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Mo F, Zhao H, Li Y, Cai H, Song Y, Wang R, Yu Y, Zhu J. Network Localization of State and Trait of Auditory Verbal Hallucinations in Schizophrenia. Schizophr Bull 2024:sbae020. [PMID: 38401526 DOI: 10.1093/schbul/sbae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
BACKGROUND AND HYPOTHESIS Neuroimaging studies investigating the neural substrates of auditory verbal hallucinations (AVH) in schizophrenia have yielded mixed results, which may be reconciled by network localization. We sought to examine whether AVH-state and AVH-trait brain alterations in schizophrenia localize to common or distinct networks. STUDY DESIGN We initially identified AVH-state and AVH-trait brain alterations in schizophrenia reported in 48 previous studies. By integrating these affected brain locations with large-scale discovery and validation resting-state functional magnetic resonance imaging datasets, we then leveraged novel functional connectivity network mapping to construct AVH-state and AVH-trait dysfunctional networks. STUDY RESULTS The neuroanatomically heterogeneous AVH-state and AVH-trait brain alterations in schizophrenia localized to distinct and specific networks. The AVH-state dysfunctional network comprised a broadly distributed set of brain regions mainly involving the auditory, salience, basal ganglia, language, and sensorimotor networks. Contrastingly, the AVH-trait dysfunctional network manifested as a pattern of circumscribed brain regions principally implicating the caudate and inferior frontal gyrus. Additionally, the AVH-state dysfunctional network aligned with the neuromodulation targets for effective treatment of AVH, indicating possible clinical relevance. CONCLUSIONS Apart from unifying the seemingly irreproducible neuroimaging results across prior AVH studies, our findings suggest different neural mechanisms underlying AVH state and trait in schizophrenia from a network perspective and more broadly may inform future neuromodulation treatment for AVH.
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Affiliation(s)
- Fan Mo
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Research Center of Clinical Medical Imaging, Anhui Province, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization, Hefei, China
| | - Han Zhao
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Research Center of Clinical Medical Imaging, Anhui Province, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization, Hefei, China
| | - Yifan Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Research Center of Clinical Medical Imaging, Anhui Province, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization, Hefei, China
| | - Huanhuan Cai
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Research Center of Clinical Medical Imaging, Anhui Province, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization, Hefei, China
| | - Yang Song
- Department of Pain, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Rui Wang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Research Center of Clinical Medical Imaging, Anhui Province, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization, Hefei, China
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Research Center of Clinical Medical Imaging, Anhui Province, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization, Hefei, China
| | - Jiajia Zhu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Research Center of Clinical Medical Imaging, Anhui Province, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization, Hefei, China
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Xie Y, Guan M, Wang Z, Ma Z, Fang P, Wang H. Cerebral blood flow changes in schizophrenia patients with auditory verbal hallucinations during low-frequency rTMS treatment. Eur Arch Psychiatry Clin Neurosci 2023; 273:1851-1861. [PMID: 37280358 DOI: 10.1007/s00406-023-01624-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/22/2023] [Indexed: 06/08/2023]
Abstract
Auditory verbal hallucinations (AVH) are a prominent symptom of schizophrenia. Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been evidenced to improve the treatment of AVH in schizophrenia. Although abnormalities in resting-state cerebral blood flow (CBF) have been reported in schizophrenia, the perfusion alterations specific to schizophrenia patients with AVH during rTMS require further investigation. In this study, we used arterial spin labeling (ASL) to investigate changes in brain perfusion in schizophrenia patients with AVH, and their associations with clinical improvement following low-frequency rTMS treatment applied to the left temporoparietal junction area. We observed improvements in clinical symptoms (e.g., positive symptoms and AVH) and certain neurocognitive functions (e.g., verbal learning and visual learning) following treatment. Furthermore, at baseline, the patients showed reductions in CBF in regions associated with language, sensory, and cognition compared to controls, primarily located in the prefrontal cortices (e.g., left inferior frontal gyrus and left middle frontal gyrus), occipital lobe (e.g., left calcarine cortex), and cingulate cortex (e.g., bilateral middle cingulate cortex), compared to controls. Conversely, we observed increased CBF in the left inferior temporal gyrus and bilateral putamen in patients relative to controls, regions known to be involved in AVH. However, the hypoperfusion or hyperperfusion patterns did not persist and instead were normalized, and were related to clinical response (e.g., AVH) in patients during low-frequency rTMS treatment. Importantly, the changes in brain perfusion were related to clinical response (e.g., AVH) in patients. Our findings suggest that low-frequency rTMS can regulate brain perfusion involving critical circuits by its remote effect in schizophrenia, and may play an important mechanistic role in the treatment of AVH.
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Affiliation(s)
- Yuanjun Xie
- Department of Military Medical Psychology, School of Psychology, Fourth Military Medical University, Xi'an, China.
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Muzhen Guan
- Department of Mental Health, Xi'an Medical University, Xi'an, China
| | - Zhongheng Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhujing Ma
- Department of Clinical Psychology, School of Psychology, Fourth Military Medical University, Xi'an, China
| | - Peng Fang
- Department of Military Medical Psychology, School of Psychology, Fourth Military Medical University, Xi'an, China.
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
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Kim JH, Kim HK, Son YD, Kim JH. In Vivo Serotonin 5-HT2A Receptor Availability and Its Relationship with Aggression Traits in Healthy Individuals: A Positron Emission Tomography Study with C-11 MDL100907. Int J Mol Sci 2023; 24:15697. [PMID: 37958691 PMCID: PMC10647245 DOI: 10.3390/ijms242115697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Serotonergic neurotransmission has been associated with aggression in several psychiatric disorders. Human aggression is a continuum of traits, ranging from normal to pathological phenomena. However, the individual differences in serotonergic neurotransmission and their relationships with aggression traits in healthy individuals remain unclear. In this study, we explored the relationship between 5-HT2A receptor availability in vivo and aggression traits in healthy participants. Thirty-three healthy participants underwent 3-Tesla magnetic resonance imaging and positron emission tomography (PET) with [11C]MDL100907, a selective radioligand for 5-HT2A receptors. To quantify 5-HT2A receptor availability, the binding potential (BPND) was derived using the basis function implementation of the simplified reference tissue model, with the cerebellum as the reference region. The participants' aggression levels were assessed using the Buss-Perry Aggression Questionnaire. The voxel-based correlation analysis with age and sex as covariates revealed that the total aggression score was significantly positively correlated with [11C]MDL100907 BPND in the right middle temporal gyrus (MTG) pole, left fusiform gyrus (FUSI), right parahippocampal gyrus, and right hippocampus. The physical aggression subscale score had significant positive correlations with [11C]MDL100907 BPND in the left olfactory cortex, left orbital superior frontal gyrus (SFG), right anterior cingulate and paracingulate gyri, left orbitomedial SFG, left gyrus rectus, left MTG, left inferior temporal gyrus, and left angular gyrus. The verbal aggression subscale score showed significant positive correlations with [11C]MDL100907 BPND in the bilateral SFG, right medial SFG, left FUSI, and right MTG pole. Overall, our findings suggest the possibility of positive correlations between aggression traits and in vivo 5-HT2A receptor availability in healthy individuals. Future research should incorporate multimodal neuroimaging to investigate the downstream effects of 5-HT2A receptor-mediated signaling and integrate molecular and systems-level information in relation to aggression traits.
