Effective Connectivity of the Hippocampus Can Differentiate Patients with Schizophrenia from Healthy Controls: A Spectral DCM Approach

We applied spectral dynamic causal modelling (Friston et al. in Neuroimage 94:396–407. 10.1016/j.neuroimage.2013.12.009, 2014) to analyze the effective connectivity differences between the nodes of three resting state networks (i.e. default mode network, salience network and dorsal attention network) in a dataset of 31 male healthy controls (HC) and 25 male patients with a diagnosis of schizophrenia (SZ). Patients showed increased directed connectivity from the left hippocampus (LHC) to the: dorsal anterior cingulate cortex (DACC), right anterior insula (RAI), left frontal eye fields and the bilateral inferior parietal sulcus (LIPS & RIPS), as well as increased connectivity from the right hippocampus (RHC) to the: bilateral anterior insula (LAI & RAI), right frontal eye fields and RIPS. In SZ, negative symptoms predicted the connectivity strengths from the LHC to: the DACC, the left inferior parietal sulcus (LIPAR) and the RHC, while positive symptoms predicted the connectivity strengths from the LHC to the LIPAR and from the RHC to the LHC. These results reinforce the crucial role of hippocampus dysconnectivity in SZ pathology and its potential as a biomarker of disease severity.

Preserved intention understanding during moral judgments in schizophrenia

INTRODUCTION

Although there is convincing evidence for socio-cognitive impairments in schizophrenia spectrum disorder (SSD), little evidence is found for deficient moral cognition. We investigated whether patients with SSD showed altered moral judgments in a story task where the protagonist either had a neutral or malicious intention towards another person. This paradigm examined whether SSD relates to altered moral cognition in general or specifically to impaired integration of prior information (such as beliefs) in moral judgments.

METHODS

23 patients and 32 healthy controls read vignettes created in a 2 x 2 design. The protagonist in each story either had a neutral or negative intention towards another person which, as a result, either died (negative outcome) or did not die (neutral outcome). Participants rated the moral permissibility of the protagonist's action. Standard null hypothesis significance testing and equivalent Bayes analyses are reported.

RESULTS

Schizophrenia patients did not differ significantly in permissibility ratings from healthy controls. This finding was supported by the Bayes analyses which favoured the null hypothesis. Task performance was not related to symptom severity or medication.

CONCLUSIONS

The current findings do not support the notion that moral judgments are deficient in schizophrenia. Furthermore, the current study shows that patients do not have observable difficulties in integrating the protagonist's belief in the rating of the moral permissibility of the action-outcome.

Reduced spontaneous perspective taking in schizophrenia

Judgments about another person's visual perspective are impaired when the self-perspective is inconsistent with the other-perspective. This is a robust finding in healthy samples as well as in schizophrenia (SZ). Studies show evidence for the existence of a reverse effect, where an inconsistent other-perspective impairs the self-perspective. Such spontaneous perspective taking processes are not yet explored in SZ. In the current fMRI experiment, 24 healthy and 24 schizophrenic participants performed a visual perspective taking task in the scanner. Either a social or a non-social stimulus was presented and their visual perspectives were consistent or inconsistent with the self-perspective of the participant. We replicated previous findings showing that healthy participants show increased reaction times when the human avatar's perspective is inconsistent to the self-perspective. Patients with SZ, however, did not show this effect, neither in the social nor in the non-social condition. BOLD responses revealed similar patterns in occipital areas and group differences were identified in the middle occipital gyrus. These findings suggest that patients with SZ are less likely to spontaneously compute the visual perspectives of others.

Schizophrenia and Category-Selectivity in the Brain: Normal for Faces but Abnormal for Houses

Face processing is regularly found to be impaired in schizophrenia (SZ), thus suggesting that social malfunctioning might be caused by dysfunctional face processing. Most studies focused on emotional face processes, whereas non-emotional face processing received less attention. While current reports on abnormal face processing in SZ are mixed, examinations of non-emotional face processing compared to adequate control stimuli may clarify whether SZ is characterized by a face-processing deficit. Patients with SZ (n = 28) and healthy controls (n = 30) engaged in an fMRI scan where images of non-emotional faces and houses were presented. A simple inverted-picture detection task warranted the participants' attention. Region of interest (ROI) analyses were conducted on face-sensitive regions including the fusiform face area, the occipital face area, and the superior temporal sulcus. Scene-sensitivity was assessed in the parahippocampal place area (PPA) and served as control condition. Patients did not show aberrant face-related neural processes in face-sensitive regions. This finding was also evident when analyses were done on individually defined ROIs or on in-house-localizer ROIs. Patients revealed a decreased specificity toward house stimuli as reflected in decreased neural response toward houses in the PPA. Again, this result was supported by supplementary analyses. Neural activation toward neutral faces was not found to be impaired in SZ, therefore speaking against an overall face-processing deficit. Aberrant activation in scene-sensitive PPA is also found in assessments of memory processes in SZ. It is up to future studies to show how impairments in PPA relate to functional outcome in SZ.

