespigny Park 16, London SE58AF, UK
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27
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Fusar-Poli P, Rocchetti M, Sardella A, Avila A, Brandizzi M, Caverzasi E, Politi P, Ruhrmann S, McGuire P. Disorder, not just state of risk: meta-analysis of functioning and quality of life in people at high risk of psychosis. Br J Psychiatry 2015; 207:198-206. [PMID: 26329563 DOI: 10.1192/bjp.bp.114.157115] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The nosology of the psychosis high-risk state is controversial. Traditionally conceived as an 'at risk' state for the development of psychotic disorders, it is also conceptualised as a clinical syndrome associated with functional impairment. AIMS To investigate meta-analytically the functional status of patients at high clinical risk for psychosis and its association with longitudinal outcomes. METHOD Three meta-analyses compared level of functioning (n = 3012) and quality of life (QoL) (n = 945) between a high-risk group, a healthy control group and group with psychosis, and baseline functioning in people in the high-risk group who did or did not have a transition to psychosis at follow-up (n = 654). RESULTS People at high risk had a large impairment in functioning (P<0.001) and worse QoL (P = 0.001) than the healthy control group, but only small to moderately better functioning (P = 0.012) and similar QoL (P = 0.958) compared with the psychosis group. Among the high-risk group, those who did not develop psychosis reported better functioning (P = 0.001) than those who did. CONCLUSIONS Our results indicate that the high-risk state is characterised by consistent and large impairments of functioning and reduction in QoL similar to those in other coded psychiatric disorders.
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Affiliation(s)
- Paolo Fusar-Poli
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Matteo Rocchetti
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Alberto Sardella
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Alessia Avila
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Martina Brandizzi
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Edgardo Caverzasi
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Pierluigi Politi
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Stephan Ruhrmann
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Philip McGuire
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
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28
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Tordesillas-Gutierrez D, Koutsouleris N, Roiz-Santiañez R, Meisenzahl E, Ayesa-Arriola R, Marco de Lucas E, Soriano-Mas C, Suarez-Pinilla P, Crespo-Facorro B. Grey matter volume differences in non-affective psychosis and the effects of age of onset on grey matter volumes: A voxelwise study. Schizophr Res 2015; 164:74-82. [PMID: 25687531 DOI: 10.1016/j.schres.2015.01.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 01/19/2015] [Accepted: 01/21/2015] [Indexed: 01/18/2023]
Abstract
Previous evidence indicates that structural brain alterations are already present in the early phases of psychosis. In this study we aim to investigate the relationships among the different diagnoses in the spectrum of non-affective psychosis. A hundred-and-one first-episode psychosis patients (FEP) and 69 healthy volunteers, matched for age, gender, handedness and educational level were analyzed by structural MRI and high-dimensional voxel-based morphometry as implemented in SPM8 software. We obtained three main results: (1) FEP patients showed reduction of grey matter volume (GMV) in the frontal, temporal and occipital lobes, left insula and cerebellum. (2) Age of disease onset was an important factor revealing a gradual decrease of GMV (healthy controls>late onset>intermediate onset>early onset) in the frontal, temporal and occipital lobes, insula and cerebellum. (3) A gradual reduction of GMV related to diagnosis spectrum in the frontal, temporal, parietal and occipital lobes of schizophrenia patients being the most affected. These results suggest that an earlier onset of psychosis is linked to an earlier disease-related disruption of structural brain development, which may be most pronounced in schizophrenia compared to other psychoses.
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Affiliation(s)
- Diana Tordesillas-Gutierrez
- Neuroimaging Unit, Technological Facilities, Valdecilla Biomedical Research Institute IDIVAL, Santander, Cantabria, Spain; CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Spain.