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Affiliation(s)
- Jeong-Hee Kim
- Neuroscience Research Institute, Gachon University, Incheon 21565, Republic of Korea
- Biomedical Engineering Research Center, Gachon University, Incheon 21936, Republic of Korea
- Department of Biomedical Engineering, College of IT Convergence, Gachon University, Seongnam-si 13120, Republic of Korea
| | - Hang-Keun Kim
- Neuroscience Research Institute, Gachon University, Incheon 21565, Republic of Korea
- Biomedical Engineering Research Center, Gachon University, Incheon 21936, Republic of Korea
- Department of Biomedical Engineering, College of IT Convergence, Gachon University, Seongnam-si 13120, Republic of Korea
| | - Young-Don Son
- Neuroscience Research Institute, Gachon University, Incheon 21565, Republic of Korea
- Biomedical Engineering Research Center, Gachon University, Incheon 21936, Republic of Korea
- Department of Biomedical Engineering, College of IT Convergence, Gachon University, Seongnam-si 13120, Republic of Korea
| | - Jong-Hoon Kim
- Neuroscience Research Institute, Gachon University, Incheon 21565, Republic of Korea
- Department of Psychiatry, Gachon University College of Medicine, Gil Medical Center, Gachon University, Incheon 21565, Republic of Korea
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Avery SN, Rogers BP, McHugo M, Armstrong K, Blackford JU, Vandekar SN, Woodward ND, Heckers S. Hippocampal Network Dysfunction in Early Psychosis: A 2-Year Longitudinal Study. Biol Psychiatry Glob Open Sci 2023; 3:979-989. [PMID: 37881573 PMCID: PMC10593896 DOI: 10.1016/j.bpsgos.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/17/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022] Open
Abstract
Background Hippocampal abnormalities are among the most consistent findings in schizophrenia. Numerous studies have reported deficits in hippocampal volume, function, and connectivity in the chronic stage of illness. While hippocampal volume and function deficits are also present in the early stage of illness, there is mixed evidence of both higher and lower functional connectivity. Here, we use graph theory to test the hypothesis that hippocampal network connectivity is broadly lowered in early psychosis and progressively worsens over 2 years. Methods We examined longitudinal resting-state functional connectivity in 140 participants (68 individuals in the early stage of psychosis, 72 demographically similar healthy control individuals). We used an anatomically driven approach to quantify hippocampal network connectivity at 2 levels: 1) a core hippocampal-medial temporal lobe cortex (MTLC) network; and 2) an extended hippocampal-cortical network. Group and time effects were tested in a linear mixed effects model. Results Early psychosis patients showed elevated functional connectivity in the core hippocampal-MTLC network, but contrary to our hypothesis, did not show alterations within the broader hippocampal-cortical network. Hippocampal-MTLC network hyperconnectivity normalized longitudinally and predicted improvement in positive symptoms but was not associated with increasing illness duration. Conclusions These results show abnormally elevated functional connectivity in a core hippocampal-MTLC network in early psychosis, suggesting that selectively increased hippocampal signaling within a localized cortical circuit may be a marker of the early stage of psychosis. Hippocampal-MTLC hyperconnectivity could have prognostic and therapeutic implications.
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Affiliation(s)
- Suzanne N. Avery
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Baxter P. Rogers
- Vanderbilt University Institute of Imaging Sciences, Nashville, Tennessee
| | - Maureen McHugo
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kristan Armstrong
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Simon N. Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Neil D. Woodward
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephan Heckers
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
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Ghamari R, Yazarlou F, Khosravizadeh Z, Moradkhani A, Abdollahi E, Alizadeh F. Serotonin transporter functional polymorphisms potentially increase risk of schizophrenia separately and as a haplotype. Sci Rep 2022; 12:1336. [PMID: 35079035 PMCID: PMC8789837 DOI: 10.1038/s41598-022-05206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
Schizophrenia is a severe, disabling psychiatric disorder with unclear etiology. Family-based, twins, and adoption studies have shown that genetic factors have major contributions in schizophrenia occurrence. Until now, many studies have discovered the association of schizophrenia and its comorbid symptoms with functional polymorphisms that lie within serotonin reuptake pathway genes. Here, we aimed to investigate the association of three variable number tandem repeats (VNTR) functional polymorphisms in MAOA and SLC6A4 with schizophrenia in the Iranian population. Two hundred and forty-one subjects with schizophrenia and three hundred and seventy age and sex-matched healthy controls were genotyped for MAOA promoter uVNTR, 5-HTTLPR, and STin2 polymorphisms. Genotyping was performed by polymerase chain reaction (PCR) with locus-specific primers and running the PCR product on agarose 2.5% gel electrophoresis. Finally, the statistical inference was performed using R programming language and Haploview software. MAOA promoter uVNTR analysis of allele frequency showed no differences between schizophrenia subjects and healthy controls in both males and females and no significant differences were observed between female cases and female controls in MAOA promoter uVNTR 4 repeat frequency. Also, there were no differences between Schizophrenia and healthy control groups in 5-HTTLPR allele and genotype frequency but, 5-HTTLPR S allele carriers are significantly more frequent among cases. In addition, STin2.12 repeats were significantly more frequent among schizophrenia patients. Genotype comparison suggested that 5-HTTLPR S allele and STin2.12 repeat carriers were significantly more frequent among schizophrenia cases and being STin2.12 repeat carrier significantly increase the risk of schizophrenia occurrence. Besides, analysis of haplotype showed stronger linkage disequilibrium between 5-HTTLPR and STin2 haplotype block in cases than controls. These results suggest that SLC6A4 functional polymorphisms potentially could play a possible role as risk factors for the incidence of schizophrenia.
