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Labouret M, Trebossen V, Ntorkou A, Bartoli S, Aubart M, Auvin S, Bader-Meunier B, Baudouin V, Corseri O, Dingulu G, Ducrocq C, Dumaine C, Elmaleh M, Fabien N, Faye A, Hau I, Hentgen V, Kwon T, Meinzer U, Ouldali N, Parmentier C, Pouletty M, Renaldo F, Savioz I, Benoist JF, Le Roux E, Ellul P, Melki I. Juvenile neuropsychiatric systemic lupus erythematosus: A specific clinical phenotype and proposal of a probability score. Lupus 2024; 33:328-339. [PMID: 38315109 DOI: 10.1177/09612033241229022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Juvenile systemic lupus erythematosus (j-SLE) is a rare chronic auto-immune disease involving several organs. Neuropsychiatric (NP) SLE (NPSLE) is frequent in j-SLE and associated with increased morbidity/mortality. Although NPSLE classification criteria exist, attributing NP features to j-SLE remains a major challenge. The study objective is to thoroughly describe j-NPSLE patients and assist in their diagnosis. METHODS This is a 4-year retrospective monocentric study of j-SLE patients. NP events were attributed to j-SLE using standardised diagnostic criteria and multidisciplinary paediatric clinical expertise. Clinical features, brain magnetic resonance imaging (MRI)s and samples analysis including cerebrospinal fluid were assessed. A risk of j-NPSLE score was developed based on multivariable logistic regression analysis. RESULTS Of 39 patients included, 44% were identified as having j-NPSLE. J-NPSLE diagnosis was established at the onset of j-SLE in 59% of patients. In addition to frequent kidney involvement (76%) and chilblains (65%), all j-NPSLE patients displayed psychiatric features: cognitive symptoms (82%), hallucinations (76%), depressed mood (35%), acute confused state (18%) and catatonia (12%). Neurological involvement was often mild and nonspecific, with headache (53%) in about half of the patients. The main features reported on brain MRI were nonspecific T2/FLAIR white matter hyperintensities (65%), and cerebral atrophy (88%). Upon immunosuppressive treatment, clinical improvement of NP features was observed in all j-NPSLE patients. The score developed to attribute j-NPSLE probability, guide further investigations and appropriate treatments is based on hallucinations, memory, sleep and renal involvement (Sensitivity: 0.95 Specificity: 0.85). Cerebrospinal fluid (CSF) neopterin assessment increases the score sensitivity and specificity. CONCLUSION Physicians should carefully and systematically assess the presence of NP features at diagnosis and early stages of j-SLE. For j-NPSLE patients with predominant psychiatric features, a multidisciplinary collaboration, including psychiatrists, is essential for the diagnosis, management and follow-up.
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Affiliation(s)
- Mathilde Labouret
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Sorbonne Université, Paris, France
| | - Vincent Trebossen
- Department of Child and Adolescent Psychiatry, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
- Université Paris Cité, UFR de Médecine Paris Nord, Paris, France
| | - Alexandra Ntorkou
- Department of Paediatric Radiology, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
| | - Sophie Bartoli
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Mélodie Aubart
- Paediatric Neurology Department, Necker-Enfants Malades Hospital, University of Paris-Cité, AP-HP, Paris, France
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, French Institute of Health and Medical Research U1163, Imagine Institute, University of Paris-Cité, Paris, France
| | - Stéphane Auvin
- Department of Paediatric Neurology, Center for Rare Epilepsies & Epilepsy Unit, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
- Université Paris Cité, INSERM NeuroDiderot, Paris, France
- Institut Universitaire de France (IUF), Paris, France
| | - Brigitte Bader-Meunier
- Department of Paediatric Haematology-Immunology And Rheumatology, Necker-Enfants-Malades University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Laboratory of Immunogenetics of Paediatric Autoimmune Diseases, Imagine Institute, INSERM UMR 1163, Université Paris Cité, Paris, France
| | - Véronique Baudouin
- Department of Paediatric Nephrology, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
| | - Olivier Corseri
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Glory Dingulu
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Camille Ducrocq
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Cécile Dumaine
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Monique Elmaleh
- Department of Paediatric Radiology, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
| | - Nicole Fabien
- Immunology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | - Albert Faye
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Université Paris Cité, UFR de Médecine Paris Nord, Paris, France
- UMR1123 Inserm, Université Paris Cité, Paris, France
| | - Isabelle Hau
- Department of General Paediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Véronique Hentgen
- Department of General Paediatrics, French Reference centre for Autoinflammatory diseases and amyloidosis (CEREMAIA), Versailles Hospital, Le Chesnay, France
| | - Théresa Kwon
- Department of Paediatric Nephrology, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
| | - Ulrich Meinzer
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Université Paris Cité, UFR de Médecine Paris Nord, Paris, France
- Center for Research on Inflammation, INSERM, Université Paris Cité, Paris, France
- Biology and Genetics of Bacterial Cell Wall Unit, Pasteur Institute, Paris, France
| | - Naim Ouldali
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Université Paris Cité, UFR de Médecine Paris Nord, Paris, France
| | - Cyrielle Parmentier
- Department of Paediatric Nephrology, Armand-Trousseau Childrens' Hospital, AP-HP, Paris, France
| | - Marie Pouletty
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Florence Renaldo
- Department of Paediatric Neurology, Center for Neurogenetic Diseases, Armand-Trousseau Childrens' Hospital, AP-HP, Paris, France
| | - Isabelle Savioz
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Jean-François Benoist
- Metabolic Biochemistry Laboratory, Reference Centre for Inherited Metabolic Diseases, Necker-Enfants-Malades University Hospital, AP-HP, Paris, France
- Université Paris Saclay, UFR Pharmacie, France
| | - Enora Le Roux
- UMR1123 Inserm, Université Paris Cité, Paris, France
- Unité d'Épidémiologie Clinique, Inserm, CIC 1426, Robert Debré Mother-Child University Hospital, Nord-Université Paris Cité, AP-HP, Paris, France
| | - Pierre Ellul
- Department of Child and Adolescent Psychiatry, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
- Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
| | - Isabelle Melki
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Department of Paediatric Haematology-Immunology And Rheumatology, Necker-Enfants-Malades University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Imagine Institute, Laboratory of Neurogenetics and Neuroinflammation, INSERM UMR 1163, Université Paris Cité, Paris, France
- Paediatrics, Rheumatology and Paediatric Internal Medicine, Children's Hospital, Bordeaux, France
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Stoltzner P, Duncan C. Casting shadows of perception: An exploration of visual hallucinations. Nurse Pract 2024; 49:20-28. [PMID: 38271146 DOI: 10.1097/01.npr.0000000000000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
ABSTRACT Hallucinations can be caused by biological, psychological, neurological, ophthalmological, and environmental factors. This article discusses a selection of the various conditions that can present with visual disturbances and hallucinations including schizophrenia, HIV, neurosyphilis, hyperammonemia, migraine, substance use, brain tumors, sleep disturbances, thyroid disorders, delirium, ophthalmologic conditions, and Lewy body dementia, providing an overview of the differential diagnosis of visual hallucinations. The mechanisms by which these conditions can lead to hallucinations are also discussed, and insight into the recommended medical workup for each is provided.
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Li S, Hu R, Yan H, Chu L, Qiu Y, Gao Y, Li M, Li J. 40-Hz auditory steady-state response deficits are correlated with the severity of persistent auditory verbal hallucination in patients with schizophrenia. Psychiatry Res Neuroimaging 2023; 336:111748. [PMID: 37984158 DOI: 10.1016/j.pscychresns.2023.111748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/04/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Abnormal 40 Hz auditory steady-state response (ASSR) has been observed in some psychiatric disorders. Nevertheless, the role of 40 Hz ASSR in persistent auditory verbal hallucinations (pAVHs) schizophrenia (SCZ) is still unknown. This study aims to investigate whether the 40 Hz ASSR impairment is related to pAVHs and can detect pAVHs severity. METHODS We analyzed high-density electroencephalography data that from 43 pAVHs patients (pAVH group), 20 moderate auditory verbal hallucinations patients (mid-AVH group), and 24 without auditory verbal hallucinations patients (non-AVH group). Event-related spectral perturbation and inter-trial phase coherence (ITPC) were calculated to quantify dynamic changes of the 40 Hz ASSR power and ITPC, respectively. RESULTS Frontal-central, the 40 Hz ASSR power, and ITPC were significantly lower in the pAVH group than in the non-AVH group; There was no significant difference between the pAVH and mid-AVH group. The 40 Hz ASSR was significantly negatively correlated with the severity of pAVHs. The 40 Hz ASSR power, and ITPC could be used as a combinational marker to detect SCZ patients with and without pAVHs. CONCLUSION Our findings have shed light on the pathological mechanism of pAVHs in SCZ patients. These results can provide potential avenues for therapeutic intervention of pAVHs.
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Affiliation(s)
- Shaobing Li
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Ruxin Hu
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Huiming Yan
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Lijun Chu
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Yuying Qiu
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Ying Gao
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Meijuan Li
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Jie Li
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China.
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4
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Gibson LL, Grinberg LT, Ffytche D, Leite REP, Rodriguez RD, Ferretti-Rebustini REL, Pasqualucci CA, Nitrini R, Jacob-Filho W, Aarsland D, Suemoto CK. Neuropathological correlates of neuropsychiatric symptoms in dementia. Alzheimers Dement 2023; 19:1372-1382. [PMID: 36150075 PMCID: PMC10033459 DOI: 10.1002/alz.12765] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/23/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Neuropsychiatric symptoms (NPS) are common in Lewy body disease (LBD), but their etiology is poorly understood. METHODS In a population-based post mortem study neuropathological data was collected for Lewy body (LB) neuropathology, neurofibrillary tangles (NFT), amyloid beta burden, TDP-43, lacunar infarcts, cerebral amyloid angiopathy (CAA), and hyaline atherosclerosis. Post mortem interviews collected systematic information regarding NPS and cognitive status. A total of 1038 cases were included: no pathology (NP; n = 761), Alzheimer's disease (AD; n = 189), LBD (n = 60), and AD+LBD (n = 28). RESULTS Hallucinations were associated with higher LB Braak stages, while higher NFT Braak staging was associated with depression, agitation, and greater number of symptoms in the Neuropsychiatric Inventory. Cases with dual AD+LBD pathology had the highest risk of hallucinations, agitation, apathy, and total symptoms but a multiplicative interaction between these pathologies was not significant. DISCUSSION LB and AD pathology contribute differentially to NPS likely with an additive process contributing to the increased burden of NPS.
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Affiliation(s)
- Lucy L Gibson
- Old Age Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology and Pathology, University of California San Francisco, San Francisco, California, USA
- University of São Paulo Medical School, São Paulo, Brazil
| | - Dominic Ffytche
- Old Age Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | | | | | | | | | - Dag Aarsland
- Old Age Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Age-Related Disease, Stavanger University Hospital, Stavanger, Norway
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Roes MM, Yin J, Taylor L, Metzak PD, Lavigne KM, Chinchani A, Tipper CM, Woodward TS. Hallucination-Specific structure-function associations in schizophrenia. Psychiatry Res Neuroimaging 2020; 305:111171. [PMID: 32916453 DOI: 10.1016/j.pscychresns.2020.111171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/31/2020] [Revised: 08/15/2020] [Accepted: 08/19/2020] [Indexed: 01/13/2023]
Abstract
Combining structural (sMRI) and functional magnetic resonance imaging (fMRI) data in schizophrenia patients with and without auditory hallucinations (9 SZ_AVH, 12 SZ_nAVH), 18 patients with bipolar disorder, and 22 healthy controls, we examined whether cortical thinning was associated with abnormal activity in functional brain networks associated with auditory hallucinations. Language-task fMRI data were combined with mean cortical thickness values from 148 brain regions in a constrained principal component analysis (CPCA) to identify brain structure-function associations predictable from group differences. Two components emerged from the multimodal analysis. The "AVH component" highlighted an association of frontotemporal and cingulate thinning with altered brain activity characteristic of hallucinations among patients with AVH. In contrast, the "Bipolar component" distinguished bipolar patients from healthy controls and linked increased activity in the language network with cortical thinning in the left occipital-temporal lobe. Our findings add to a body of evidence of the biological underpinnings of hallucinations and illustrate a method for multimodal data analysis of structure-function associations in psychiatric illness.