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Bavaria, Germany
| | - Roberto Roiz-Santiañez
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Spain; Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Bavaria, Germany
| | - Rosa Ayesa-Arriola
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Spain; Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain
| | - Enrique Marco de Lucas
- Department of Radiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Carles Soriano-Mas
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Spain; Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Spain
| | - Paula Suarez-Pinilla
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Spain; Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain
| | - Benedicto Crespo-Facorro
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Spain; Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain
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29
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Bernasconi R, Smieskova R, Schmidt A, Harrisberger F, Raschle NM, Lenz C, Walter A, Simon A, Riecher-Rössler A, Radue EW, Lang UE, Fusar-Poli P, Borgwardt SJ. Hippocampal volume correlates with attenuated negative psychotic symptoms irrespective of antidepressant medication. NEUROIMAGE-CLINICAL 2015; 8:230-7. [PMID: 26110110 PMCID: PMC4473852 DOI: 10.1016/j.nicl.2015.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/23/2015] [Accepted: 04/25/2015] [Indexed: 12/18/2022]
Abstract
Background Individuals with at-risk mental state for psychosis (ARMS) often suffer from depressive and anxiety symptoms, which are clinically similar to the negative symptomatology described for psychosis. Thus, many ARMS individuals are already being treated with antidepressant medication. Objectives To investigate clinical and structural differences between psychosis high-risk individuals with or without antidepressants. Methods We compared ARMS individuals currently receiving antidepressants (ARMS-AD; n = 18), ARMS individuals not receiving antidepressants (ARMS-nonAD; n = 31) and healthy subjects (HC; n = 24), in terms of brain structure abnormalities, using voxel-based morphometry. We also performed region of interest analysis for the hippocampus, anterior cingulate cortex, amygdala and precuneus. Results The ARMS-AD had higher ‘depression’ and lower ‘motor hyperactivity’ scores than the ARMS-nonAD. Compared to HC, there was significantly less GMV in the middle frontal gyrus in the whole ARMS cohort and in the superior frontal gyrus in the ARMS-AD subgroup. Compared to ARMS-nonAD, the ARMS-AD group showed more gray matter volume (GMV) in the left superior parietal lobe, but less GMV in the left hippocampus and the right precuneus. We found a significant negative correlation between attenuated negative symptoms and hippocampal volume in the whole ARMS cohort. Conclusion Reduced GMV in the hippocampus and precuneus is associated with short-term antidepressant medication and more severe depressive symptoms. Hippocampal volume is further negatively correlated with attenuated negative psychotic symptoms. Longitudinal studies are needed to distinguish whether hippocampal volume deficits in the ARMS are related to attenuated negative psychotic symptoms or to antidepressant action. We compared brain structure in high-risk patients with/without antidepressants (AD). We found attenuated negative psychotic symptoms (ANS) irrespective of AD. We found a significant correlation between ANS and hippocampal volume. Results indicate relevance of ANS for clinical high-risk studies.
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Affiliation(s)
- Raffaele Bernasconi
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
| | - Renata Smieskova
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
| | - André Schmidt
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Nora Maria Raschle
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
| | - Claudia Lenz
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
| | - Anna Walter
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
| | - Andor Simon
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
| | | | | | - Undine E. Lang
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
| | - Paolo Fusar-Poli
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stefan J. Borgwardt
- Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, Basel, Switzerland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Medical Image Analysis Centre, University Hospital, Basel, Switzerland
- Correspondence to: Department of Psychiatry (UPK), University of Basel, Wilhelm Klein-strasse 27, Basel 4056, Switzerland. Tel.: +41 (0)61 325 81 87; fax: +41 (0)61 325 81 80.
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30
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What drives poor functioning in the at-risk mental state? A systematic review. Schizophr Res 2014; 159:267-77. [PMID: 25261041 DOI: 10.1016/j.schres.2014.09.012] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/18/2014] [Accepted: 09/04/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Transition to psychotic disorder has been the traditional outcome of interest for research in the at-risk mental state (ARMS). However, there is growing recognition that individuals with ARMS may function poorly regardless of whether they develop psychosis. We aimed to review the literature to determine whether there are specific factors associated with, or predictive of, functional impairment in the ARMS population. METHOD An electronic database search of MEDLINE, PsycINFO and Embase from inception until May 2014 was conducted using keyword search terms synonymous with the at-risk mental state and functioning. Eligible studies were original peer-reviewed English language research articles with populations that met validated at-risk diagnostic criteria and examined the cross-sectional or longitudinal association between any variable and a measure of functioning. RESULTS Seventy-two eligible studies were identified. Negative symptoms and neurocognitive impairment were associated with poor functioning in cross-sectional studies. Negative and disorganised symptoms, neurocognitive deficits and poor functioning at baseline were predictive of poor functional outcome in longitudinal studies. Positive symptoms were unrelated to functioning in both cross-sectional and longitudinal studies. Functional disability was persistent and resistant to current treatments. CONCLUSIONS Negative and disorganised symptoms and cognitive deficits pre-date frank psychotic symptoms and are risk factors for poor functioning. This is consistent with a subgroup of ARMS individuals potentially having neurodevelopmental schizophrenia. Treatments aimed at improving functioning must be considered a priority on par with preventing transition to psychosis in the development of future interventions in the ARMS group.