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Affiliation(s)
- Rana Ghamari
- Department of Genetics, Faculty of Biology, Kharazmi University, Tehran, Iran
| | - Fatemeh Yazarlou
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Khosravizadeh
- Clinical Research Development Unit, Infertility treatment clinic, Amiralmomenin Hospital, Arak University of Medical Sciences, Arak, Iran
| | - Atefeh Moradkhani
- Department of Biology, Faculty of Science, Zanjan Branch, Islamic Azad University, Zanjan, Iran
| | - Elaheh Abdollahi
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fatemeh Alizadeh
- Department of Genomic Psychiatry and Behavioral Genomics (DGPBG), Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Antonova I, van Swam C, Hubl D, Griskova-Bulanova I, Dierks T, Koenig T. Altered Visuospatial Processing in Schizophrenia: An Event-related Potential Microstate Analysis Comparing Patients with and without Hallucinations with Healthy Controls. Neuroscience 2021; 479:140-156. [PMID: 34687795 DOI: 10.1016/j.neuroscience.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022]
Abstract
Patients with schizophrenia present with various symptoms related to different domains. Abnormalities of auditory and visual perception are parts of a more general problem. Nevertheless, the relationship between the lifetime history of auditory verbal hallucination (AVH), one of the most prevalent symptoms in schizophrenia, and visuospatial deficits remains unclear. This study aimed to investigate differences in hemispheric involvement and visuospatial processing between healthy controls (HCs) and schizophrenia patients with and without AVHs. HCs (N = 20), schizophrenia patients with AVH (AVH group, N = 16), and schizophrenia patients without hallucinations (NH group, N = 10) participated in a 4-choice reaction task with lateralized stimuli. An event-related potential (ERP)-microstate approach was used to analyze ERP differences between the conditions and groups. The schizophrenia patients without hallucinations had slower responses than the HCs. An early visual N1 contralateral to stimulation side was prominent in all groups of participants but with decreased amplitude in the patients with schizophrenia, especially in the AVH group over the right hemisphere. The amplitude of P3b, a cognitive evaluation component, was also decreased in schizophrenia. Compared to AVH and HC groups, the patients in the NH group had altered microstate patterns: P3b was replaced by a novelty component, P3a. Although the difference between both patient groups was only based on the presence of AVHs, our findings indicated that patients had specific visuospatial deficits associated with a lifetime history of hallucinations: patients with AVHs showed early visual component alterations in the right hemisphere, and those without AVHs had more prominent visuospatial impairment.
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Affiliation(s)
- Ingrida Antonova
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Vilnius University, Life Sciences Center, Vilnius, Lithuania; Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland.
| | - Claudia van Swam
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Daniela Hubl
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Thomas Dierks
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Koenig
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Pinheiro AP, Schwartze M, Kotz SA. Cerebellar circuitry and auditory verbal hallucinations: An integrative synthesis and perspective. Neurosci Biobehav Rev 2020; 118:485-503. [DOI: 10.1016/j.neubiorev.2020.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/30/2020] [Accepted: 08/07/2020] [Indexed: 02/06/2023]
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Zhao Z, Xu G, Shen Z, Grunebaum M, Li X, Sun B, Li S, Xu Y, Huang M, Xu D. The Effect of Auditory Verbal Hallucinations on the Relationship between Spontaneous Brain Activity and intraventricular Brain Temperature in Patients with Drug-Naïve Schizophrenia. Neurosci Lett 2020; 729:134933. [PMID: 32325103 DOI: 10.1016/j.neulet.2020.134933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
Our recent study reported that adolescent-onset schizophrenia showed an uncoupling between intraventricular brain temperature (iBT) and local spontaneous brain activity (SBA). While auditory verbal hallucinations (AVH) are common in schizophrenia, the role of AVH in the iBT-SBA relationship is unclear. The current study recruited 24 drug-naïve schizophrenia patients with AVH, 20 patients without AVH and 30 matched healthy controls (HC). We used a diffusion-weighted imaging (DWI) based thermometry method to calculate the iBT for each participant and used both regional homogeneity and amplitude of low-frequency fluctuation methods to assess the SBA. One-way ANOVA was used to detect group differences in iBT, and a partial correlation analysis controlling for lateral ventricles volume, sex and age was applied to detect the relationships between iBT and SBA across the three groups. The results demonstrated that the AVH group showed a significant coupling between iBT and SBA in the bilateral lingual gyrus, left superior occipital gyrus and caudate compared with the other two groups, and no uncoupling was found in the two patients groups relative to HCs. These findings suggest that AVH may modulate the relationship between iBT and SBA in schizophrenia-related regions.
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Affiliation(s)
- Zhiyong Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, China; Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China; Molecular Imaging and Neuropathology Division, Columbia University Department of Psychiatry & New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Guojun Xu
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China; Molecular Imaging and Neuropathology Division, Columbia University Department of Psychiatry & New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Zhe Shen
- College of Medicine, Zhejiang University, No. 268, Kaixuan Road, Hangzhou, 310000, Zhejiang Province, China
| | - Michael Grunebaum
- Molecular Imaging and Neuropathology Division, Columbia University Department of Psychiatry & New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Xuzhou Li
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China; Molecular Imaging and Neuropathology Division, Columbia University Department of Psychiatry & New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Bin Sun
- College of Medicine, Zhejiang University, No. 268, Kaixuan Road, Hangzhou, 310000, Zhejiang Province, China
| | - Shangda Li
- College of Medicine, Zhejiang University, No. 268, Kaixuan Road, Hangzhou, 310000, Zhejiang Province, China
| | - Yi Xu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, 310003, Zhejiang Province, China
| | - Manli Huang
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, 310003, Zhejiang Province, China.
| | - Dongrong Xu
- Molecular Imaging and Neuropathology Division, Columbia University Department of Psychiatry & New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA.
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Dean B, Scarr E. Muscarinic M1 and M4 receptors: Hypothesis driven drug development for schizophrenia. Psychiatry Res 2020; 288:112989. [PMID: 32315882 DOI: 10.1016/j.psychres.2020.112989] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 02/02/2023]
Abstract
The finding that the drug KarXT, a formulation of xanomeline and tropsium which targets muscarinic receptors, has given a positive result in reducing the positive and negative symptoms of schizophrenia in a phase II trial suggests targeting muscarinic receptors is a new approach to treating the disorder. This review will detail the synergistic interplay between studies to understand the role of muscarinic receptors in the aetiology of schizophrenia and drug development and how this has supported the hypothesis that activating the muscarinic M1 and M4 receptors is critical to the efficacy of KarXT, in schizophrenia. The discovery of an intermediate phenotype within schizophrenia which is characterised by the presence of a marked loss of cortical muscarinic M1 receptors will be reviewed. Highlighted will be progress in understanding the biochemistry of that intermediate phenotype and evidence to suggest that those with the intermediate phenotype may resist treatment with agonist to the orthosteric site on the muscarinic M1 and M4 receptor. Finally, the possibility of using drugs targeting the allosteric binding sites on muscarinic receptors to treat schizophrenia will be discussed. This timely review will therefore highlight how research can influence hypothesis driven drug discovery that should produce new treatments for schizophrenia.