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Affiliation(s)
- Meighen M Roes
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada; BC Mental Health and Substance Use Services Research Institute, Provincial Health Services Authority, Vancouver, BC, Canada
| | - John Yin
- BC Mental Health and Substance Use Services Research Institute, Provincial Health Services Authority, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Laura Taylor
- BC Mental Health and Substance Use Services Research Institute, Provincial Health Services Authority, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Paul D Metzak
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Katie M Lavigne
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Abhijit Chinchani
- BC Mental Health and Substance Use Services Research Institute, Provincial Health Services Authority, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Christine M Tipper
- BC Mental Health and Substance Use Services Research Institute, Provincial Health Services Authority, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Todd S Woodward
- BC Mental Health and Substance Use Services Research Institute, Provincial Health Services Authority, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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Falkenberg LE, Westerhausen R, Johnsen E, Kroken R, Løberg EM, Beresniewicz J, Kazimierczak K, Kompus K, Ersland L, Sandøy LB, Hugdahl K. Hallucinating schizophrenia patients have longer left arcuate fasciculus fiber tracks: a DTI tractography study. Psychiatry Res Neuroimaging 2020; 302:111088. [PMID: 32480045 DOI: 10.1016/j.pscychresns.2020.111088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 02/07/2023]
Abstract
The arcuate fasciculus (AF) has been implicated in the pathology behind schizophrenia and auditory verbal hallucinations (AVHs). White matter tracts forming the arcuate fasciculus can be quantified and visualized using diffusion tensor imaging (DTI) tractography. Although there have been a number of studies on this topic, the results have been conflicting. Studying the underlying white matter structure of the AF could shed light on the constrains for interaction between temporal and frontal language areas in AVHs. The participants were 66 patients with a schizophrenia diagnosis, where AVHs were defined from the Positive and Negative Syndrome Scale (PANSS), and compared with a healthy control group. DTI was performed on a 3T MR scanner, and tensor estimation was done using deterministic streamline tractography. Statistical analysis of the data showed significantly longer reconstructed tracks along the AF in patients with severe and frequent AVHs, as well as an overall significant asymmetry with longer tracks in the left compared to the right side. In addition, there were significant positive correlations between PANSS scores and track length, track volume, and number of track streamlines for the posterior AF segment on the left side. It is concluded that the present DTI results may have implications for interpretations of functional imaging results.
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Affiliation(s)
- Liv E Falkenberg
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Erik Johnsen
- Division of Psychiatry and NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
| | - Rune Kroken
- Division of Psychiatry and NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry and NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Norway
| | | | | | - Kristiina Kompus
- Department of Biological and Medical Psychology, University of Bergen, Norway
| | - Lars Ersland
- Department of Biological and Medical Psychology, University of Bergen, Norway; Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | | | - Kenneth Hugdahl
- Division of Psychiatry and NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Biological and Medical Psychology, University of Bergen, Norway; Department of Radiology, Haukeland University Hospital, Bergen, Norway.
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Ban KY, Osborn DPJ, Hameed Y, Pandey S, Perez J, Jones PB, Kirkbride JB. Personality disorder in an Early Intervention Psychosis cohort: Findings from the Social Epidemiology of Psychoses in East Anglia (SEPEA) study. PLoS One 2020; 15:e0234047. [PMID: 32502161 PMCID: PMC7274401 DOI: 10.1371/journal.pone.0234047] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/17/2020] [Indexed: 11/19/2022] Open
Abstract
AIM Personality Disorders (PD) often share clinical and phenomenological overlap with psychotic disorders, especially at onset. However, there is little research on comorbid PD among people experiencing first episode psychosis. We examined the prevalence of PD recording and its sociodemographic and clinical correlates in people accepted to Early Intervention in Psychosis (EIP) services. METHODS Participants were aged 16-35, accepted into 6 EIP services for suspected psychosis, as part of the Social Epidemiology of Psychoses in East Anglia (SEPEA) study. PD was recorded by clinicians according to ICD-10. Multilevel logistic regression was performed. RESULTS Of 798 participants, 76 people (9.5%) received a clinical diagnosis of PD, with emotionally unstable PD (75.0%, N = 57) the most common subtype. In multivariable analysis, risk factors for PD included female sex (odds ratio [OR]: 3.4; 95% CI: 2.0-5.7), absence of psychotic disorder after acceptance to EIP (OR: 3.0; 95% CI: 1.6-5.5), more severe hallucinations (OR: 1.6; 95% CI: 1.2-2.1), and lower parental SES (OR: 1.4; 95% CI: 1.1-1.8). Compared with the white British, black and minority ethnic groups were less likely to receive a PD diagnosis (OR: 0.3; 95% CI: 0.1-0.7). There was no association between PD and neighbourhood-level deprivation or population-density. CONCLUSIONS Recording of a PD diagnosis was three times more common amongst participants later found not to meet threshold criteria for psychotic disorder, implying phenomenological overlap at referral which highlights difficulties encountered in accurate diagnostic assessment, treatment and onward referral. People with PD experienced more individual-level, but not neighbourhood-level social disadvantage in an already disadvantaged sample.
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Affiliation(s)
- Ka-Young Ban
- Division of Psychiatry, UCL, London, United Kingdom
| | - David P. J. Osborn
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Yasir Hameed
- Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom
| | - Santvana Pandey
- Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom
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Abstract
BACKGROUND Auditory verbal hallucinations (AVH) are a cardinal feature of schizophrenia, but they can also appear in otherwise healthy individuals. Imaging studies implicate language networks in the generation of AVH; however, it remains unclear if alterations reflect biologic substrates of AVH, irrespective of diagnostic status, age, or illness-related factors. We applied multimodal imaging to identify AVH-specific pathology, evidenced by overlapping gray or white matter deficits between schizophrenia patients and healthy voice-hearers. METHODS Diffusion-weighted and T1-weighted magnetic resonance images were acquired in 35 schizophrenia patients with AVH (SCZ-AVH), 32 healthy voice-hearers (H-AVH), and 40 age- and sex-matched controls without AVH. White matter fractional anisotropy (FA) and gray matter thickness (GMT) were computed for each region comprising ICBM-DTI and Desikan-Killiany atlases, respectively. Regions were tested for significant alterations affecting both SCZ-AVH and H-AVH groups, relative to controls. RESULTS Compared with controls, the SCZ-AVH showed widespread FA and GMT reductions; but no significant differences emerged between H-AVH and control groups. While no overlapping pathology appeared in the overall study groups, younger (<40 years) H-AVH and SCZ-AVH subjects displayed overlapping FA deficits across four regions (p < 0.05): the genu and splenium of the corpus callosum, as well as the anterior limbs of the internal capsule. Analyzing these regions with free-water imaging ascribed overlapping FA abnormalities to tissue-specific anisotropy changes. CONCLUSIONS We identified white matter pathology associated with the presence of AVH, independent of diagnostic status. However, commonalities were constrained to younger and more homogenous groups, after reducing pathologic variance associated with advancing age and chronicity effects.
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Affiliation(s)
- Maria Angelique Di Biase
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fan Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amanda Lyall
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marek Kubicki
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - René C W Mandl
- Department of Psychiatry, UMC Utrecht Brain Center, Utrecht, The Netherlands
- CNSR, Mental Health Center Glostrup, Glostrup, Denmark
| | - Iris E Sommer
- Department of Neuroscience, Rijksuniversiteit Groningen (RUG), University Medical Center Groningen, Antonie Deusinglaan 2 Groningen, The Netherlands
| | - Ofer Pasternak
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Dooley N, O'Hanlon E, Healy C, Adair A, McCandless C, Coppinger D, Kelleher I, Clarke M, Leemans A, Frodl T, Cannon M. Psychotic experiences in childhood are associated with increased structural integrity of the left arcuate fasciculus - A population-based case-control study. Schizophr Res 2020; 215:378-384. [PMID: 31495700 DOI: 10.1016/j.schres.2019.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/26/2019] [Accepted: 08/19/2019] [Indexed: 01/03/2023]
Abstract
Around 1 in 5 children under 13 years old experience sub-clinical psychotic experiences (PEs) like hallucinations and delusions. While PEs in childhood are a significant risk factor for adult psychotic disorders, the majority of those experiencing childhood PEs do not develop a psychotic disorder. Individual differences in regional brain maturation rates may be responsible for this age-related and often transient emergence of PEs. Fronto-temporal association tracts undergo extensive maturation and myelination throughout childhood and adolescence, thus we focus on individual differences in one such tract, the arcuate fasciculus. A normative population-based sample of children (aged 11-13) attended a clinical interview and MRI (n = 100), 25 of whom were identified as reporting strong PEs. This group had reduced mean and radial diffusivity in the arcuate fasciculus compared with a group of matched controls (n = 25) who reported no PEs. The group difference was greater in the left hemisphere than the right. Mediation analyses showed that this group difference was driven predominantly by perceptual disturbances and an along-tract analysis showed that the group difference was greatest approximately halfway between the frontal and temporal termination points of the tract (adjacent to the left lateral ventricle). This study is the first to investigate links between arcuate fasciculus diffusivity and psychotic experiences in a population sample of children.
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Affiliation(s)
- Niamh Dooley
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
| | - Erik O'Hanlon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Amy Adair
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
| | - Conor McCandless
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - David Coppinger
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, the Netherlands.
| | - Thomas Frodl
- Otto-von-Guericke University Magdeburg, Department of Psychiatry and Psychotherapy, Magdeburg, Germany.
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
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10
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Escarti MJ, Garcia-Marti G, Sanz-Requena R, Marti-Bonmatí L, Cabrera B, Vieta E, Lobo A, Castro-Fornieles J, González-Pinto A, Cortizo R, Pina-Camacho L, Parellada M, Bernardo M, Sanjuan J. Auditory hallucinations in first-episode psychosis: A voxel-based morphometry study. Schizophr Res 2019; 209:148-155. [PMID: 31113747 DOI: 10.1016/j.schres.2019.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 02/05/2019] [Accepted: 05/01/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Auditory hallucinations (AH) are a core symptom of psychosis. The brain abnormalities responsible for AH remain controversial due to inconsistent and conflicting findings across studies, with substantial confounding factors, such as chronicity. Few studies have examined the pathological changes that occur in the gray matter (GM) of patients with first-episode psychosis (FEP) and AH. The present study aims to validate the presence and characteristics of these structural abnormalities in relation to the intensity of psychotic symptoms and AH in a larger homogeneous sample than those of previous studies. METHODS A magnetic resonance voxel-based morphometric analysis was applied to a group of 215 patients with FEP (93 patients with AH and 122 patients without AH) and 177 healthy controls. The patients were evaluated using the PANSS scale. RESULTS Patients with FEP exhibited greater reductions in GM concentrations in the temporal, frontal, cingulate and insular areas than the healthy controls did. No specific differences were found between the patients with FEP and AH and the patients without AH. In addition, total scores on the PANSS were negatively correlated with GM reductions in the FEP group. No correlations were found between the severity of the AH and the GM volumes. CONCLUSIONS As in previous studies, reductions in the GM concentrations in patients with FEP suggest that alterations are present in the early stages of psychosis, and these alterations are correlated with the severity of the illness. The GM reductions were not found to be related to the presence or severity of AH.