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31
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Wotruba D, Michels L, Buechler R, Metzler S, Theodoridou A, Gerstenberg M, Walitza S, Kollias S, Rössler W, Heekeren K. Aberrant coupling within and across the default mode, task-positive, and salience network in subjects at risk for psychosis. Schizophr Bull 2014; 40:1095-104. [PMID: 24243441 PMCID: PMC4133671 DOI: 10.1093/schbul/sbt161] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The task-positive network (TPN) is anticorrelated with activity in the default mode network (DMN), and possibly reflects competition between the processing of external and internal information, while the salience network (SN) is pivotal in regulating TPN and DMN activity. Because abnormal functional connectivity in these networks has been related to schizophrenia, we tested whether alterations are also evident in subjects at risk for psychosis. Resting-state functional magnetic resonance imaging was tested in 28 subjects with basic symptoms reporting subjective cognitive-perceptive symptoms; 19 with attenuated or brief, limited psychotic symptoms; and 29 matched healthy controls. We characterized spatial differences in connectivity patterns, as well as internetwork connectivity. Right anterior insula (rAI) was selected as seed region for identifying the SN; medioprefrontal cortex (MPFC) for the DMN and TPN. The 3 groups differed in connectivity patterns between the MPFC and right dorsolateral prefrontal cortex (rDLPFC), and between the rAI and posterior cingulate cortex (PCC). In particular, the typically observed antagonistic relationship in MPFC-rDLPFC, rAI-PCC, and internetwork connectivity of DMN-TPN was absent in both at-risk groups. Notably, those connectivity patterns were associated with symptoms related to reality distortions, whereas enhanced connectivity strengths of MPFC-rDLPFC and TPN-DMN were related to poor performance in cognitive functions. We propose that the loss of a TPN-DMN anticorrelation, accompanied by an aberrant spatial extent in the DMN, TPN, and SN in the psychosis risk state, reflects the confusion of internally and externally focused states and disturbance of cognition, as seen in psychotic disorders.
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Affiliation(s)
| | - Lars Michels
- Clinic of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Roman Buechler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Zurich University Hospital of Psychiatry, Zurich, Switzerland;,Clinic of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Sibylle Metzler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Anastasia Theodoridou
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Zurich University Hospital of Psychiatry, Zurich, Switzerland;,Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Miriam Gerstenberg
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Zurich University Hospital of Psychiatry, Zurich, Switzerland;,University Clinics for Child and Adolescent Psychiatry, Zurich, Switzerland
| | - Susanne Walitza
- University Clinics for Child and Adolescent Psychiatry, Zurich, Switzerland
| | - Spyros Kollias
- Clinic of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Zurich University Hospital of Psychiatry, Zurich, Switzerland;,Collegium Helveticum, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland;,Laboratory of Neuroscience (LIM-27), Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | - Karsten Heekeren
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Zurich University Hospital of Psychiatry, Zurich, Switzerland;,Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
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32
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Neurodegenerative Aspects in Vulnerability to Schizophrenia Spectrum Disorders. Neurotox Res 2014; 26:400-13. [DOI: 10.1007/s12640-014-9473-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/21/2014] [Accepted: 04/21/2014] [Indexed: 01/20/2023]
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33
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Smieskova R, Marmy J, Schmidt A, Bendfeldt K, Riecher-Rӧssler A, Walter M, Lang UE, Borgwardt S. Do subjects at clinical high risk for psychosis differ from those with a genetic high risk?--A systematic review of structural and functional brain abnormalities. Curr Med Chem 2014; 20:467-81. [PMID: 23157639 PMCID: PMC3580804 DOI: 10.2174/0929867311320030018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 10/25/2012] [Accepted: 10/30/2012] [Indexed: 11/22/2022]
Abstract