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Abstract
Perceptual disturbances in psychosis, such as auditory verbal hallucinations, are associated with increased baseline activity in the associative auditory cortex and increased dopamine transmission in the associative striatum. Perceptual disturbances are also associated with perceptual biases that suggest increased reliance on prior expectations. We review theoretical models of perceptual inference and key supporting physiological evidence, as well as the anatomy of associative cortico-striatal loops that may be relevant to auditory perceptual inference. Integrating recent findings, we outline a working framework that bridges neurobiology and the phenomenology of perceptual disturbances via theoretical models of perceptual inference.
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McCutcheon RA, Abi-Dargham A, Howes OD. Schizophrenia, Dopamine and the Striatum: From Biology to Symptoms. Trends Neurosci 2019; 42:205-220. [PMID: 30621912 PMCID: PMC6401206 DOI: 10.1016/j.tins.2018.12.004] [Citation(s) in RCA: 367] [Impact Index Per Article: 73.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/04/2018] [Accepted: 12/16/2018] [Indexed: 12/15/2022]
Abstract
The mesolimbic hypothesis has been a central dogma of schizophrenia for decades, positing that aberrant functioning of midbrain dopamine projections to limbic regions causes psychotic symptoms. Recently, however, advances in neuroimaging techniques have led to the unanticipated finding that dopaminergic dysfunction in schizophrenia is greatest within nigrostriatal pathways, implicating the dorsal striatum in the pathophysiology and calling into question the mesolimbic theory. At the same time our knowledge of striatal anatomy and function has progressed, suggesting new mechanisms via which striatal dysfunction may contribute to the symptoms of schizophrenia. This Review draws together these developments, to explore what they mean for our understanding of the pathophysiology, clinical manifestations, and treatment of the disorder. Techniques for characterising the mesostriatal dopamine system, both in humans and animal models, have advanced significantly over the past decade. In vivo imaging studies in schizophrenia patients demonstrate that dopaminergic dysfunction in schizophrenia is greatest in nigrostriatal as opposed to mesolimbic pathways. Better understanding of striatal structure and function has enhanced our insight into the neurobiological basis of psychotic symptoms. The role of other neurotransmitters in modulating striatal dopamine function merits further exploration, and modulating these neurotransmitter systems has potential to offer new therapeutic strategies.
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Affiliation(s)
- Robert A McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK; MRC London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, W12 0NN, UK; South London and Maudsley NHS Foundation Trust, London, SE5 8AF, UK
| | - Anissa Abi-Dargham
- Department of Psychiatry, School of Medicine, Stony Brook University, New York, USA
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK; MRC London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, W12 0NN, UK; South London and Maudsley NHS Foundation Trust, London, SE5 8AF, UK.
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12
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Kim JH, Son YD, Kim JH, Lee HJ, Kang NI, Chung GH, Park JI, Cui Y, Kim WS, Chung YC. Neural Signature for Auditory Hallucinations in Schizophrenia: A High-Resolution Positron Emission Tomography Study with Fludeoxyglucose ( 18F). Clin Psychopharmacol Neurosci 2018; 16:324-332. [PMID: 30121983 PMCID: PMC6124871 DOI: 10.9758/cpn.2018.16.3.324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/06/2018] [Accepted: 04/23/2018] [Indexed: 11/18/2022]
Abstract
Objective Auditory hallucinations (AHs) are a core symptom of schizophrenia. We investigated the neural signature of AHs by comparing hallucinating patients with schizophrenia with non-hallucinating patients with schizophrenia. Methods We recruited hallucinating patients with schizophrenia meeting the criteria for persistent, prominent, and predominant AHs (n=10) and non-hallucinating patients with schizophrenia (n=12). Various clinical assessments were performed incluing Psychotic Symptom Rating Scale for Auditory Hallucinations. Using fludeoxyglucose (18F) positron emission tomography, regional differences in neural activity between the groups were analyzed. Results The regions of interest analysis showed significantly lower standardized uptake value ratio (SUVR) in the superior, middle, and inferior frontal gyri, and higher SUVR in the putamen in patients with AHs versus patients without AHs. These findings were confirmed in the voxel-wise analysis. Conclusion Our findings indicate that hypoactivity in the frontal and cingulate gyri, coupled with hyperactivity in the temporal gyrus and putamen, may contribute to the pathophysiology of AHs.
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Affiliation(s)
- Jong-Hoon Kim
- Department of Psychiatry, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea.,Neuroscience Research Institute, Incheon, Korea
| | - Young Don Son
- Department of Biomedical Engineering, Gachon University, Incheon, Korea
| | - Jeong-Hee Kim
- Research Institute for Advanced Industrial Technology, Korea University, Sejong, Korea
| | - Hyo-Jong Lee
- Department of Computer Science and Engineering & Center for Advanced Image and Information Technology, Chonbuk National University, Jeonju, Korea
| | - Nam-In Kang
- Department of Psychiatry, Maeumsarang Hospital, Wanju, Korea
| | - Gyung Ho Chung
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.,Departments of Radiology, Chonbuk National University Medical School, Jeonju, Korea
| | - Jong-Il Park
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.,Departments of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea
| | - Yin Cui
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.,Departments of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea
| | - Woo-Sung Kim
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.,Departments of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea
| | - Young-Chul Chung
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.,Departments of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea
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13
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Zhuo C, Zhu J, Qin W, Qu H, Ma X, Yu C. Cerebral blood flow alterations specific to auditory verbal hallucinations in schizophrenia. Br J Psychiatry 2017; 210:209-215. [PMID: 28104737 DOI: 10.1192/bjp.bp.115.174961] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 09/25/2016] [Accepted: 10/07/2016] [Indexed: 01/17/2023]
Abstract
BackgroundAuditory verbal hallucinations (AVHs) have been associated with deficits in auditory and speech-related networks. However, the resting-state cerebral blood flow (CBF) alterations specific to AVHs in schizophrenia remain unknown.AimsTo explore AVH-related CBF alterations in individuals with schizophrenia.MethodIn total, 35 individuals with schizophrenia with AVHs, 41 individuals with schizophrenia without AVHs and 50 controls underwent arterial spin labelling magnetic resonance imaging. The CBF differences were voxel-wise compared across the three groups.ResultsWe found AVH-specific CBF increase in the right superior temporal gyrus and caudate, and AVH-specific CBF decrease in the bilateral occipital and left parietal cortices. We also observed consistent CBF changes in both schizophrenia subgroups (i.e. those with and without AVHs) including decreased CBF in the bilateral occipital regions, the left lateral prefrontal and insular cortices, and the right anterior cingulate cortex and increased CBF in the bilateral lateral temporal regions and putamen, the left middle cingulate cortex and the right thalamus.ConclusionsThe AVH-specific CBF increases in the auditory and striatal areas and CBF reductions in the visual and parietal areas suggest that there exists a CBF redistribution associated with AVHs.