[Risks for Burden among Relatives Caring for Schizophrenia Patients]

OBJECTIVE

Relatives of persons with schizophrenia have an essential role in informal caregiving. This may result in a high level of burden. Aim of the study was to investigate, if the frequency of unmet needs among relatives caring for schizophrenia patients increases the risk for burden among these relatives.

METHODS

135 relatives of patients with schizophrenia or schizoaffective disorder were investigated by means of the "Involvement Evaluation Questionnaire" (IEQ) and the "Carer's Needs Assessment for Schizophrenia" (CNA-S).

RESULTS

Multiple linear regression analyses showed positive associations between the frequency of caregivers' unmet needs and the IEQ-subscores "tension" and "worrying". Further, the IEQ-subscore "worrying" was significantly lower among caregivers of outpatients than among caregivers of inpatients or day hospital patients. The IEQ-subscore "urging" was significantly associated with patient's negative symptoms.

CONCLUSION

Unmet needs among caring relatives have negative effects on their burden. Further, the patients' type of treatment setting (inpatient, outpatient, day hospital) seems to predict caregivers' burden.

[Incidence and risk factors for mental abnormalities in children of psychiatric inpatients]

Children of mentally ill parents are exposed to a variety of stress- and harmful life events. To which extent the mental illness of one or both parents affects their children's mental development is barely studied. Therefore, over a period of 6 months 142 patients with children below the age of 18 (n=237 children), who were admitted to the Dept. for Psychiatry and Psychotherapy 1 of the Paracelsus Medical University Salzburg, were questioned for abnormalities in their children's mental development. Additionally all these patients were assessed for their family situation, demographic data and psychiatric disorder. 38.4% (n=91) of the children showed mental abnormalities. The most common one were emotional (n=41), social (n=41) and learning (n=34) disabilities. Parental duration of the illness (p=0.001), age of the children (p=0.044), illness of both parents (p=0.008), longlasting family conflicts (p=0.003) and living with only one parent (p=0.012) were correlated significantly with mental abnormalities in children. The results confirm an increase risk for mental abnormalities in children of psychiatric patients. This risk varies with existing risk and protective factors, which can be partially influenced. Therefore children of mentally ill parents with problems in their mental development should be detected early. Even if genetic risk factors cannot be changed reducing known psychosocial risk factors and promotion protective factors can significantly influence a healthy development of these vulnerable children.

[Prevalence of psychiatric disorders among homeless adolescents]

Various studies show a high prevalence of mental disorders among homeless people. So far most of these studies deal solely with single men, mainly affected by homelessness. Few data exist for women, children, adolescents and whole families that are more and more affected by poverty and homelessness. This study, conducted in Innsbruck/Austria, determined the prevalence of psychiatric disorders among homeless adolescents. The adolescents were recruited in a counselling centre and homeless shelter specifically founded for homeless youth. Mental disorders were diagnosed with the Structured Clinical Interview for DSM-IV (SKID-I). 40 adolescents and young adults ranging from 14-23 years (mean 17.9 years) were included in the study. The results show that 58% of the homeless adolescents were exposed to continuous violence in their families and that violence was a major reason for them to leave home. The overall prevalence of diagnosed psychiatric disorders was 80% in the whole sample; the leading disorder was substance abuse/dependence (65%), followed by mood disorders (42.5%), anxiety disorders (17.5%) and eating disorders (17.5%). 57.5% of the adolescents had a history of self-harm and 25% reported at least one suicide attempt. Duration of homelessness had the greatest influence on the prevalence of mental disorders. Longer duration of homelessness was associated with a higher risk of psychiatric disorder or self-harm. These results demonstrate the urgent need for early psychosocial and psychiatric help for homeless adolescents.

[Minor relatives of schizophrenia patients: burden and needs]

OBJECTIVES

The aim of the present study was to investigate the burden of minor relatives of schizophrenia patients and of the needs for support for the relatives.

METHODS

135 relatives of patients with schizophrenia or schizoaffective disorders were assessed by using the "Involvement Evaluation Questionnaire" and the "Carers' Needs Assessment for Schizophrenia".

RESULTS

24.4% of the total sample (N=33) had minor (i.e. below 18 years) siblings (N=18) or children (N=15). If the patient had minor siblings, almost the half of the adult relatives reported moderate or severe problems. However, among those patients who had to take care for minor children, only a fifth reported moderate or severe problems. Among the patients' offsprings being under the age of 16 behavioural disturbances, reduced appetite and other consequences of the disease were reported frequently.

CONCLUSIONS

These results indicate that patients with schizophrenia or schizoaffective disorders often have minor relatives in their family frequently suffering from marked burden.