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Affiliation(s)
- María Jose Escarti
- Department of Psychiatry, Hospital Clinic, University of Valencia, INCLIVA, Valencia, Spain; Department of Psychiatry, Hospital Peset, Av. de Gaspar Aguilar, 90, 46017 Valencia, Spain; Ciber del Área de Salud Mental (CIBERSAM), Spain.
| | - Gracian Garcia-Marti
- Department of Radiology, Quirón Hospital, Avda. Blasco Ibáñez, 14, 46010 Valencia, Spain; Ciber del Área de Salud Mental (CIBERSAM), Spain
| | - Roberto Sanz-Requena
- Department of Radiology, Quirón Hospital, Avda. Blasco Ibáñez, 14, 46010 Valencia, Spain
| | - Luis Marti-Bonmatí
- Department of Radiology, Quirón Hospital, Avda. Blasco Ibáñez, 14, 46010 Valencia, Spain; Biomedical Imaging Research Group (GIBI2^30), Hospital Universitari i Politècnic La Fe, Avda. Fernando Abril Martorell 106, Torre A, 46026, Valencia, Spain
| | - Bibiana Cabrera
- Barcelona Clinic Schizophrenia Unit, Neurosciences Institute, Hospital Clinic, Barcelona, Spain; Ciber del Área de Salud Mental (CIBERSAM), Spain
| | - Eduard Vieta
- Bipolar Disorder Unit, Hospital Clinic of Barcelona, University of Barcelona, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, IDIBAPS, Barcelona, Spain; Ciber del Área de Salud Mental (CIBERSAM), Spain
| | - Antonio Lobo
- Department of Medicine and Psychiatry, Hospital Clinico, University of Zaragoza, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragon) y Universidad de Zaragoza, Spain; Ciber del Área de Salud Mental (CIBERSAM), Spain
| | - Josefina Castro-Fornieles
- Dept. of Child and Adolescent Psychiatry and Psychology, SGR-489, Institute Clinic of Neurosciences, Hospital Clinic of Barcelona, Spain; Ciber del Área de Salud Mental (CIBERSAM), Spain
| | - Ana González-Pinto
- Department of Psychiatry, Hospital Universitario de Álava (Sede Santiago), EHU/University of the Basque Country, Vitoria, Spain; Ciber del Área de Salud Mental (CIBERSAM), Spain
| | - Romina Cortizo
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
| | - Laura Pina-Camacho
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañon, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain; Ciber del Área de Salud Mental (CIBERSAM), Spain
| | - Mara Parellada
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañon, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain; Ciber del Área de Salud Mental (CIBERSAM), Spain
| | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neurosciences Institute, Hospital Clinic, Barcelona, Spain; Ciber del Área de Salud Mental (CIBERSAM), Spain
| | - Julio Sanjuan
- Department of Psychiatry, Hospital Clinic, University of Valencia, INCLIVA, Valencia, Spain; Faculty of Medicine, Universitat de València, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain; Ciber del Área de Salud Mental (CIBERSAM), Spain
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11
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Abstract
Peduncular hallucinosis (PH) is a rare clinical syndrome with dream-like visual hallucinations intruding normal consciousness. It was initially reported in a 72-year-old woman by Jean Lhermitte in 1992. We uncovered the medical file of this patient with handwritten notes by Lhermitte and commented on it in the light of neurological knowledge that was common at that time. All along his career, Lhermitte has always been fascinated by consciousness disturbances, dreams and hallucinations. He had here the brilliant intuition of linking PH to awareness mechanisms located in the mesencephalic area. This PH case represented a good opportunity to him to emphasize the close relationships between neurology and psychiatry.
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Affiliation(s)
- E Drouin
- Centre d'études de la renaissance, 59, rue Néricault-Destouches, 37013 Tours, France.
| | - Y Péréon
- FILNEMUS, laboratoire d'explorations fonctionnelles, centre de référence maladies neuromusculaires rares Atlantique-Occitanie-Caraïbes, European Reference Network Neuromuscular Diseases EURO-NMD, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France
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12
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Zhang X, Gao J, Zhu F, Wang W, Fan Y, Ma Q, Ma X, Yang J. Reduced white matter connectivity associated with auditory verbal hallucinations in first-episode and chronic schizophrenia: A diffusion tensor imaging study. Psychiatry Res Neuroimaging 2018; 273:63-70. [PMID: 29395749 DOI: 10.1016/j.pscychresns.2018.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/14/2018] [Accepted: 01/20/2018] [Indexed: 01/10/2023]
Abstract
This study aims to explore whether auditory verbal hallucinations (AVH) in schizophrenia are associated with the white matter abnormalities in tracts connecting language, auditory and memory/limbic networks in first-episode and chronic schizophrenia patients. 21 first-episode (FE-AVH) and 12 chronic (chronic-AVH group) patients who suffered from auditory verbal hallucinations and 26 healthy controls (HC group) were enrolled. Diffusion tensor imaging with tract-based spatial statistics was performed to assess the white matter changes between the two patient groups and HC group. Decreased fractional anisotropy and increased radial diffusivity were found in the patient groups compared to the HC group in multiple white matter tracts including the corpus callosum, superior longitudinal fasciculus, inferior fronto-occipital fasciculus, uncinate fasciculus, cingulum, external capsule and anterior limb of the internal capsule. The chronic-AVH group showed more widespread white matter impairment than the FE-AVH group. Furthermore, increased axial diffusivity was also observed in some discrete regions of the chronic-AVH group. Auditory verbal hallucinations in schizophrenia are accompanied by white matter abnormalities in tracts connecting the language, auditory and memory/limbic networks. Chronic-AVH schizophrenia patients may present with more severe neurodegeneration relative to first-episode patients.
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Affiliation(s)
- Xiaoling Zhang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, PR China; Department of MRI Diagnosis, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an, PR China
| | - Jie Gao
- Department of MRI Diagnosis, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an, PR China
| | - Feng Zhu
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, PR China
| | - Wei Wang
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, PR China
| | - Yajuan Fan
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, PR China
| | - Qingyan Ma
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, PR China
| | - Xiancang Ma
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, PR China
| | - Jian Yang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, PR China.
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13
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Qian W, Fischer CE, Schweizer TA, Munoz DG. Association Between Psychosis Phenotype and APOE Genotype on the Clinical Profiles of Alzheimer's Disease. Curr Alzheimer Res 2018; 15:187-194. [PMID: 28847281 PMCID: PMC6211852 DOI: 10.2174/1567205014666170829114346] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 03/13/2017] [Revised: 07/07/2017] [Accepted: 08/29/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Psychosis is a common phenomenon in Alzheimer's disease (AD). The APOE ε4 allele is the strongest genetic risk factor for the development of AD, but its association with psychosis remains unclear. OBJECTIVE We investigated the associations between psychosis, subdivided into delusions and hallucinations, as well as APOE ε4 allele on cognitive and functional outcomes. Secondarily, we investigated the associations between APOE ε4, Lewy bodies, and psychosis. METHODS Data from the National Alzheimer's Coordinating Center (NACC) were used. Nine hundred patients with a confirmed diagnosis of AD based on the NIA-AA Reagan were included in the analysis. Global cognition was assessed using the Mini-Mental State Exam (MMSE) and functional status was assessed using the Functional Activities Questionnaire (FAQ). Psychosis status was determined using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Factorial design was used to assess the effects of psychosis and APOE ε4, as well as their interaction. RESULTS Psychosis and the presence of APOE ε4 were both associated with lower MMSE scores, while only psychosis was associated with higher FAQ scores. Furthermore, patients with hallucinations had lower MMSE and higher FAQ scores than patients with only delusions. There was a significant interaction effect between psychosis and APOE ε4 on MMSE scores, with APOE ε4 negatively affecting patients with hallucinations-only psychosis. APOE ε4 was positively associated with the presence of Lewy body pathology, and both were found to be more prevalent in psychotic patients, with a stronger association with hallucinations. CONCLUSION Psychosis in AD was associated with greater cognitive and functional impairments. Patients with hallucinations-with or without delusions-conferred even greater deficits compared to patients with only delusions. The APOE ε4 allele was associated with worse cognition, especially for patients with hallucination-only psychosis. APOE ε4 may mediate cognitive impairment in the hallucinations phenotype through the development of Lewy bodies. Our findings support that subtypes of psychosis should be evaluated separately.
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Affiliation(s)
- Winnie Qian
- Keenan Research Centre for Biomedical Research, The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Corinne E. Fischer
- Keenan Research Centre for Biomedical Research, The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Tom A. Schweizer
- Keenan Research Centre for Biomedical Research, The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, ON, Canada
- Division of Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
| | - David G. Munoz
- Keenan Research Centre for Biomedical Research, The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Division of Pathology, St. Michael’s Hospital, Toronto, ON, Canada
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14
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Cui Y, Liu B, Song M, Lipnicki DM, Li J, Xie S, Chen Y, Li P, Lu L, Lv L, Wang H, Yan H, Yan J, Zhang H, Zhang D, Jiang T. Auditory verbal hallucinations are related to cortical thinning in the left middle temporal gyrus of patients with schizophrenia. Psychol Med 2018; 48:115-122. [PMID: 28625224 DOI: 10.1017/s0033291717001520] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Auditory verbal hallucinations (AVHs) are one of the most common and severe symptoms of schizophrenia, but the neuroanatomical abnormalities underlying AVHs are not well understood. The present study aims to investigate whether AVHs are associated with cortical thinning. METHODS Participants were schizophrenia patients from four centers across China, 115 with AVHs and 93 without AVHs, as well as 261 healthy controls. All received 3 T T1-weighted brain scans, and whole brain vertex-wise cortical thickness was compared across groups. Correlations between AVH severity and cortical thickness were also determined. RESULTS The left middle part of the middle temporal gyrus (MTG) was significantly thinner in schizophrenia patients with AVHs than in patients without AVHs and healthy controls. Inferences were made using a false discovery rate approach with a threshold at p < 0.05. Left MTG thickness did not differ between patients without AVHs and controls. These results were replicated by a meta-analysis showing them to be consistent across the four centers. Cortical thickness of the left MTG was also found to be inversely correlated with hallucination severity across all schizophrenia patients. CONCLUSION The results of this multi-center study suggest that an abnormally thin left MTG could be involved in the pathogenesis of AVHs in schizophrenia.
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Affiliation(s)
- Y Cui
- Brainnetome Center,Institute of Automation,Chinese Academy of Sciences,Beijing,China
| | - B Liu
- Brainnetome Center,Institute of Automation,Chinese Academy of Sciences,Beijing,China
| | - M Song
- Brainnetome Center,Institute of Automation,Chinese Academy of Sciences,Beijing,China
| | - D M Lipnicki
- CHeBA (Centre for Healthy Brain Ageing), School of Psychiatry,University of New South Wales,Randwick, NSW,Australia
| | - J Li
- Brainnetome Center,Institute of Automation,Chinese Academy of Sciences,Beijing,China
| | - S Xie
- Brainnetome Center,Institute of Automation,Chinese Academy of Sciences,Beijing,China
| | - Y Chen
- Department of Psychiatry,Xijing Hospital,The Fourth Military Medical University,Xi'an,China
| | - P Li
- Peking University Sixth Hospital/Institute of Mental Health,Beijing,China
| | - L Lu
- Peking University Sixth Hospital/Institute of Mental Health,Beijing,China
| | - L Lv
- Department of Psychiatry,Henan Mental Hospital,The Second Affiliated Hospital of Xinxiang Medical University,Xinxiang,China
| | - H Wang
- Department of Psychiatry,Xijing Hospital,The Fourth Military Medical University,Xi'an,China
| | - H Yan
- Peking University Sixth Hospital/Institute of Mental Health,Beijing,China
| | - J Yan
- Peking University Sixth Hospital/Institute of Mental Health,Beijing,China
| | - H Zhang
- Department of Psychiatry,Henan Mental Hospital,The Second Affiliated Hospital of Xinxiang Medical University,Xinxiang,China
| | - D Zhang
- Peking University Sixth Hospital/Institute of Mental Health,Beijing,China
| | - T Jiang
- Brainnetome Center,Institute of Automation,Chinese Academy of Sciences,Beijing,China
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15
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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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16
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Xi YB, Guo F, Li H, Chang X, Sun JB, Zhu YQ, Liu WM, Cui LB, Chen G, Wang HN, Yin H. The structural connectivity pathology of first-episode schizophrenia based on the cardinal symptom of auditory verbal hallucinations. Psychiatry Res Neuroimaging 2016; 257:25-30. [PMID: 27744190 DOI: 10.1016/j.pscychresns.2016.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 11/17/2022]
Abstract
Heterogeneous findings across studies of structural abnormality in schizophrenia (SZ) have impeded the development a unified theory of white matter pathology. As a cardinal symptom of SZ, auditory verbal hallucination (AVH) has been suspected to be associated with improper communication among several brain regions, which might indicated white matter pathology. Participants comprised 25 first-episode (FE) patients with AVH, 25 patients without AVH and 25 healthy subjects. Diffusion tensor imaging (DTI) measures were calculated using the TBSS of FSL. Voxel-based ANOVA tests were performed among the three groups and threshold-free cluster enhancement (TFCE) method correction was used for multiple comparisons. Voxel-based one-way ANOVA showed significant group effects for fractional anisotropy (FA) and radial diffusivity (RD) values. Post-hoc t-tests indicated that schizophrenia patients had lower FA and higher RD values in the internal capsule and anterior corona radiata than control subjects. Post-hoc analyses exhibited more widespread fiber disruptions in AVH patients than non-AVH patients. These results hinted on the important role of projection fiber disruption in schizophrenia patients. In addition, the current study also suggested that direct comparison between studies using patients with different symptom profiles should be interpreted with caution.