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Affiliation(s)
- Chuanjun Zhuo
- Chuanjun Zhuo, MD, PhD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, and Department of Psychiatry Functional Neuroimaging Laboratory, Tianjin Mental Health Center, Tianjin Anding Hospital, Tianjin; Jiajia Zhu, MD, Wen Qin, MD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, China; Hongru Qu, MD, Xiaolei Ma, MD, Department of Psychiatry, Tianjin Anning Hospital, Tianjin, China; Chunshui Yu, MD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiajia Zhu
- Chuanjun Zhuo, MD, PhD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, and Department of Psychiatry Functional Neuroimaging Laboratory, Tianjin Mental Health Center, Tianjin Anding Hospital, Tianjin; Jiajia Zhu, MD, Wen Qin, MD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, China; Hongru Qu, MD, Xiaolei Ma, MD, Department of Psychiatry, Tianjin Anning Hospital, Tianjin, China; Chunshui Yu, MD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Wen Qin
- Chuanjun Zhuo, MD, PhD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, and Department of Psychiatry Functional Neuroimaging Laboratory, Tianjin Mental Health Center, Tianjin Anding Hospital, Tianjin; Jiajia Zhu, MD, Wen Qin, MD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, China; Hongru Qu, MD, Xiaolei Ma, MD, Department of Psychiatry, Tianjin Anning Hospital, Tianjin, China; Chunshui Yu, MD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongru Qu
- Chuanjun Zhuo, MD, PhD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, and Department of Psychiatry Functional Neuroimaging Laboratory, Tianjin Mental Health Center, Tianjin Anding Hospital, Tianjin; Jiajia Zhu, MD, Wen Qin, MD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, China; Hongru Qu, MD, Xiaolei Ma, MD, Department of Psychiatry, Tianjin Anning Hospital, Tianjin, China; Chunshui Yu, MD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaolei Ma
- Chuanjun Zhuo, MD, PhD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, and Department of Psychiatry Functional Neuroimaging Laboratory, Tianjin Mental Health Center, Tianjin Anding Hospital, Tianjin; Jiajia Zhu, MD, Wen Qin, MD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, China; Hongru Qu, MD, Xiaolei Ma, MD, Department of Psychiatry, Tianjin Anning Hospital, Tianjin, China; Chunshui Yu, MD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Chunshui Yu
- Chuanjun Zhuo, MD, PhD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, and Department of Psychiatry Functional Neuroimaging Laboratory, Tianjin Mental Health Center, Tianjin Anding Hospital, Tianjin; Jiajia Zhu, MD, Wen Qin, MD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, China; Hongru Qu, MD, Xiaolei Ma, MD, Department of Psychiatry, Tianjin Anning Hospital, Tianjin, China; Chunshui Yu, MD, Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
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Abstract
Auditory verbal hallucinations (AVH) are a frequently occurring phenomenon in the general population and are considered a psychotic symptom when presented in the context of a psychiatric disorder. Neuroimaging literature has shown that AVH are subserved by a variety of alterations in brain structure and function, which primarily concentrate around brain regions associated with the processing of auditory verbal stimuli and with executive control functions. However, the direction of association between AVH and brain function remains equivocal in certain research areas and needs to be carefully reviewed and interpreted. When AVH have significant impact on daily functioning, several efficacious treatments can be attempted such as antipsychotic medication, brain stimulation and cognitive-behavioural therapy. Interestingly, the neural correlates of these treatments largely overlap with brain regions involved in AVH. This suggests that the efficacy of treatment corresponds to a normalization of AVH-related brain activity. In this selected review, we give a compact yet comprehensive overview of the structural and functional neuroimaging literature on AVH, with a special focus on the neural correlates of efficacious treatment.
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Affiliation(s)
- M M Bohlken
- Department of Psychiatry,Brain Center Rudolf Magnus,University Medical Center Utrecht,3584CX Utrecht,The Netherlands
| | - K Hugdahl
- Department of Biological and Medical Psychology,University of Bergen,Bergen,Norway
| | - I E C Sommer
- Department of Psychiatry,Brain Center Rudolf Magnus,University Medical Center Utrecht,3584CX Utrecht,The Netherlands
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15
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Dean B, Thomas N, Scarr E, Udawela M. Evidence for impaired glucose metabolism in the striatum, obtained postmortem, from some subjects with schizophrenia. Transl Psychiatry 2016; 6:e949. [PMID: 27845781 DOI: 10.1038/tp.2016.226] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 09/28/2016] [Indexed: 12/25/2022] Open
Abstract
Studies using central nervous system tissue obtained postmortem suggest pathways involved in energy and metabolism contribute to the pathophysiology of schizophrenia; neuroimaging studies suggesting glucose metabolism is particularly affected in the striatum. To gain information on the status of pathways involved in glucose metabolism in the striatum, we measured levels of glucose, pyruvate, acetyl-CoA and lactate as well as the β subunit of pyruvate dehydrogenase, a rate limiting enzyme, in the postmortem tissue from subjects with schizophrenia and age/sex-matched controls. The subjects with schizophrenia were made up of two subgroups, which could be divided because they either had (muscarinic receptor deficit schizophrenia (MRDS)), or did not have (non-MRDS), a marked deficit in cortical muscarinic receptors. Compared to controls, levels of β subunit of pyruvate dehydrogenase were lower (Δ mean=-20%) and levels of pyruvate (Δ mean=+47%) and lactate (Δ mean=+15%) were significantly higher in the striatum from subjects with schizophrenia. Notably, in subjects with non-MRDS, striatal levels of β subunit of pyruvate dehydrogenase were lower (Δ mean=-29%), whereas levels of pyruvate (Δ mean=-66%), acetyl-CoA (Δ mean=-28%) and glucose (Δ mean=-27%) were higher, whereas levels of lactate (Δ mean=+17%) were higher in MRDS. Finally, discriminate analyses using levels the β subunit of pyruvate dehydrogenase and glucose, or better still, β subunit of pyruvate dehydrogenase and glucose in combination with pyruvate, lactate or acetyl-CoA could separate subjects with non-MRDS from controls with high levels of specificity (up to 93%) and selectivity (up to 91%). Our data show the benefit of being able to study defined subgroups within the syndrome of schizophrenia as such an approach has revealed that changes in glucose metabolism may be a significant contributor to the pathophysiology of non-MRDS.