Introduction: Pre-psychotic and early psychotic characteristics are investigated in the high-risk (HR) populations for psychosis. There are two different approaches based either on hereditary factors (genetic high risk, G-HR) or on the clinically manifested symptoms (clinical high risk, C-HR). Common features are an increased risk for development of psychosis and similar cognitive as well as structural and functional brain abnormalities. Methods: We reviewed the existing literature on longitudinal structural, and on functional imaging studies, which included G-HR and/or C-HR individuals for psychosis, healthy controls (HC) and/or first episode of psychosis (FEP) or schizophrenia patients (SCZ). Results: With respect to structural brain abnormalities, vulnerability to psychosis was associated with deficits in frontal, temporal, and cingulate regions in HR, with additional insular and caudate deficits in C-HR population. Furthermore, C-HR had progressive prefrontal deficits related to the transition to psychosis. With respect to functional brain abnormalities, vulnerability to psychosis was associated with prefrontal, cingulate and middle temporal abnormalities in HR, with additional parietal, superior temporal, and insular abnormalities in C-HR population. Transition-to-psychosis related differences emphasized prefrontal, hippocampal and striatal components, more often detectable in C-HR population. Multimodal studies directly associated psychotic symptoms displayed in altered prefrontal and hippocampal activations with striatal dopamine and thalamic glutamate functions. Conclusion: There is an evidence for similar structural and functional brain abnormalities within the whole HR population, with more pronounced deficits in the C-HR population. The most consistent evidence for abnormality in the prefrontal cortex reported in structural, functional and multimodal studies of HR population may underlie the complexity of higher cognitive functions that are impaired during HR mental state for psychosis.
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Affiliation(s)
- R Smieskova
- Department of Psychiatry, University of Basel, c/o University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland.
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34
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Brent BK, Thermenos HW, Keshavan MS, Seidman LJ. Gray Matter Alterations in Schizophrenia High-Risk Youth and Early-Onset Schizophrenia: A Review of Structural MRI Findings. Child Adolesc Psychiatr Clin N Am 2013; 22:689-714. [PMID: 24012081 PMCID: PMC3767930 DOI: 10.1016/j.chc.2013.06.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article reviews the literature on structural magnetic resonance imaging findings in pediatric and young adult populations at clinical or genetic high-risk for schizophrenia and early-onset schizophrenia. The implications of this research are discussed for understanding the pathophysiology of schizophrenia and for early intervention strategies. The evidence linking brain structural changes in prepsychosis development and early-onset schizophrenia with disruptions of normal neurodevelopmental processes during childhood or adolescence is described. Future directions are outlined for research to address knowledge gaps regarding the neurobiological basis of brain structural abnormalities in schizophrenia and to improve the usefulness of these abnormalities for preventative interventions.
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Affiliation(s)
- Benjamin K Brent
- Harvard Medical School, Boston, MA 02115, USA; Division of Public Psychiatry, Massachusetts Mental Health Center, 75 Fenwood Road, Boston, MA 02115, USA; Department of Psychiatry, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.
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Yu Q, Allen EA, Sui J, Arbabshirani MR, Pearlson G, Calhoun VD. Brain connectivity networks in schizophrenia underlying resting state functional magnetic resonance imaging. Curr Top Med Chem 2013; 12:2415-25. [PMID: 23279180 DOI: 10.2174/156802612805289890] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/06/2012] [Accepted: 09/26/2012] [Indexed: 02/01/2023]
Abstract
Schizophrenia (SZ) is a severe neuropsychiatric disorder. A leading hypothesis is that SZ is a brain dysconnection syndrome, involving abnormal interactions between widespread brain networks. Resting state functional magnetic resonance imaging (R-fMRI) is a powerful tool to explore the dysconnectivity of brain networks in SZ and other disorders. Seed-based functional connectivity analysis, spatial independent component analysis (ICA), and graph theory-based analysis are popular methods to quantify brain network connectivity in R-fMRI data. Widespread network dysconnectivity in SZ has been observed using both seed-based analysis and ICA, although most seed-based studies report decreased connectivity while ICA studies report both increases and decreases. Importantly, most of the findings from both techniques are also associated with typical symptoms of the illness. Disrupted topological properties and altered modular community structure of brain system in SZ have been shown using graph theory-based analysis. Overall, the resting-state findings regarding brain networks deficits have advanced our understanding of the underlying pathology of SZ. In this article, we review aberrant brain connectivity networks in SZ measured in R-fMRI by the above approaches, and discuss future challenges.
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Affiliation(s)
- Qingbao Yu
- Mind Research Network, 1101 Yale Blvd NE, Albuquerque, NM 87106, USA.