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Affiliation(s)
- Yi-Bin Xi
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Fan Guo
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Hua Li
- Department of Radiology, The Second Hospital, Yulin, Shaanxi, China
| | - Xiao Chang
- Department of Medical Psychology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Jin-Bo Sun
- Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi'an, China
| | - Yuan-Qiang Zhu
- Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi'an, China
| | - Wen-Ming Liu
- Department of Psychiatry, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Long-Biao Cui
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Gang Chen
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Hua-Ning Wang
- Department of Psychiatry, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China.
| | - Hong Yin
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China.
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17
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Khundakar AA, Hanson PS, Erskine D, Lax NZ, Roscamp J, Karyka E, Tsefou E, Singh P, Cockell SJ, Gribben A, Ramsay L, Blain PG, Mosimann UP, Lett DJ, Elstner M, Turnbull DM, Xiang CC, Brownstein MJ, O'Brien JT, Taylor JP, Attems J, Thomas AJ, McKeith IG, Morris CM. Analysis of primary visual cortex in dementia with Lewy bodies indicates GABAergic involvement associated with recurrent complex visual hallucinations. Acta Neuropathol Commun 2016; 4:66. [PMID: 27357212 PMCID: PMC4928325 DOI: 10.1186/s40478-016-0334-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 01/12/2023] Open
Abstract
Dementia with Lewy bodies (DLB) patients frequently experience well formed recurrent complex visual hallucinations (RCVH). This is associated with reduced blood flow or hypometabolism on imaging of the primary visual cortex. To understand these associations in DLB we used pathological and biochemical analysis of the primary visual cortex to identify changes that could underpin RCVH. Alpha-synuclein or neurofibrillary tangle pathology in primary visual cortex was essentially absent. Neurone density or volume within the primary visual cortex in DLB was also unchanged using unbiased stereology. Microarray analysis, however, demonstrated changes in neuropeptide gene expression and other markers, indicating altered GABAergic neuronal function. Calcium binding protein and GAD65/67 immunohistochemistry showed preserved interneurone populations indicating possible interneurone dysfunction. This was demonstrated by loss of post synaptic GABA receptor markers including gephyrin, GABARAP, and Kif5A, indicating reduced GABAergic synaptic activity. Glutamatergic neuronal signalling was also altered with vesicular glutamate transporter protein and PSD-95 expression being reduced. Changes to the primary visual cortex in DLB indicate that reduced GABAergic transmission may contribute to RCVH in DLB and treatment using targeted GABAergic modulation or similar approaches using glutamatergic modification may be beneficial.
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Affiliation(s)
- Ahmad A Khundakar
- Edwardson Building, Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
| | - Peter S Hanson
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK
| | - Daniel Erskine
- Edwardson Building, Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK
| | - Nichola Z Lax
- Edwardson Building, Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Joseph Roscamp
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK
| | - Evangelia Karyka
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK
| | - Eliona Tsefou
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK
| | - Preeti Singh
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK
| | - Simon J Cockell
- Bioinformatics Support Unit, Newcastle University, Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Andrew Gribben
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK
| | - Lynne Ramsay
- Edwardson Building, Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
| | - Peter G Blain
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK
| | - Urs P Mosimann
- University Hospital of Old Age Psychiatry, University Bern, CH 3010, Bern, Switzerland
| | - Deborah J Lett
- Edwardson Building, Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
| | - Matthias Elstner
- Department of Neurology and Clinical Neurophysiology, Academic Hospital Bogenhausen, Technical University of Munich, Munich, Germany
| | - Douglass M Turnbull
- Edwardson Building, Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Charles C Xiang
- Laboratory of Genetics at the National Institute of Mental Health/National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, MD20892, USA
| | - Michael J Brownstein
- Laboratory of Genetics at the National Institute of Mental Health/National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, MD20892, USA
| | - John T O'Brien
- Biomedical Research Building, Institute of Neuroscience, Newcastle University, Newcastle University, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - John-Paul Taylor
- Biomedical Research Building, Institute of Neuroscience, Newcastle University, Newcastle University, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
| | - Johannes Attems
- Edwardson Building, Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Biomedical Research Building, Institute of Neuroscience, Newcastle University, Newcastle University, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
| | - Ian G McKeith
- Biomedical Research Building, Institute of Neuroscience, Newcastle University, Newcastle University, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
| | - Christopher M Morris
- Edwardson Building, Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK.
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK.
- Laboratory of Genetics at the National Institute of Mental Health/National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, MD20892, USA.
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Lee YM, Chung YI, Park JM, Lee BD, Moon E, Jeong HJ, Kim JH, Kim HJ, Mun CW, Kim TH, Kim YH, Kim EJ. Decreased gray matter volume is associated with the subtypes of psychotic symptoms in patients with antipsychotic-naïve mild or moderate Alzheimer's disease: A voxel-based morphometry study. Psychiatry Res Neuroimaging 2016; 249:45-51. [PMID: 27000306 DOI: 10.1016/j.pscychresns.2015.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/30/2015] [Accepted: 12/05/2015] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate the association between brain regional gray matter volume and two subtypes of psychotic symptoms, namely paranoid and misidentification subtypes, in antipsychotic-naïve mild or moderate Alzheimer's disease (AD) patients. Forty AD patients with psychotic symptoms and 25 AD patients without psychotic symptoms were assessed for cognitive and functional impairment. Presence and subtype of psychotic symptoms were assessed by using the delusion and hallucination subscale of the Korean Neuropsychiatric Inventory (K-NPI). Structural MRI images were acquired on a 3 T scanner, and were analyzed using voxel-based morphometry (VBM) for automated analysis. The misidentification subtype is associated with more severe gray matter atrophy, and paranoid subtype is associated with less severe gray matter atrophy compared to non-psychosis group. These results suggest that the misidentification, the paranoid subtype and the non-psychosis group have a distinct neural correlation.
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Affiliation(s)
- Young-Min Lee
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Young-In Chung
- Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Korea.
| | - Je-Min Park
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung-Dae Lee
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eunsoo Moon
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hee-Jeong Jeong
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ji-Hoon Kim
- Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Korea
| | - Hak-Jin Kim
- Department of Radiology, Pusan National University School of Medicine, Busan, Korea
| | - Chi-Woong Mun
- Department of Biomedical Engineering and FIRST, Inje University, Gimhae, Korea
| | - Tae-Hyung Kim
- Department of Biomedical Engineering and FIRST, Inje University, Gimhae, Korea
| | - Young-Hoon Kim
- Department of Psychiatry, Medical School, Inje University, Haeundae Paik Hospital, Busan, Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University School of Medicine, Busan, Korea
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Yao N, Cheung C, Pang S, Shek-kwan Chang R, Lau KK, Suckling J, Yu K, Ka-Fung Mak H, Chua SE, Ho SL, McAlonan GM. Multimodal MRI of the hippocampus in Parkinson's disease with visual hallucinations. Brain Struct Funct 2016; 221:287-300. [PMID: 25287513 PMCID: PMC4720723 DOI: 10.1007/s00429-014-0907-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 09/24/2014] [Indexed: 11/29/2022]
Abstract
Visual hallucinations carry poor prognosis in Parkinson's disease. Here we tested the hypothesis that the hippocampus and visuospatial memory impairment play a central role in the pathology of PD with visual hallucinations. Multimodal magnetic resonance imaging of the brain was carried out in 12 people with PD and visual hallucinations; 15 PD individuals without hallucinations; and 14 healthy controls. Age, gender, cognitive ability, and education level were matched across the three groups. PD patients were taking dopaminergic medication. Hippocampal volume, shape, mean diffusivity (MD), and functional connectivity within the whole brain were examined. Visuospatial memory was compared between groups, and correlations with hippocampal MD, functional connectivity, and the severity of hallucinations were explored. There were no macrostructural differences across groups, but individuals with hallucinations had higher diffusivity in posterior hippocampus than the other two groups. Visuospatial memory was poorer in both PD groups compared to controls, and was correlated with hallucinations. Finally, hippocampal functional connectivity in the visual cortices was lower in those with hallucinations than other groups, and this correlated with visuospatial memory impairment. In contrast, functional connectivity between the hippocampus and default mode network regions and frontal regions was greater in the PD hallucinators compared to other groups. We suggest that hippocampal pathology, which disrupts visuospatial memory, makes a key contribution to visual hallucinations in PD. These findings may pave the way for future studies of imaging biomarkers to measure treatment response in those with PD who are most at risk of poor outcomes.
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Affiliation(s)
- Nailin Yao
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Charlton Cheung
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
- State Key Laboratory for Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Shirley Pang
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Richard Shek-kwan Chang
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - John Suckling
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, United Kingdom and Cambridge and Peterborough Foundation NHS Trust, University of Cambridge, Cambridge, UK
| | - Kevin Yu
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Henry Ka-Fung Mak
- Department of Diagnostic Radiology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Siew Eng Chua
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
- State Key Laboratory for Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Shu-Leong Ho
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Grainne M McAlonan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
- State Key Laboratory for Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong.
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, King's College London, London, SE5 8AZ, UK.
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Hugdahl K, Craven AR, Nygård M, Løberg EM, Berle JØ, Johnsen E, Kroken R, Specht K, Andreassen OA, Ersland L. Glutamate as a mediating transmitter for auditory hallucinations in schizophrenia: a (1)H MRS study. Schizophr Res 2015; 161:252-60. [PMID: 25542859 DOI: 10.1016/j.schres.2014.11.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/07/2014] [Accepted: 11/15/2014] [Indexed: 01/16/2023]
Abstract
This is a (1)H MR spectroscopy (MRS) study of glutamate (Glu), measured as Glx, levels in temporal and frontal lobe regions in patients with schizophrenia compared with a healthy control group with the objective of revealing aspects of the underlying neurochemistry of auditory hallucinations. We further compared and correlated Glu(Glx) levels for the patients-only against frequency and severity of auditory hallucinations and the sum of Positive symptoms, and also for frequency and severity of emotional withdrawal, and sum of Negative symptoms. The sample included 23 patients with an ICD-10 and DSM-IV diagnosis of schizophrenia, and 26 healthy control subjects without any known psychiatric or neurological disorders. Symptom scores were obtained from the Positive and Negative Syndrome Scale (PANSS). (1)H MRS data were acquired on a 3T MR scanner from two temporal and two frontal voxels, using standard sequences and analysis parameters. The results showed that schizophrenia patients as a group had reduced Glu(Glx) levels in the voxels of interest compared to the healthy control subjects, while increased levels were found for patients with frequent and severe auditory hallucinations, relative to patients with less frequent and severe hallucination. We further found significant positive correlations between frequency and severity of auditory hallucinations, and for sum Positive symptoms, and Glu(Glx) levels in all regions, not seen when the analysis was done for negative symptoms. It is concluded that the results show for the first time that glutamate may be a mediating factor in auditory hallucinations in schizophrenia.