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16
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Alderson-Day B, Diederen K, Fernyhough C, Ford JM, Horga G, Margulies DS, McCarthy-Jones S, Northoff G, Shine JM, Turner J, van de Ven V, van Lutterveld R, Waters F, Jardri R. Auditory Hallucinations and the Brain's Resting-State Networks: Findings and Methodological Observations. Schizophr Bull 2016; 42:1110-23. [PMID: 27280452 PMCID: PMC4988751 DOI: 10.1093/schbul/sbw078] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In recent years, there has been increasing interest in the potential for alterations to the brain's resting-state networks (RSNs) to explain various kinds of psychopathology. RSNs provide an intriguing new explanatory framework for hallucinations, which can occur in different modalities and population groups, but which remain poorly understood. This collaboration from the International Consortium on Hallucination Research (ICHR) reports on the evidence linking resting-state alterations to auditory hallucinations (AH) and provides a critical appraisal of the methodological approaches used in this area. In the report, we describe findings from resting connectivity fMRI in AH (in schizophrenia and nonclinical individuals) and compare them with findings from neurophysiological research, structural MRI, and research on visual hallucinations (VH). In AH, various studies show resting connectivity differences in left-hemisphere auditory and language regions, as well as atypical interaction of the default mode network and RSNs linked to cognitive control and salience. As the latter are also evident in studies of VH, this points to a domain-general mechanism for hallucinations alongside modality-specific changes to RSNs in different sensory regions. However, we also observed high methodological heterogeneity in the current literature, affecting the ability to make clear comparisons between studies. To address this, we provide some methodological recommendations and options for future research on the resting state and hallucinations.
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Affiliation(s)
| | - Kelly Diederen
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | | | - Judith M. Ford
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Guillermo Horga
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | - Daniel S. Margulies
- Max Planck Research Group for Neuroanatomy & Connectivity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | | | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal’s Institute of Mental Health Research, Ottawa, ON, Canada
| | - James M. Shine
- Department of Psychology, Stanford University, Stanford, CA
| | - Jessica Turner
- Department of Psychology, Neuroscience Institute, Georgia State University, Atlanta, GA
| | - Vincent van de Ven
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Remko van Lutterveld
- Center for Mindfulness, University of Massachusetts Medical School, Worcester, MA
| | - Flavie Waters
- North Metro Health Service Mental Health, Graylands Health Campus, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, WA, Australia
| | - Renaud Jardri
- Univ Lille, CNRS (UMR 9193), SCALab & CHU Lille, Psychiatry dept. (CURE), Lille, France
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17
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Horga G, Cassidy CM, Xu X, Moore H, Slifstein M, Van Snellenberg JX, Abi-Dargham A. Dopamine-Related Disruption of Functional Topography of Striatal Connections in Unmedicated Patients With Schizophrenia. JAMA Psychiatry 2016; 73:862-70. [PMID: 27145361 PMCID: PMC5310843 DOI: 10.1001/jamapsychiatry.2016.0178] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Despite the well-established role of striatal dopamine in psychosis, current views generally agree that cortical dysfunction is likely necessary for the emergence of psychotic symptoms. The topographic organization of striatal-cortical connections is central to gating and integration of higher-order information, so a disruption of such topography via dysregulated dopamine could lead to cortical dysfunction in schizophrenia. However, this hypothesis remains to be tested using multivariate methods ascertaining the global pattern of striatal connectivity and without the confounding effects of antidopaminergic medication. OBJECTIVES To examine whether the pattern of brain connectivity across striatal subregions is abnormal in unmedicated patients with schizophrenia and whether this abnormality relates to psychotic symptoms and extrastriatal dopaminergic transmission. DESIGN, SETTING, AND PARTICIPANTS In this multimodal, case-control study, we obtained resting-state functional magnetic resonance imaging data from 18 unmedicated patients with schizophrenia and 24 matched healthy controls from the New York State Psychiatric Institute. A subset of these (12 and 17, respectively) underwent positron emission tomography with the dopamine D2 receptor radiotracer carbon 11-labeled FLB457 before and after amphetamine administration. Data were acquired between June 16, 2011, and February 25, 2014. Data analysis was performed from September 1, 2014, to January 11, 2016. MAIN OUTCOMES AND MEASURES Group differences in the striatal connectivity pattern (assessed via multivariable logistic regression) across striatal subregions, the association between the multivariate striatal connectivity pattern and extrastriatal baseline D2 receptor binding potential and its change after amphetamine administration, and the association between the multivariate connectivity pattern and the severity of positive symptoms evaluated with the Positive and Negative Syndrome Scale. RESULTS Of the patients with schizophrenia (mean [SEM] age, 35.6 [11.8] years), 9 (50%) were male and 9 (50%) were female. Of the controls (mean [SEM] age, 33.7 [8.8] years), 10 (42%) were male and 14 (58%) were female. Patients had an abnormal pattern of striatal connectivity, which included abnormal caudate connections with a distributed set of associative cortex regions (χ229 = 53.55, P = .004). In patients, more deviation from the multivariate pattern of striatal connectivity found in controls correlated specifically with more severe positive symptoms (ρ = -0.77, P = .002). Striatal connectivity also correlated with baseline binding potential across cortical and extrastriatal subcortical regions (t25 = 3.01, P = .01, Bonferroni corrected) but not with its change after amphetamine administration. CONCLUSIONS AND RELEVANCE Using a multimodal, circuit-level interrogation of striatal-cortical connections, it was demonstrated that the functional topography of these connections is globally disrupted in unmedicated patients with schizophrenia. These findings suggest that striatal-cortical dysconnectivity may underlie the effects of dopamine dysregulation on the pathophysiologic mechanism of psychotic symptoms.