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Longitudinal gray matter change in young people who are at enhanced risk of schizophrenia due to intellectual impairment. Biol Psychiatry 2013; 73:985-92. [PMID: 23332356 DOI: 10.1016/j.biopsych.2012.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Existing studies of brain structural changes before the onset of schizophrenia have considered individuals with either familial risk factors or prodromal symptomatology. We aimed to determine whether findings from these studies are also applicable to those at enhanced risk of developing schizophrenia for another reason-intellectual impairment. METHODS Participants with intellectual impairment (mean IQ: 78.2) received magnetic resonance imaging of the brain at baseline (mean age: 16 years old) and again 6 years later. The Positive and Negative Syndrome Scale was used to assess psychotic symptoms. Participants were dichotomized using their Positive and Negative Syndrome Scale scores at follow-up and gray matter changes were compared between the groups using tensor based morphometry and semiautomated region of interest analysis. RESULTS Forty-six individuals had scans of sufficient quality to be included in the study. The tensor based morphometry analyses revealed that those with psychotic symptoms at follow-up showed significantly greater gray matter reductions over 6 years in the medial temporal lobes bilaterally. Region of interest analyses revealed that those individuals with psychotic symptoms at follow-up showed a reduced right hippocampal volume at age 16 and reduced bilateral hippocampal volumes at follow-up. CONCLUSIONS This unique study of individuals vulnerable to schizophrenia due to intellectual impairment highlights aberrant development in the medial temporal lobe associated with the occurrence of psychotic symptoms. These developmental changes are also evident in populations at enhanced risk of schizophrenia for familial and symptomatic reasons, suggesting they are central to the development of the disorder regardless of the nature of the vulnerability state.
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Wood SJ, Reniers RLEP, Heinze K. Neuroimaging findings in the at-risk mental state: a review of recent literature. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:13-8. [PMID: 23327751 DOI: 10.1177/070674371305800104] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The at-risk mental state (ARMS) has been the subject of much interest during the past 15 years. A great deal of effort has been expended to identify neuroimaging markers that can inform our understanding of the risk state and to help predict who will transition to frank psychotic illness. Recently, there has been an explosion of neuroimaging literature from people with an ARMS, which has meant that reviews and meta-analyses lack currency. Here we review papers published in the past 2 years, and contrast their findings with previous reports. While it is clear that people in the ARMS do show brain alterations when compared with healthy control subjects, there is an overall lack of consistency as to which of these alterations predict the development of psychosis. This problem arises because of variations in methodology (in patient recruitment, region of interest, method of analysis, and functional task employed), but there has also been too little effort put into replicating previous research. Nonetheless, there are areas of promise, notably that activation of the stress system and increased striatal dopamine synthesis seem to mark out patients in the ARMS most at risk for later transition. Future studies should focus on these areas, and on network-level analysis, incorporating graph theoretical approaches and intrinsic connectivity networks.
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Affiliation(s)
- Stephen J Wood
- Professor of Adolescent Brain Development and Mental Health, School of Psychology, University of Birmingham, Edgbaston, England.
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Borgwardt S, Fusar-Poli P. White matter pathology--an endophenotype for bipolar disorder? BMC Psychiatry 2012; 12:138. [PMID: 22970986 PMCID: PMC3527345 DOI: 10.1186/1471-244x-12-138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 09/04/2012] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Neuroimaging investigations of white matter abnormalities in subjects at genetic risk for bipolar disorders (BD) potentially predating the onset of BD offer several advantages. They are not confounded by the presence of illness duration or previous treatment with medication and may ultimately inform evaluation of risk for subsequent development of BD and subsequent therapeutic intervention. DISCUSSION Although a number of imaging studies in subjects at genetic risk for BD are available the results are conflicting and no reliable structural markers of genetic liability to bipolar disorders have been proposed. We debate that white matter pathology may be central to the genetic risk to develop BD. Thus, white matter abnormalities detectable in HR subjects but not in controls may reflect genetically driven trait markers. Similar abnormalities may be also evident both in the HR and in BD, suggesting the possibility of genetic risk factors shared by both groups. Conversely, white matter alterations observed in BD patients but not in HR and controls can be interpreted as state markers. SUMMARY We suggest that white matter alterations may represent endophenotypes and neurobiological markers intermediate between the underlying susceptibility genes and the clinical expression of BD.