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Affiliation(s)
- Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Radiology, Haukeland University Hospital, Bergen, Norway; NORMENT Center of Excellence, University of Oslo and Oslo University Hospital, Norway.
| | - Alexander R Craven
- Department of Biological and Medical Psychology, University of Bergen, Norway
| | - Merethe Nygård
- Department of Biological and Medical Psychology, University of Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Norway
| | - Jan Øystein Berle
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Section of Psychiatry, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rune Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Karsten Specht
- Department of Biological and Medical Psychology, University of Bergen, Norway; Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Ole A Andreassen
- Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway; NORMENT Center of Excellence, University of Oslo and Oslo University Hospital, Norway
| | - Lars Ersland
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
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Blanc F, Noblet V, Philippi N, Cretin B, Foucher J, Armspach JP, Rousseau F. Right anterior insula: core region of hallucinations in cognitive neurodegenerative diseases. PLoS One 2014; 9:e114774. [PMID: 25479196 PMCID: PMC4257732 DOI: 10.1371/journal.pone.0114774] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 12/10/2013] [Accepted: 11/13/2014] [Indexed: 02/07/2023] Open
Abstract
Objectives We investigated the neural basis of hallucinations Alzheimer's disease (AD) by applying voxel-based morphometry (VBM) to anatomical and functional data from the AD Neuroimaging Initiative. Methods AD patients with hallucinations, based on the Neuropsychiatric Inventory (NPI-Q) (AD-hallu group; n = 39), were compared to AD patients without hallucinations matched for age, sex, educational level, handedness and MMSE (AD-c group; n = 39). Focal brain volume on MRI was analyzed and compared between the two groups according to the VBM method. We also performed voxel-level correlations between brain volume and hallucinations intensity. A similar paradigm was used for the PET analysis. “Core regions” (i.e. regions identified in both MRI and PET analyses, simply done by retaining the clusters obtained from the two analyses that are overlapping) were then determined. Results Regions with relative atrophy in association with hallucinations were: anterior part of the right insula, left superior frontal gyrus and lingual gyri. Regions with relative hypometabolism in association with hallucinations were a large right ventral and dorsolateral prefrontal area. "Core region" in association with hallucinations was the right anterior part of the insula. Correlations between intensity of hallucinations and brain volume were found in the right anterior insula, precentral gyrus, superior temporal gyrus, and left precuneus. Correlations between intensity of hallucinations and brain hypometabolism were found in the left midcingulate gyrus. We checked the neuropathological status and we found that the 4 patients autopsied in the AD-hallu group had the mixed pathology AD and Dementia with Lewy bodies (DLB). Conclusion Neural basis of hallucinations in cognitive neurodegenerative diseases (AD or AD and DLB) include a right predominant anterior-posterior network, and the anterior insula as the core region. This study is coherent with the top-down/bottom-up hypotheses on hallucinations but also hypotheses of the key involvement of the anterior insula in hallucinations in cognitive neurodegenerative diseases.
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Affiliation(s)
- Frédéric Blanc
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Strasbourg, France
- University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France
- University Hospital of Strasbourg, Day Hospital of Geriatrics, Geriatrics Service, Strasbourg, France
- * E-mail:
| | - Vincent Noblet
- University of Strasbourg and CNRS, ICube laboratory UMR 7357, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Strasbourg, France
| | - Nathalie Philippi
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Strasbourg, France
- University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France
| | - Benjamin Cretin
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Strasbourg, France
- University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France
| | - Jack Foucher
- University of Strasbourg and CNRS, ICube laboratory UMR 7357, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Strasbourg, France
| | - Jean-Paul Armspach
- University of Strasbourg and CNRS, ICube laboratory UMR 7357, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Strasbourg, France
| | - François Rousseau
- University of Strasbourg and CNRS, ICube laboratory UMR 7357, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Strasbourg, France
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22
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Geoffroy PA, Houenou J, Duhamel A, Amad A, De Weijer AD, Curčić-Blake B, Linden DEJ, Thomas P, Jardri R. The Arcuate Fasciculus in auditory-verbal hallucinations: a meta-analysis of diffusion-tensor-imaging studies. Schizophr Res 2014; 159:234-7. [PMID: 25112160 DOI: 10.1016/j.schres.2014.07.014] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [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: 03/09/2014] [Revised: 06/09/2014] [Accepted: 07/13/2014] [Indexed: 12/15/2022]
Abstract
Auditory-verbal hallucinations (AVHs) are associated with an impaired connectivity of large-scale networks. To examine the relationship between white-matter integrity and AVHs, we conducted a meta-analysis of diffusion-tensor-imaging studies that compared patients with schizophrenia and AVHs with matched healthy controls (HCs). Five studies were retained gathering 256 DTI data points, divided into AVHs (n=106) and HCs (n=150). The meta-analysis demonstrated a reduced fractional anisotropy in the left Arcuate Fasciculus (AF) of hallucinators (hg= -0.42; CI[-0.69,-0.16]; p<10(-3)). The current meta-analysis confirmed disruptions of white matter integrity in the left AF bundle of schizophrenia patients with AVHs.
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Affiliation(s)
- Pierre A Geoffroy
- Centre Hospitalier Universitaire de Lille (CHRU), Lille, France; INSERM UMR-S1144, VariaPsy équipe 1, Hôpital Fernand Widal, APHP, Paris, France.
| | - Josselin Houenou
- APHP, Henri Mondor Hospitals, INSERM U955, Team 15 'Psychiatry & Genetics', Créteil, France; Neurospin, Uniact lab, CEA Saclay, France
| | - Alain Duhamel
- Centre Hospitalier Universitaire de Lille (CHRU), Lille, France; Université Lille Nord de France, France
| | - Ali Amad
- Centre Hospitalier Universitaire de Lille (CHRU), Lille, France; Université Lille Nord de France, France; Université Droit & Santé Lille, SCA-Lab., PSYchiC team, Lille, France
| | | | | | - David E J Linden
- MRC Centre for Neuropsychiatric Genetics & Genomics, Cardiff University, Cardiff, UK
| | - Pierre Thomas
- Centre Hospitalier Universitaire de Lille (CHRU), Lille, France; Université Lille Nord de France, France; Université Droit & Santé Lille, SCA-Lab., PSYchiC team, Lille, France
| | - Renaud Jardri
- Centre Hospitalier Universitaire de Lille (CHRU), Lille, France; Université Lille Nord de France, France; Université Droit & Santé Lille, SCA-Lab., PSYchiC team, Lille, France.
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23
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Martinez-Granados B, Martinez-Bisbal MC, Sanjuan J, Aguilar EJ, Marti-Bonmati L, Molla E, Celda B. Study of the inferior colliculus in patients with schizophrenia by magnetic resonance spectroscopy. Rev Neurol 2014; 59:1-7. [PMID: 24965924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION. Previous studies have suggested morphometric and functional abnormalities in the inferior colliculus in patients with schizophrenia. Auditory hallucinations are one of the central symptoms in schizophrenia. In this complex and multidimensional event both attention and emotion are thought to play a key role. AIM. To study metabolic changes in the inferior colliculus, a nucleus integrated in the auditory pathway, in patients with schizophrenia and the possible relationship with auditory hallucinations. SUBJECTS AND METHODS. Magnetic resonance spectroscopic imaging studies were performed in 30 right-handed patients with chronic schizophrenia (19 of them with auditory hallucinations) and 28 controls. A magnetic resonance spectroscopic imaging 2D slice was acquired and the voxels representative of both inferior colliculi were selected. N-acetylaspartate (NAA), creatine (Cr) and choline (Cho) peak areas were measured. RESULTS. The patients with schizophrenia showed a NAA/Cr significant reduction in the right inferior colliculus compared to the control subjects. The metabolic data in the right inferior colliculus were correlated with emotional auditory hallucinations items. CONCLUSIONS. The contribution of the inferior colliculus on neural underpinnings of auditory hallucinations is particularly relevant for the right inferior colliculus and is centered on attention-emotional component of this symptom.
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Affiliation(s)
| | | | | | | | | | | | - B Celda
- Universidad de Valencia. Facultad de Quimica, 46100 Burjassot, Espana
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24
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Diederich NJ, Stebbins G, Schiltz C, Goetz CG. Are patients with Parkinson's disease blind to blindsight? Brain 2014; 137:1838-49. [PMID: 24764573 PMCID: PMC4032103 DOI: 10.1093/brain/awu094] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 02/08/2014] [Accepted: 03/15/2014] [Indexed: 12/22/2022] Open
Abstract
In Parkinson's disease, visual dysfunction is prominent. Visual hallucinations can be a major hallmark of late stage disease, but numerous visual deficits also occur in early stage Parkinson's disease. Specific retinopathy, deficits in the primary visual pathway and the secondary ventral and dorsal pathways, as well as dysfunction of the attention pathways have all been posited as causes of hallucinations in Parkinson's disease. We present data from patients with Parkinson's disease that contrast with a known neuro-ophthalmological syndrome, termed 'blindsight'. In this syndrome, there is an absence of conscious object identification, but preserved 'guess' of the location of a stimulus, preserved reflexive saccades and motion perception and preserved autonomical and expressive reactions to negative emotional facial expressions. We propose that patients with Parkinson's disease have the converse of blindsight, being 'blind to blindsight'. As such they preserve conscious vision, but show erroneous 'guess' localization of visual stimuli, poor saccades and motion perception, and poor emotional face perception with blunted autonomic reaction. Although a large data set on these deficits in Parkinson's disease has been accumulated, consolidation into one specific syndrome has not been proposed. Focusing on neuropathological and physiological data from two phylogenetically old and subconscious pathways, the retino-colliculo-thalamo-amygdala and the retino-geniculo-extrastriate pathways, we propose that aberrant function of these systems, including pathologically inhibited superior colliculus activity, deficient corollary discharges to the frontal eye fields, dysfunctional pulvinar, claustrum and amygdaloid subnuclei of the amygdala, the latter progressively burdened with Lewy bodies, underlie this syndrome. These network impairments are further corroborated by the concept of the 'silent amygdala'. Functionally being 'blind to blindsight' may facilitate the highly distinctive 'presence' or 'passage' hallucinations of Parkinson's disease and can help to explain handicaps in driving capacities and dysfunctional 'theory of mind'. We propose this synthesis to prompt refined neuropathological and neuroimaging studies on the pivotal nuclei in these pathways in order to better understand the networks underpinning this newly conceptualized syndrome in Parkinson's disease.
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Affiliation(s)
- Nico J Diederich
- 1 Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg2 Centre for Systems Biomedicine, University of Luxembourg, Esch-Belval, Luxembourg3 Department of Neurological Sciences, Rush University Medical Centre, Chicago, USA
| | - Glenn Stebbins
- 3 Department of Neurological Sciences, Rush University Medical Centre, Chicago, USA
| | - Christine Schiltz
- 4 Institute of Cognitive Science and Assessment, Research Unit Education, Culture, Cognition and Society, University of Luxembourg, Luxembourg-City, Luxembourg
| | - Christopher G Goetz
- 3 Department of Neurological Sciences, Rush University Medical Centre, Chicago, USA
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van Os J, Lataster T, Delespaul P, Wichers M, Myin-Germeys I. Evidence that a psychopathology interactome has diagnostic value, predicting clinical needs: an experience sampling study. PLoS One 2014; 9:e86652. [PMID: 24466189 PMCID: PMC3900579 DOI: 10.1371/journal.pone.0086652] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 12/15/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND For the purpose of diagnosis, psychopathology can be represented as categories of mental disorder, symptom dimensions or symptom networks. Also, psychopathology can be assessed at different levels of temporal resolution (monthly episodes, daily fluctuating symptoms, momentary fluctuating mental states). We tested the diagnostic value, in terms of prediction of treatment needs, of the combination of symptom networks and momentary assessment level. METHOD Fifty-seven patients with a psychotic disorder participated in an ESM study, capturing psychotic experiences, emotions and circumstances at 10 semi-random moments in the flow of daily life over a period of 6 days. Symptoms were assessed by interview with the Positive and Negative Syndrome Scale (PANSS); treatment needs were assessed using the Camberwell Assessment of Need (CAN). RESULTS Psychotic symptoms assessed with the PANSS (Clinical Psychotic Symptoms) were strongly associated with psychotic experiences assessed with ESM (Momentary Psychotic Experiences). However, the degree to which Momentary Psychotic Experiences manifested as Clinical Psychotic Symptoms was determined by level of momentary negative affect (higher levels increasing probability of Momentary Psychotic Experiences manifesting as Clinical Psychotic Symptoms), momentary positive affect (higher levels decreasing probability of Clinical Psychotic Symptoms), greater persistence of Momentary Psychotic Experiences (persistence predicting increased probability of Clinical Psychotic Symptoms) and momentary environmental stress associated with events and activities (higher levels increasing probability of Clinical Psychotic Symptoms). Similarly, the degree to which momentary visual or auditory hallucinations manifested as Clinical Psychotic Symptoms was strongly contingent on the level of accompanying momentary paranoid delusional ideation. Momentary Psychotic Experiences were associated with CAN unmet treatment needs, over and above PANSS measures of psychopathology, similarly moderated by momentary interactions with emotions and context. CONCLUSION The results suggest that psychopathology, represented as an interactome at the momentary level of temporal resolution, is informative in diagnosing clinical needs, over and above traditional symptom measures.