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Affiliation(s)
- Guillermo Horga
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York,Division of Translational Imaging, New York State Psychiatric Institute, New York, New York,Please address correspondence to Guillermo Horga, MD, PhD, at New York State Psychiatric Institute, Columbia University Medical Center, Unit 31, 1051 Riverside Dr., New York, NY 10032, or
| | - Clifford M. Cassidy
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York,Division of Translational Imaging, New York State Psychiatric Institute, New York, New York
| | - Xiaoyan Xu
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York,Division of Translational Imaging, New York State Psychiatric Institute, New York, New York
| | - Holly Moore
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York,Division of Integrative Neuroscience, New York State Psychiatric Institute, New York, New York
| | - Mark Slifstein
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York,Division of Translational Imaging, New York State Psychiatric Institute, New York, New York
| | - Jared X. Van Snellenberg
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York,Division of Translational Imaging, New York State Psychiatric Institute, New York, New York
| | - Anissa Abi-Dargham
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York,Division of Translational Imaging, New York State Psychiatric Institute, New York, New York
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18
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Upthegrove R, Broome MR, Caldwell K, Ives J, Oyebode F, Wood SJ. Understanding auditory verbal hallucinations: a systematic review of current evidence. Acta Psychiatr Scand 2016; 133:352-67. [PMID: 26661730 DOI: 10.1111/acps.12531] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Auditory verbal hallucinations (AVHs) are core features of psychotic illness and remain significant in predicting poor outcome and risk. There has been a wide range of approaches to understanding these experiences. METHOD A systematic literature review summarizing different methods of investigation and their results; phenomenology, descriptive psychopathology, psychological, cognitive neurobiology, and neuroimaging. RESULTS A number of 764 papers and texts were screened and 113 reviewed. Phenomenological studies are comparably few in number, and psychopathology remains based on concepts defined in the early 20th century. Psychological models focus on voice content and emotional reaction, and suggest a continuum of AVHs from normal experience. Neuropsychological models include AVHs as misattribution of inner speech, whilst functional neuroimaging studies focus on the spontaneous activity and connectivity of auditory networks. CONCLUSION There has been a large growth in research on AVHs in recent decades dominated by neurobiological and neuroimaging studies. Future research should include focus on phenomenological aspects and AVHs change over the course of developing illness. Integration between branches of enquiry is needed, and the risk is that without this, models are proposed and investigated that bear scant relevance to the symptom itself.
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Affiliation(s)
- R Upthegrove
- Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK.,Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - M R Broome
- Department of Psychiatry, University of Oxford, Oxford, UK.,Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - K Caldwell
- Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK.,Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - J Ives
- Medicine, Ethics, Society and History, The University of Birmingham, Birmingham, UK
| | - F Oyebode
- Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK.,Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - S J Wood
- School of Psychology, University of Birmingham, Birmingham, UK.,Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Melbourne, Vic., Australia
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Mamah D, Wen J, Luo J, Ulrich X, Barch DM, Yablonskiy D. Subcomponents of brain T2* relaxation in schizophrenia, bipolar disorder and siblings: A Gradient Echo Plural Contrast Imaging (GEPCI) study. Schizophr Res 2015; 169:36-45. [PMID: 26603058 PMCID: PMC4681636 DOI: 10.1016/j.schres.2015.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/02/2015] [Accepted: 10/06/2015] [Indexed: 11/30/2022]
Abstract
Investigating brain tissue T2* relaxation properties in vivo can potentially guide the uncovering of neuropathology in psychiatric illness, which is traditionally examined post mortem. We use an MRI-based Gradient Echo Plural Contrast Imaging (GEPCI) technique that produces inherently co-registered images allowing quantitative assessment of tissue cellular and hemodynamic properties. Usually described as R2* (=1/T2*) relaxation rate constant, recent developments in GEPCI allow the separation of cellular-specific (R2*C) and hemodynamic (BOLD) contributions to the MRI signal decay. We characterize BOLD effect in terms of tissue concentration of deoxyhemoglobin, i.e. CDEOXY, which reflects brain activity. 17 control (CON), 17 bipolar disorder (BPD), 16 schizophrenia (SCZ), and 12 unaffected schizophrenia sibling (SIB) participants were scanned and post-processed using GEPCI protocols. A MANOVA of 38gray matter regions ROIs showed significant group effects for CDEOXY but not for R2*C. In the three non-control groups, 71-92% of brain regions had increased CDEOXY. Group effects were observed in the superior temporal cortex and the thalamus. Increased superior temporal cortex CDEOXY was found in SCZ (p=0.01), BPD (p=0.01) and SIB (p=0.02), with bilateral effects in SCZ and only left hemisphere effects in BPD and SIB. Thalamic CDEOXY abnormalities were observed in SCZ (p=0.003), BPD (p=0.03) and SIB (p=0.02). Our results suggest that increased activity in certain brain regions is part of the underlying pathophysiology of specific psychiatric disorders. High CDEOXY in the superior temporal cortex suggests abnormal activity with auditory, language and/or social cognitive processing. Larger studies are needed to clarify the clinical significance of relaxometric abnormalities.
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, United States.
| | - Jie Wen
- Department of Radiology, Washington University Medical School, St. Louis, United States
| | - Jie Luo
- Department of Radiology, Washington University Medical School, St. Louis, United States
| | - Xialing Ulrich
- Department of Radiology, Washington University Medical School, St. Louis, United States
| | - Deanna M. Barch
- Department of Psychiatry, Washington University Medical School, St. Louis, United States, Department of Psychology, Washington University in St. Louis, United States, Department of Anatomy and Neurobiology, Washington University in St. Louis, United States
| | - Dmitriy Yablonskiy
- Department of Radiology, Washington University Medical School, St. Louis, United States
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20
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Huang P, Xi Y, Lu ZL, Chen Y, Li X, Li W, Zhu X, Cui LB, Tan Q, Liu W, Li C, Miao D, Yin H. Decreased bilateral thalamic gray matter volume in first-episode schizophrenia with prominent hallucinatory symptoms: A volumetric MRI study. Sci Rep 2015; 5:14505. [PMID: 26403064 DOI: 10.1038/srep14505] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 08/26/2015] [Indexed: 01/19/2023] Open
Abstract
Studies comparing gray matter (GM) volume of schizophrenic patients with or without auditory verbal hallucinations (AVHs) to that of normal controls remain controversial. This project aims to investigate changes of GM volumes of drug-naïve schizophrenic patients with and without AVHs. Eighteen first episode schizophrenic (FES) patients with AVHs, 18 FES patients without AVHs, and 18 healthy controls were scanned using structural MRI. Voxel-based morphometry (VBM) analysis was conducted to investigate changes of GM volume among the three groups. Patients with and without AVHs exhibited reduced GM volumes relative to normal controls in the left superior temporal gyrus, frontal regions, cerebellum and caudate. Further analysis of the GM of subcortical structures found that patients with AVHs had reduced thalamic volume than healthy controls. No significant difference was found between patients with and without AVHs. Significant correlation was found between the total scores of the Positive and Negative Syndrome Scale and bilateral thalamic volume. ROC analysis of thalamic volumes of the patients with AVHs and normal controls showed that the area under the curve was 0.698 (P = 0.043). The decreased thalamic volumes might serve as a biomarker for discriminating FES AVHs patients from normals.