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Affiliation(s)
- Stefan Borgwardt
- Department of Psychiatry, University of Basel, Basel, Switzerland.
| | - Paolo Fusar-Poli
- King’s College, Institute of Psychiatry, King’s College London, London, UK
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Jung WH, Borgwardt S, Fusar-Poli P, Kwon JS. Gray matter volumetric abnormalities associated with the onset of psychosis. Front Psychiatry 2012; 3:101. [PMID: 23227013 PMCID: PMC3512053 DOI: 10.3389/fpsyt.2012.00101] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 11/06/2012] [Indexed: 01/15/2023] Open
Abstract
Patients with psychosis display structural brain abnormalities in multiple brain regions. The disorder is characterized by a putative prodromal period called ultra-high-risk (UHR) status, which precedes the onset of full-blown psychotic symptoms. Recent studies on psychosis have focused on this period. Neuroimaging studies of UHR individuals for psychosis have revealed that the structural brain changes observed during the established phases of the disorder are already evident prior to the onset of the illness. Moreover, certain brain regions show extremely dynamic changes during the transition to psychosis. These neurobiological features may be used as prognostic and predictive biomarkers for psychosis. With advances in neuroimaging techniques, neuroimaging studies focusing on gray matter abnormalities provide new insights into the pathophysiology of psychosis, as well as new treatment strategies. Some of these novel approaches involve antioxidants administration, because it is suggested that this treatment may delay the progression of UHR to a full-blown psychosis and prevent progressive structural changes. The present review includes an update on the most recent developments in early intervention strategies for psychosis and potential therapeutic treatments for schizophrenia. First, we provide the basic knowledge of the brain regions associated with structural abnormalities in individuals at UHR. Next, we discuss the feasibility on the use of magnetic resonance imaging (MRI)-biomarkers in clinical practice. Then, we describe potential etiopathological mechanisms underlying structural brain abnormalities in prodromal psychosis. Finally, we discuss the potentials and limitations related to neuroimaging studies in individuals at UHR.
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Affiliation(s)
- Wi Hoon Jung
- Interdisciplinary Program in Neuroscience, Seoul National University Seoul, South Korea ; Institute of Human Behavioral Medicine, Seoul National University-MRC Seoul, South Korea
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Rapp C, Bugra H, Riecher-Rössler A, Tamagni C, Borgwardt S. Effects of cannabis use on human brain structure in psychosis: a systematic review combining in vivo structural neuroimaging and post mortem studies. Curr Pharm Des 2012; 18:5070-80. [PMID: 22716152 PMCID: PMC3474956 DOI: 10.2174/138161212802884861] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 04/12/2012] [Indexed: 11/22/2022]
Abstract
It is unclear yet whether cannabis use is a moderating or causal factor contributing to grey matter alterations in schizophrenia and the development of psychotic symptoms. We therefore systematically reviewed structural brain imaging and post mortem studies addressing the effects of cannabis use on brain structure in psychosis. Studies with schizophrenia (SCZ) and first episode psychosis (FEP) patients as well as individuals at genetic (GHR) or clinical high risk for psychosis (ARMS) were included. We identified 15 structural magnetic resonance imaging (MRI) (12 cross sectional / 3 longitudinal) and 4 post mortem studies. The total number of subjects encompassed 601 schizophrenia or first episode psychosis patients, 255 individuals at clinical or genetic high risk for psychosis and 397 healthy controls. We found evidence for consistent brain structural abnormalities in cannabinoid 1 (CB1) receptor enhanced brain areas as the cingulate and prefrontal cortices and the cerebellum. As these effects have not consistently been reported in studies examining nonpsychotic and healthy samples, psychosis patients and subjects at risk for psychosis might be particularly vulnerable to brain volume loss due to cannabis exposure.
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Affiliation(s)
- Charlotte Rapp
- Department of Psychiatry, University of Basel, 4031 Basel, Switzerland
| | - Hilal Bugra
- Department of Psychiatry, University of Basel, 4031 Basel, Switzerland
| | | | - Corinne Tamagni
- Department of Psychiatry, University of Basel, 4031 Basel, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel, 4031 Basel, Switzerland
- Medical Image Analysis Centre, University of Basel, Switzerland
- King’s College London, Department of Psychosis Studies, De Crespigny Park, London SE5 8AF, United Kingdom
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