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Affiliation(s)
- Jim van Os
- Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
- * E-mail:
| | - Tineke Lataster
- Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Philippe Delespaul
- Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marieke Wichers
- Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Inez Myin-Germeys
- Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
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van Tol MJ, van der Meer L, Bruggeman R, Modinos G, Knegtering H, Aleman A. Voxel-based gray and white matter morphometry correlates of hallucinations in schizophrenia: The superior temporal gyrus does not stand alone. Neuroimage Clin 2013; 4:249-57. [PMID: 25061563 PMCID: PMC4107370 DOI: 10.1016/j.nicl.2013.12.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/19/2013] [Accepted: 12/20/2013] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Auditory verbal hallucinations (AVH) in schizophrenia (SZ) have been proposed to result from abnormal local, interregional and interhemispheric integration of brain signals in regions involved in language production and perception. This abnormal functional integration may find its base in morphological abnormalities. Structurally, AVHs have been frequently linked to abnormal morphology of the superior temporal gyrus (STG), but only a few studies investigated the relation of hallucination presence with both whole-brain gray matter (GM) and white matter (WM) morphometry. METHODS Using a unified voxel-based morphometry-DARTEL approach, we investigated correlates of AVH presence in 51 schizophrenia patients (20 non-hallucinating [SZ -], 31 hallucinating [SZ +]), and included 51 age and sex matched healthy participants. Effects are reported at p < .05 FWE corrected. RESULTS Patients showed lower GM volume of the left STG than controls, irrespective of AVH presence. In addition, SZ + showed lower GM volume of the left inferior frontal and right parahippocampal gyrus, and higher WM volume of the left postcentral and superior parietal lobule than controls. Finally, volume of the putamen was lower in SZ + compared to SZ -. No effects on corpus callosum morphometry were observed. Delusion severity, general positive and negative symptomatology illness duration, and medication status could not explain the results. DISCUSSION Results suggest that STG GM abnormalities underlie the general susceptibility to experience psychotic symptoms and that additional abnormalities in a network of medial temporal, ventrolateral, putaminal, and parietal regions related to verbal memory and speech production may specifically increase the likelihood of experiencing AVH. Future studies should clarify the meaning of morphometry abnormalities for functional interregional communication.
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Affiliation(s)
- Marie-José van Tol
- University of Groningen, University Medical Center Groningen, Neuroimaging Center, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands
| | - Lisette van der Meer
- University of Groningen, University Medical Center Groningen, Neuroimaging Center, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands
- Lentis Institution for Mental Health Care, Department of Rehabilitation, PO Box 128, 9470 AC Zuidlaren, The Netherlands
| | - Richard Bruggeman
- University Medical Center Groningen, Department of Psychiatry, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Gemma Modinos
- Institute of Psychiatry, King's College London, Department of Psychosis Studies, 16 De Crespigny Park, London SE5 8AF, UK
| | - Henderikus Knegtering
- Lentis Institution for Mental Health Care, Groningen and Lentis Institution for Mental Health Care, Department of Rehabilitation, Postbus 128, 9470 AC Zuidlaren, The Netherlands
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Neuroimaging Center, Antonius Deusinglaan 2, 9713 AW Groningen, The Netherlands
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Watanabe H, Senda J, Kato S, Ito M, Atsuta N, Hara K, Tsuboi T, Katsuno M, Nakamura T, Hirayama M, Adachi H, Naganawa S, Sobue G. Cortical and subcortical brain atrophy in Parkinson's disease with visual hallucination. Mov Disord 2013; 28:1732-6. [PMID: 24150865 DOI: 10.1002/mds.25641] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 06/30/2013] [Accepted: 07/15/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the cortical and subcortical brain structures in Parkinson's disease (PD) with visual hallucination (VH), and to elucidate the association between the proposed hypothesis of VH in PD and regional brain volume changes. METHODS We used 3T magnetic resonance imaging (MRI) and voxel-based morphometry (VBM) to investigate the brain structures of PD patients with VH (PD-VH; n = 13) and PD patients without VH (PD-C; n = 13). RESULTS The PD-VH patients showed significant cortical atrophy compared to the PD-C patients in the bilateral dorsolateral prefrontal cortex, left rostral region of the prefrontal cortex, left ventral section of the cingulate cortex, bilateral primary visual cortex, and secondary visual cortex including the left inferior occipital gyrus, right lingual cortex, right supramarginal gyrus, and left fusiform gyrus. Significant subcortical atrophic changes were observed in the white matter of the right parahippocampal gyrus, the bilateral posterior part of the cingulate gyrus, the left lingual gyrus, and the right middle occipital gyrus. CONCLUSIONS VH in PD can occur due to distinctive neuroanatomical involvement.
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Affiliation(s)
- Hirohisa Watanabe
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Klirova M, Horacek J, Novak T, Cermak J, Spaniel F, Skrdlantova L, Mohr P, Höschl C. Individualized rTMS neuronavigated according to regional brain metabolism ((18)FGD PET) has better treatment effects on auditory hallucinations than standard positioning of rTMS: a double-blind, sham-controlled study. Eur Arch Psychiatry Clin Neurosci 2013; 263:475-84. [PMID: 22983355 DOI: 10.1007/s00406-012-0368-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 09/06/2012] [Indexed: 01/18/2023]
Abstract
Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) of the left temporo-parietal cortex (LTPC) has been proposed as a useful therapeutic method for auditory hallucinations (AHs). Stereotactic neuronavigation enables the magnetic coil to be targeted according to the individual parameters obtained from neuroimaging. Individualized rTMS neuronavigated according to 18-fluorodeoxyglucose positron emission tomography ((18)FDG PET) allows us to focus the coil explicitly on a given area with detected maxima of specific abnormalities, thus presuming a higher therapeutic effect of the method. The objective of this study is to test clinical efficacy of neuronavigated LF-rTMS administered according to the local maxima of (18)FDG PET uptake of LTPC and to compare it with treatment effects of standard and sham rTMS. In a double-blind, sham-controlled design, patients with AHs underwent a 10-day series of LF-rTMS using (1) (18)FDG PET-guided "neuronavigation," (2) "standard" anatomically guided positioning, and (3) sham coil. The effect of different rTMS conditions was assessed by the Auditory Hallucinations Rating Scale (AHRS) and the Positive and Negative Syndrome Scale (PANSS). Fifteen patients were randomized to a treatment sequence and ten of them completed all three treatment conditions. The intention-to-treat analysis of AHRS score change revealed superiority of the (18)FDG PET-guided rTMS over both the standard and the sham rTMS. The analyses of the PANSS scores failed to detect significant difference among the treatments. Our data showed acute efficacy of (18)FDG PET-guided rTMS in the treatment of AHs. Neuronavigated rTMS was found to be more effective than standard, anatomically guided rTMS.
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Affiliation(s)
- Monika Klirova
- Prague Psychiatric Center, Ústavní 91, Prague 8, 181 03, Czech Republic.
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van Lutterveld R, Diederen KMJ, Koops S, Begemann MJH, Sommer IEC. The influence of stimulus detection on activation patterns during auditory hallucinations. Schizophr Res 2013; 145:27-32. [PMID: 23375942 DOI: 10.1016/j.schres.2013.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Neuroimaging studies investigating auditory verbal hallucinations (AVH) have revealed involvement of several cortical structures. These findings may however be biased by brain activity related to stimulus detection and motor processes associated with the task to indicate the presence of AVH. Disentangling brain activation specifically related to AVH and to additional cognitive processes may help focus on the true neuronal substrates of AVH and strengthen the development of new focal treatment strategies. METHODS Brain activation during AVH as indicated by button press was compared to brain activation during auditory stimulus detection indicated by button press. We performed two neuroimaging meta-analyses, assessing 10 AVH and 11 auditory stimulus detection studies. A random-effects activation likelihood estimation was performed using GingerALE to assess commonalities and differences across AVH and stimulus detection studies. RESULTS Activity in the claustrum, pulvinar area, medial geniculum body, pyramis, culmen, putamen, insula, and parahippocampal, medial frontal, precentral, postcentral, superior temporal and right inferior frontal gyri was found to be specifically related to AVH. The pars opercularis of the left inferior frontal gyrus and the left transverse temporal gyrus were activated to a similar extent during AVH and auditory stimulus detection. DISCUSSION Development of new focal treatment strategies for AVH may focus on the areas uniquely activated in the AVH analysis. The pars opercularis and the transverse temporal gyrus may not be directly involved in the experience of AVH itself, but rather in auditory stimulus detection.
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Smieskova R, Fusar-Poli P, Aston J, Simon A, Bendfeldt K, Lenz C, Stieglitz RD, McGuire P, Riecher-Rössler A, Borgwardt SJ. Insular volume abnormalities associated with different transition probabilities to psychosis. Psychol Med 2012; 42:1613-1625. [PMID: 22126702 PMCID: PMC3413195 DOI: 10.1017/s0033291711002716] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 10/25/2011] [Accepted: 10/26/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although individuals vulnerable to psychosis show brain volumetric abnormalities, structural alterations underlying different probabilities for later transition are unknown. The present study addresses this issue by means of voxel-based morphometry (VBM). METHOD We investigated grey matter volume (GMV) abnormalities by comparing four neuroleptic-free groups: individuals with first episode of psychosis (FEP) and with at-risk mental state (ARMS), with either long-term (ARMS-LT) or short-term ARMS (ARMS-ST), compared to the healthy control (HC) group. Using three-dimensional (3D) magnetic resonance imaging (MRI), we examined 16 FEP, 31 ARMS, clinically followed up for on average 3 months (ARMS-ST, n=18) and 4.5 years (ARMS-LT, n=13), and 19 HC. RESULTS The ARMS-ST group showed less GMV in the right and left insula compared to the ARMS-LT (Cohen's d 1.67) and FEP groups (Cohen's d 1.81) respectively. These GMV differences were correlated positively with global functioning in the whole ARMS group. Insular alterations were associated with negative symptomatology in the whole ARMS group, and also with hallucinations in the ARMS-ST and ARMS-LT subgroups. We found a significant effect of previous antipsychotic medication use on GMV abnormalities in the FEP group. CONCLUSIONS GMV abnormalities in subjects at high clinical risk for psychosis are associated with negative and positive psychotic symptoms, and global functioning. Alterations in the right insula are associated with a higher risk for transition to psychosis, and thus may be related to different transition probabilities.
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Affiliation(s)
- R. Smieskova
- Department of Psychiatry, University of Basel, Switzerland
- Medical Image Analysis Centre, University of Basel, Switzerland
| | - P. Fusar-Poli
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, UK
| | - J. Aston
- Department of Psychiatry, University of Basel, Switzerland
| | - A. Simon
- Specialized Out-patient Service for Early Psychosis, Department of Psychiatry, Bruderholz, Switzerland
- University Hospital of Psychiatry, University of Bern, Switzerland
| | - K. Bendfeldt
- Medical Image Analysis Centre, University of Basel, Switzerland
| | - C. Lenz
- Radiological Physics, University Hospital Basel, Switzerland
| | | | - P. McGuire
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, UK
| | | | - S. J. Borgwardt
- Department of Psychiatry, University of Basel, Switzerland
- Medical Image Analysis Centre, University of Basel, Switzerland
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, UK
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Taylor JP, Firbank M, Barnett N, Pearce S, Livingstone A, Mosimann U, Eyre J, McKeith IG, O'Brien JT. Visual hallucinations in dementia with Lewy bodies: transcranial magnetic stimulation study. Br J Psychiatry 2011; 199:492-500. [PMID: 22016436 PMCID: PMC3227808 DOI: 10.1192/bjp.bp.110.090373] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 03/09/2011] [Accepted: 06/16/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aetiology of visual hallucinations is poorly understood in dementia with Lewy bodies. Pathological alterations in visual cortical excitability may be one contributory mechanism. AIMS To determine visual cortical excitability in people with dementia with Lewy bodies compared with aged-matched controls and also the relationship between visual cortical excitability and visual hallucinations in dementia with Lewy bodies. METHOD Visual cortical excitability was determined by using transcranial magnetic stimulation (TMS) applied to the occiput to elicit phosphenes (transient subjective visual responses) in 21 patients with dementia with Lewy bodies and 19 age-matched controls. RESULTS Phosphene parameters were similar between both groups. However, in the patients with dementia with Lewy bodies, TMS measures of visual cortical excitability correlated strongly with the severity of visual hallucinations (P = 0.005). Six patients with dementia with Lewy bodies experienced visual hallucination-like phosphenes (for example, seeing people or figures on stimulation) compared with none of the controls (P = 0.02). CONCLUSIONS Increased visual cortical excitability in dementia with Lewy bodies does not appear to explain visual hallucinations but it may be a marker for their severity.