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Abstract
The neural mechanisms that produce hallucinations and other psychotic symptoms remain unclear. Previous research suggests that deficits in predictive signals for learning, such as prediction error signals, may underlie psychotic symptoms, but the mechanism by which such deficits produce psychotic symptoms remains to be established. We used model-based fMRI to study sensory prediction errors in human patients with schizophrenia who report daily auditory verbal hallucinations (AVHs) and sociodemographically matched healthy control subjects. We manipulated participants' expectations for hearing speech at different periods within a speech decision-making task. Patients activated a voice-sensitive region of the auditory cortex while they experienced AVHs in the scanner and displayed a concomitant deficit in prediction error signals in a similar portion of auditory cortex. This prediction error deficit correlated strongly with increased activity during silence and with reduced volumes of the auditory cortex, two established neural phenotypes of AVHs. Furthermore, patients with more severe AVHs had more deficient prediction error signals and greater activity during silence within the region of auditory cortex where groups differed, regardless of the severity of psychotic symptoms other than AVHs. Our findings suggest that deficient predictive coding accounts for the resting hyperactivity in sensory cortex that leads to hallucinations.
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22
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Horga G, Fernández-Egea E, Mané A, Font M, Schatz KC, Falcon C, Lomeña F, Bernardo M, Parellada E. Brain metabolism during hallucination-like auditory stimulation in schizophrenia. PLoS One 2014; 9:e84987. [PMID: 24416328 PMCID: PMC3885666 DOI: 10.1371/journal.pone.0084987] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 11/25/2013] [Indexed: 11/19/2022] Open
Abstract
Auditory verbal hallucinations (AVH) in schizophrenia are typically characterized by rich emotional content. Despite the prominent role of emotion in regulating normal perception, the neural interface between emotion-processing regions such as the amygdala and auditory regions involved in perception remains relatively unexplored in AVH. Here, we studied brain metabolism using FDG-PET in 9 remitted patients with schizophrenia that previously reported severe AVH during an acute psychotic episode and 8 matched healthy controls. Participants were scanned twice: (1) at rest and (2) during the perception of aversive auditory stimuli mimicking the content of AVH. Compared to controls, remitted patients showed an exaggerated response to the AVH-like stimuli in limbic and paralimbic regions, including the left amygdala. Furthermore, patients displayed abnormally strong connections between the amygdala and auditory regions of the cortex and thalamus, along with abnormally weak connections between the amygdala and medial prefrontal cortex. These results suggest that abnormal modulation of the auditory cortex by limbic-thalamic structures might be involved in the pathophysiology of AVH and may potentially account for the emotional features that characterize hallucinatory percepts in schizophrenia.
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Affiliation(s)
- Guillermo Horga
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, United States of America
- Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
- * E-mail:
| | - Emilio Fernández-Egea
- Department of Psychiatry, University of Cambridge, Cambridge, and the Cambridgeshire and Peterborough NHS Foundation Trust, Huntingdon, United Kingdom
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Anna Mané
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Centre Forum, Barcelona, Spain
| | - Mireia Font
- Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Kelly C. Schatz
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, United States of America
| | | | - Francisco Lomeña
- Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d′Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Miguel Bernardo
- Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d′Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eduard Parellada
- Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d′Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Stephane M. Auditory verbal hallucinations result from combinatoric associations of multiple neural events. Front Hum Neurosci 2013; 7:239. [PMID: 23755004 PMCID: PMC3668292 DOI: 10.3389/fnhum.2013.00239] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 05/16/2013] [Indexed: 11/13/2022] Open
Abstract
While Auditory Verbal Hallucinations (AVH) refer to specific experiences shared by all subjects who have AVH—the perception of auditory speech without corresponding external stimuli, the characteristics of these experiences differ from one subject to another. These characteristics include aspects such as the location of AVH (inside or outside the head), the linguistic complexity of AVH (hearing words, sentences, or conversations), the range of content of AVH (repetitive or systematized content), and many other variables. In another word, AVH are phenomenologically heterogeneous experiences. After decades of research focused on a few explanatory mechanisms for AVH, it is apparent that none of these mechanisms alone explains the wide phenomenological range of AVH experiences. To date, our phenomenological understanding of AVH remains largely disjointed from our understanding of the mechanisms of AVH. For a cohesive understanding of AVH, I review the phenomenology and the cognitive and neural basis of AVH. This review indicates that the phenomenology of AVH is not a pointless curiosity. How a subject describes his AVH experiences could inform about the neural events that resulted in AVH. I suggest that a subject-specific combinatoric associations of different neural events result in AVH experiences phenomenologically diverse across subjects.
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Affiliation(s)
- Massoud Stephane
- Department of Psychiatry, Oregon Health and Science University Portland, OR, USA
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García-Martí G, Aguilar EJ, Martí-Bonmatí L, Escartí MJ, Sanjuán J. Multimodal morphometry and functional magnetic resonance imaging in schizophrenia and auditory hallucinations. World J Radiol 2012; 4:159-66. [PMID: 22590670 PMCID: PMC3351684 DOI: 10.4329/wjr.v4.i4.159] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 03/31/2012] [Accepted: 04/07/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To validate a multimodal [structural and functional magnetic resonance (MR)] approach as coincidence brain clusters are hypothesized to correlate with clinical severity of auditory hallucinations.
METHODS: Twenty-two patients meeting Diagnostic and Statistical Manual of Mental Disorders (fourth edition, DSM-IV) criteria for schizophrenia and experiencing persistent hallucinations together with 28 healthy controls were evaluated with structural and functional MR imaging with an auditory paradigm designed to replicate those emotions related to the patients’ hallucinatory experiences. Coincidence maps were obtained by combining structural maps of gray matter reduction with emotional functional increased activation. Abnormal areas were correlated with the brief psychiatric rating scale (BPRS) and the psychotic symptom rating scale (PSYRATS) scales.
RESULTS: The coincidence analysis showed areas with coexistence gray matter reductions and emotional activation in bilateral middle temporal and superior temporal gyri. Significant negative correlations between BPRS and PSYRATS scales were observed. BPRS scores were negatively correlated in the middle temporal gyrus (right) (t = 6.86, P = 0.001), while negative PSYRATS correlation affected regions in both the superior temporal gyrus (left) (t = 7.85, P = 0.001) and middle temporal gyrus (left) (t = 4.97, P = 0.002).
CONCLUSION: Our data identify left superior and middle temporal gyri as relevant areas for the understanding of auditory hallucinations in schizophrenia. The use of multimodal approaches, sharing structural and functional information, may demonstrate areas specifically linked to the severity of auditory hallucinations.
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