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Affiliation(s)
- John-Paul Taylor
- Institute for Ageing and Health, Newcastle University, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK.
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Abstract
BACKGROUND Concurrence of migraine and hallucinations is extremely rare and the underlying mechanism is poorly understood. METHODS We report a 22-year-old man with migraine associated with auditory hallucinations. Concurrent psychotic illness has been excluded. RESULTS Brain MR scans showed a stable, patchy FLAIR hyperintensity over the posterolateral aspect of the left cerebral peduncle, just below the level of the red nucleus. This was felt to represent an area of gliosis based on the interval stability over 19 months. There was absence of features for aggressive neoplasms, such as lesional high cellular turnover (choline/NAA ratio >1.0) or high cerebral blood volume on advanced MR imaging with MR spectroscopy and dynamic perfusion MR. EEG and brainstem auditory evoked potentials were unremarkable. CONCLUSIONS To our knowledge, there are no reports to date on similar auditory hallucinations in adult migraine patients, as well as with associated MRI brainstem lesions. The peduncular lesion could represent a previous migrainous infarct, and a possible analogy can be drawn from the descriptions of peduncular hallucinosis. Brainstem lesions, particularly in the midbrain and pons, have rarely been associated with this condition. It has been postulated that the damage to ascending reticular systems or thalamocortical circuitry may contribute to its pathogenesis.
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Affiliation(s)
- Y L Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Outram Road, Singapore.
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Hoffman RE, Fernandez T, Pittman B, Hampson M. Elevated functional connectivity along a corticostriatal loop and the mechanism of auditory/verbal hallucinations in patients with schizophrenia. Biol Psychiatry 2011; 69:407-14. [PMID: 21145042 PMCID: PMC3039042 DOI: 10.1016/j.biopsych.2010.09.050] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [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: 03/14/2010] [Revised: 09/25/2010] [Accepted: 09/28/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Higher levels of inter-region functional coordination can facilitate emergence of neural activity as conscious percepts. We consequently tested the hypothesis that auditory/verbal hallucinations (AVHs) arise from elevated functional coordination within a speech processing network. METHODS Functional coordination was indexed with functional connectivity (FC) computed from functional magnetic resonance imaging data. Thirty-two patients with schizophrenia reporting AVHs, 24 similarly diagnosed patients without hallucinations, and 23 healthy control subjects were studied. FC was seeded from a bilateral Wernicke's region delineated according to activation detected during AVHs in a prior study. RESULTS Wernicke's-seeded FC with Brodmann area 45/46 of the left inferior frontal gyrus (IFG) was significantly greater for hallucinating patients compared with nonhallucinating patients but not compared with healthy control subjects. In contrast, Wernicke's-seeded FC with a large subcortical region that included the thalamus, midbrain, and putamen was significantly greater for the combined patient group compared with healthy control subjects after false discovery rate correction, but not when comparing the two patient groups. Within that subcortical domain, the putamen demonstrated significantly greater FC relative to a secondary left IFG seed region when hallucinators were compared with nonhallucinating patients. A follow-up analysis found that FC summed along a loop linking the Wernicke's and IFG seed regions and the putamen was robustly greater for hallucinating patients compared with nonhallucinating patients and healthy control subjects. CONCLUSIONS These findings suggest that higher levels of functional coordination intrinsic to a corticostriatal loop comprise a causal factor leading to AVHs in schizophrenia.
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Affiliation(s)
- Ralph E Hoffman
- Department of Psychiatry, Yale University School of Medicine, Yale-New Haven Psychiatric Hospital, 184 Liberty Street LV108, New Haven, CT 06519, USA.
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Huang M, Dai J, Meltzer HY. 5-HT(2A) and 5-HT(2C) receptor stimulation are differentially involved in the cortical dopamine efflux-Studied in 5-HT(2A) and 5-HT(2C) genetic mutant mice. Eur J Pharmacol 2010; 652:40-5. [PMID: 21118683 DOI: 10.1016/j.ejphar.2010.10.094] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 10/13/2010] [Accepted: 10/31/2010] [Indexed: 02/03/2023]
Abstract
Both 5-HT(2A) and 5-HT(2C) receptors modulate cortical dopamine efflux, but in opposite directions. We have now compared the ability of the three 5-HT(2A/2C) receptor agonists, DOI (R(-)-2,5-dimethoxy-4-iodoamphetamine), mCPP (meta-chlorophenylpiperazine) and MK-212 (6-Chloro-2-(piperazinyl) pyrazine), to modulate cortical dopamine efflux in 5-HT(2A) and 5-HT(2C) genetic mutant mice. In the 5-HT(2A) mice, the preferential 5-HT(2A) receptor agonist DOI (2.5mg/kg, s.c.) induced a slight but significant increase in cortical dopamine efflux only in the wild type (WT) mice; MK-212 (2.5mg/kg) reduced dopamine efflux in both WT and receptor knockout (KO) mice; moreover, MCPP, 2.5mg/kg, had no effect in either types. In 5-HT(2C) mice, DOI increased dopamine efflux in both types; while MK-212 decreased dopamine efflux in the WT, but not the receptor KO mice. These results provide new evidence that 5-HT(2A) receptor stimulation enhances and 5-HT(2C) receptor stimulation inhibits cortical dopamine efflux, and suggest the effects of DOI, MK-212 and mCPP on the cortical dopamine efflux are due to their different abilities on 5-HT(2A) and 5-HT(2C) receptors stimulation. Of these three agents, only DOI, the more selective 5-HT(2A) receptor agonist, is hallucinogenic. The absence of hallucinations with mCPP may be due to its relatively more potent 5-HT(2C) receptor agonist effect, inhibiting the ability of mCPP to enhance dopamine efflux in cortical and perhaps limbic regions as well. The present data provide additional evidence that hallucinations are due, in part, to 5-HT(2A) rather than 5-HT(2C) receptor stimulation. These findings suggest that 5-HT(2C) receptor agonists may be useful as antipsychotics, consistent with previous suggestions.
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Affiliation(s)
- Mei Huang
- Division of Psychopharcology, Department of Psychiatry, Vanderbilt University School of Medicine, TN, USA
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Abstract
Involvement of the insular cortex is a common finding in neuroanatomical studies of schizophrenia, yet its contribution to disease pathology remains unknown. This review describes the normal function of the insula and examines pathology of this region in schizophrenia. The insula is a cortical structure with extensive connections to many areas of the cortex and limbic system. It integrates external sensory input with the limbic system and is integral to the awareness of the body's state (interoception). Many deficits observed in schizophrenia involve these functions and may relate to insula pathology. Furthermore, reports describing deficits caused by lesions of the insula parallel deficits observed in schizophrenia. Examples of insula-related functions that are altered in schizophrenia include the processing of both visual and auditory emotional information, pain, and neuronal representations of the self. The last of these functions, processing representations of the self, plays a key role in discriminating between self-generated and external information, suggesting that insula dysfunction may contribute to hallucinations, a cardinal feature of schizophrenia.
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Affiliation(s)
- Korey P Wylie
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Aurora, CO 80045, United States
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Kempster PA, O'Sullivan SS, Holton JL, Revesz T, Lees AJ. Relationships between age and late progression of Parkinson's disease: a clinico-pathological study. Brain 2010; 133:1755-62. [PMID: 20371510 DOI: 10.1093/brain/awq059] [Citation(s) in RCA: 267] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
To investigate the relationships between age, the advanced clinical stages of Parkinson's disease and neuropathology, we surveyed 129 case records from donors with pathologically proven Parkinson's disease at the Queen Square Brain Bank for Neurological Disorders. Cases were separated into five groups according to age at death, thus comparing patients who reached the advanced stage of the disease at different ages. Four milestones of advanced disease (frequent falls, visual hallucinations, dementia and need for residential care) occurred at a similar time from death in each group. There were no significant differences in disease duration across these age groupings, nor were there differences in the severity and distribution of Lewy body and other pathologies. The milestones of dementia (P < 0.0005) and visual hallucinations (P = 0.02) as well as the accumulation of multiple milestones (P < 0.0005) were associated with high cortical Lewy body scores. Demented cases also had significantly more Alzheimer neurofibrillary and amyloid-beta plaque pathology. Correlation analysis showed that the time intervals between disease onset and recording of milestones were strongly influenced by age at onset (P < 0.0001) and by total disease duration (P < 0.0001). The advanced disease phase plays out in a similar fashion at whatever age it occurs, with a common pathological endpoint. The clinico-pathological comparisons for the final stage of Parkinson's disease do support a staging system based on the rostral extent and severity of Lewy body pathology, although other pathologies may play a synergistic role in causing cognitive disability. The chief effects of age on the rate of progression are seen over the early-middle part of the disease. An exponential curve for clinical progression provides the best explanation for these observations about age and the disease course.
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Affiliation(s)
- Peter A Kempster
- Reta Lila Weston Institute of Neurological Studies, University College London, 1 Wakefield Street, London WC1N 1PJ, UK
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Demetriades AK, Bhangoo RS. Peduncular hallucinosis and cerebellar cognitive affective syndrome: letter to the editor. Acta Neurochir (Wien) 2010; 152:379-80. [PMID: 19588074 DOI: 10.1007/s00701-009-0412-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 05/10/2009] [Indexed: 11/24/2022]
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Abstract
Functional brain imaging studies of patients with schizophrenia may be grouped into those that assume that the signs and symptoms of schizophrenia are due to disordered circuitry within a critical brain region and studies that assume that the signs and symptoms are due to disordered connections among brain regions. Studies have investigated the disordered functional brain anatomy of both the positive and negative symptoms of schizophrenia. Studies of spontaneous hallucinations find that although hallucinations are associated with abnormal brain activity in primary and secondary sensory areas, disordered brain activation associated with hallucinations is not limited to sensory systems. Disordered activation in non-sensory regions appear to contribute to the emotional strength and valence of hallucinations, to be a factor underlying an inability to distinguish ongoing mental processing from memories, and to reflect the brain's attempt to modulate the intensity of hallucinations and resolve conflicts with other processing demands. Brain activation studies support the view that auditory/verbal hallucinations are associated with an impaired ability of internal speech plans to modulate neural activation in sensory language areas. In early studies, negative symptoms of schizophrenia were hypothesized to be associated with impaired function in frontal brain areas. In support of this hypothesis meta-analytical studies have found that resting blood flow or metabolism in frontal cortex is reduced in schizophrenia, though the magnitude of the effect is only small to moderate. Brain activation studies of working memory (WM) functioning are typically associated with large effect sizes in the frontal cortex, whereas studies of functions other than WM generally reveal smaller effects. Findings from some functional connectivity studies have supported the hypothesis that schizophrenia patients experience impaired functional connections between frontal and temporal cortex, although the nature of the disordered connectivity is complex. More recent studies have used functional brain imaging to study neural compensation in schizophrenia, to serve as endophenotypes in genetic studies and to provide biomarkers in drug development studies. These emerging trends in functional brain imaging research are likely to help stimulate the development of a general neurobiological theory of the complex symptoms of schizophrenia.
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Affiliation(s)
- Gregory G Brown
- Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
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Henke H, Robinson PA, Drysdale PM, Loxley PN. Spatiotemporal dynamics of pattern formation in the primary visual cortex and hallucinations. Biol Cybern 2009; 101:3-18. [PMID: 19504122 DOI: 10.1007/s00422-009-0315-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 02/27/2009] [Indexed: 05/27/2023]
Abstract
The existence of visual hallucinations with prominent temporal oscillations is well documented in conditions such as Charles Bonnett Syndrome. To explore these phenomena, a continuum model of cortical activity that includes additional physiological features of axonal propagation and synapto-dendritic time constants, is used to study the generation of hallucinations featuring both temporal and spatial oscillations. A detailed comparison of the physiological features of this model with those of two others used previously in the modeling of hallucinations is made, and differences, particularly regarding temporal dynamics, relevant to pattern formation are analyzed. Linear analysis and numerical calculation are then employed to examine the pattern forming behavior of this new model for two different forms of spatiotemporal coupling between neurons. Numerical calculations reveal an oscillating mode whose frequency depends on synaptic, dendritic, and axonal time constants not previously simultaneously included in such analyses. Its properties are qualitatively consistent with descriptions of a number of physiological disorders and conditions with temporal dynamics, but the analysis implies that corticothalamic effects will need to be incorporated to treat the consequences quantitatively.
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Affiliation(s)
- H Henke
- School of Physics, The University of Sydney, Sydney, NSW 2006, Australia.
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Chong PKS, Loo AVP. Visual epilepsy in glioblastoma multiforme. Med J Malaysia 2008; 63:406-407. [PMID: 19803301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report a 33-year-old Chinese gentleman who presented with visual epilepsy and symptoms of raised intracranial pressure in which clinical examination revealed normal visual fields and acuity despite Magnetic Resonance Imaging (MRI) brain showing large contrast enhancing mass at the right occipital lobe. Craniotomy and excision of tumour was done and the histology confirmed glioblastoma multiforme (GBM). He completed radiotherapy and recovered well except developing left inferior homonymous quadrantropia post operatively which improved with time.
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Affiliation(s)
- P K S Chong
- Department of Ophthalmology, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
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Cohen Kadosh R, Walsh V. Synaesthesia and cortical connections: cause or correlation? Trends Neurosci 2008; 31:549-50; author reply 550-1. [PMID: 18801583 DOI: 10.1016/j.tins.2008.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 08/19/2008] [Indexed: 12/01/2022]
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Vesteinsdottir E, Matthiasson P. [Case of the month. A malignant brain tumor presenting with depression and hallucinations]. LAEKNABLADID 2008; 94:613-614. [PMID: 18784388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Kataoka H, Furiya Y, Morikawa M, Ueno S, Inoue M. Increased temporal blood flow associated with visual hallucinations in Parkinson's disease with dementia. Mov Disord 2008; 23:464-5. [PMID: 18163457 DOI: 10.1002/mds.21923] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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García-Martí G, Aguilar EJ, Lull JJ, Martí-Bonmatí L, Escartí MJ, Manjón JV, Moratal D, Robles M, Sanjuán J. Schizophrenia with auditory hallucinations: a voxel-based morphometry study. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:72-80. [PMID: 17716795 DOI: 10.1016/j.pnpbp.2007.07.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 07/11/2007] [Accepted: 07/11/2007] [Indexed: 11/29/2022]
Abstract
Many studies have shown widespread but subtle pathological changes in gray matter in patients with schizophrenia. Some of these studies have related specific alterations to the genesis of auditory hallucinations, particularly in the left superior temporal gyrus, but none has analysed the relationship between morphometric data and a specific scale for auditory hallucinations. The present study aims to define the presence and characteristics of structural abnormalities in relation with the intensity and phenomenology of auditory hallucinations by means of magnetic resonance voxel-based morphometry (MR-VBM) method applied on a highly homogeneous group of 18 persistent hallucinatory patients meeting DSM-IV criteria for schizophrenia compared to 19 healthy matched controls. Patients were evaluated using the PSYRATS scale for auditory hallucinations. Reductions of gray matter concentration in patients to controls were observed in bilateral insula, bilateral superior temporal gyri and left amygdala. In addition, specific relationships between left inferior frontal and right postcentral gyri reductions and the severity of auditory hallucinations were observed. All these areas might be implicated in the genesis and/or persistence of auditory hallucinations through specific mechanisms. Precise morphological abnormalities may help to define reliable MR-VBM biomarkers for the genesis and persistence of auditory hallucinations.
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Affiliation(s)
- Gracián García-Martí
- Bioengineering, Electronic and Telemedicine Group, Polytechnic University of Valencia, Camino de Vera, s/n, ES-46022 Valencia, Spain.
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Allen P, Larøi F, McGuire PK, Aleman A. The hallucinating brain: A review of structural and functional neuroimaging studies of hallucinations. Neurosci Biobehav Rev 2008; 32:175-91. [PMID: 17884165 DOI: 10.1016/j.neubiorev.2007.07.012] [Citation(s) in RCA: 347] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 07/20/2007] [Accepted: 07/26/2007] [Indexed: 12/13/2022]
Abstract
Hallucinations remains one of the most intriguing phenomena in psychopathology. In the past two decades the advent of neuroimaging techniques have allowed researchers to investigate what is happening in the brain of those who experience hallucinations. In this article we review both structural and functional neuroimaging studies of patients with auditory and visual hallucinations as well as a small number of studies that have assessed cognitive processes associated with hallucinations in healthy volunteers. The current literature suggests that in addition to secondary (and occasionally primary) sensory cortices, dysfunction in prefrontal premotor, cingulate, subcortical and cerebellar regions also seem to contribute to hallucinatory experiences. Based on the findings of these studies we tentatively propose a neurocognitive model in which both bottom-up and top-down processes interact to produce these erroneous percepts. Finally, directions for future work are discussed.
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Affiliation(s)
- Paul Allen
- Kings College London, Department of Psychological Medicine and Psychiatry, Institute of Psychiatry, London, UK.
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Horacek J, Brunovsky M, Novak T, Skrdlantova L, Klirova M, Bubenikova-Valesova V, Krajca V, Tislerova B, Kopecek M, Spaniel F, Mohr P, Höschl C. Effect of low-frequency rTMS on electromagnetic tomography (LORETA) and regional brain metabolism (PET) in schizophrenia patients with auditory hallucinations. Neuropsychobiology 2007; 55:132-42. [PMID: 17641545 DOI: 10.1159/000106055] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Accepted: 04/10/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Auditory hallucinations are characteristic symptoms of schizophrenia with high clinical importance. It was repeatedly reported that low frequency (<or=1 Hz) repetitive transcranial magnetic stimulation (rTMS) diminishes treatment-resistant auditory hallucinations. A neuroimaging study elucidating the effect of rTMS in auditory hallucinations has yet to be published. OBJECTIVE To evaluate the distribution of neuronal electrical activity and the brain metabolism changes after low-frequency rTMS in patients with auditory hallucinations. METHODS Low-frequency rTMS (0.9 Hz, 100% of motor threshold, 20 min) applied to the left temporoparietal cortex was used for 10 days in the treatment of medication-resistant auditory hallucinations in schizophrenia (n = 12). The effect of rTMS on the low-resolution brain electromagnetic tomography (LORETA) and brain metabolism ((18)FDG PET) was measured before and after 2 weeks of treatment. RESULTS We found a significant improvement in the total and positive symptoms (PANSS), and on the hallucination scales (HCS, AHRS). The rTMS decreased the brain metabolism in the left superior temporal gyrus and in interconnected regions, and effected increases in the contralateral cortex and in the frontal lobes. We detected a decrease in current densities (LORETA) for the beta-1 and beta-3 bands in the left temporal lobe whereas an increase was found for beta-2 band contralaterally. CONCLUSION Our findings implicate that the effect is connected with decreased metabolism in the cortex underlying the rTMS site, while facilitation of metabolism is propagated by transcallosal and intrahemispheric connections. The LORETA indicates that the neuroplastic changes affect the functional laterality and provide the substrate for a metabolic effect.
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Affiliation(s)
- Jiri Horacek
- Prague Psychiatric Center, Prague, Czech Republic.
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Seok JH, Park HJ, Chun JW, Lee SK, Cho HS, Kwon JS, Kim JJ. White matter abnormalities associated with auditory hallucinations in schizophrenia: a combined study of voxel-based analyses of diffusion tensor imaging and structural magnetic resonance imaging. Psychiatry Res 2007; 156:93-104. [PMID: 17884391 DOI: 10.1016/j.pscychresns.2007.02.002] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Revised: 01/18/2007] [Accepted: 02/03/2007] [Indexed: 12/11/2022]
Abstract
White matter (WM) abnormalities in schizophrenia may offer important clues to a better understanding of the disconnectivity associated with the disorder. The aim of this study was to elucidate a WM basis of auditory hallucinations in schizophrenia through the simultaneous investigation of WM tract integrity and WM density. Diffusion tensor images (DTIs) and structural T1 magnetic resonance images (MRIs) were taken from 15 hallucinating schizophrenic patients, 15 non-hallucinating schizophrenic patients and 22 normal controls. Voxel-based analyses and post-hoc region of interest analyses were obtained to compare the three groups on fractional anisotropy (FA) derived from DTI as well as WM density derived from structural MRIs. In both the hallucinating and non-hallucinating groups, FA of the WM regions was significantly decreased in the left superior longitudinal fasciculus (SLF), whereas WM density was significantly increased in the left inferior longitudinal fasciculus (ILF). The mean FA value of the left frontal part of the SLF was positively correlated with the severity score of auditory hallucinations in the hallucinating patient group. Our findings show that WM changes were mainly observed in the frontal and temporal areas, suggesting that disconnectivity in the left fronto-temporal area may contribute to the pathophysiology of schizophrenia. In addition, pathologic WM changes in this region may be an important step in the development of auditory hallucinations in schizophrenia.
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Affiliation(s)
- Jeong-Ho Seok
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Severance Mental Health Hospital, 696-6 Tanbul-dong Gwangju, Gyeonggi, 464-100 South Korea
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Reulbach U, Bleich S, Maihofner C, Kornhuber J, Sperling W. Specific and unspecific auditory hallucinations in patients with schizophrenia: a magnetoencephalographic study. Neuropsychobiology 2007; 55:89-95. [PMID: 17570952 DOI: 10.1159/000103907] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 03/17/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Different neuroimaging techniques have indicated that auditory association and language cortices are active in patients with schizophrenia and auditory hallucinations. Auditory verbal hallucinations are thought to arise from a disorder of inner speech, but little is known about their origin. METHODS Spontaneous magnetoencephalographic (MEG) measurements were recorded with a 74-channel two-sensor system (BIOMAGNES II) in 16 patients with schizophrenia and 8 healthy subjects in frequency ranges from 2 to 6 and 12.5 to 30 Hz. Eight patients had auditory hallucinations during the MEG recordings. RESULTS The total group of patients with schizophrenia showed a statistically significant elevation of the number of dipoles and dipole density maxima in slow frequency ranges compared to healthy subjects (p <0.001). Significant dipole activities in the fast frequency range were only found during auditory hallucinations (p <0.001). Dipole localization was concentrated in frontal and temporal regions depending on different qualities of hallucinations. In patients with external imperative voices we found a parallel activation of the dorsolateral frontal and temporal cortex. CONCLUSION We conclude that various auditory hallucinations in schizophrenia are induced by different neuronal activities and may be represented by different cortical regions.
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Affiliation(s)
- Udo Reulbach
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen-Nuremberg, Germany
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Ramírez-Ruiz B, Martí MJ, Tolosa E, Giménez M, Bargalló N, Valldeoriola F, Junqué C. Cerebral atrophy in Parkinson's disease patients with visual hallucinations. Eur J Neurol 2007; 14:750-6. [PMID: 17594330 DOI: 10.1111/j.1468-1331.2007.01768.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although visual hallucinations (VH) are relatively frequent in Parkinson's disease (PD) patients, their neural substrates are only known from neuropathological and functional magnetic resonance studies. The aim of this study was to investigate possible structural brain changes on MRI in non-demented PD patients with VH using voxel-based morphometry. Eighteen PD patients with VH were compared to 20 patients with PD without VH and 21 healthy controls. Compared with both controls and the non-hallucinating PD group, PD patients with VH had grey matter volume reductions in the lingual gyrus and superior parietal lobe. Structural changes in these areas involved in higher visual processing may be important in understanding the VH and visual deficits in PD patients.
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Affiliation(s)
- B Ramírez-Ruiz
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
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Abstract
A range of psychological theories have been proposed to account for the experience of auditory hallucinations in patients with psychosis. Influential amongst these theories are those implicating the defective monitoring of inner speech. Furthermore, self-monitoring and inner speech models have been the most studied using functional imaging. The aim of this article is to review the behavioural and neuroimaging evidence for the impaired monitoring of inner speech in patients who experience auditory verbal hallucinations. A comprehensive literature search was conducted for research investigating inner speech and cognitive self-monitoring models of auditory hallucinations in patients with schizophrenia. The evidence is critically discussed and directions for future investigations are suggested.
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Affiliation(s)
- Paul Allen
- Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, De Crespigny Park, Denmark Hill, King's College, London, UK.
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