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Wolf RC, Nolte HM, Hirjak D, Hofer S, Seidl U, Depping MS, Stieltjes B, Maier-Hein K, Sambataro F, Thomann PA. Structural network changes in patients with major depression and schizophrenia treated with electroconvulsive therapy. Eur Neuropsychopharmacol 2016; 26:1465-1474. [PMID: 27424799 DOI: 10.1016/j.euroneuro.2016.06.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/06/2016] [Accepted: 06/18/2016] [Indexed: 02/06/2023]
Abstract
Electroconvulsive therapy (ECT) is one of the most effective treatments in severe and treatment-resistant major depressive disorder (MDD). In schizophrenia (SZ), ECT is frequently considered in drug-resistant cases, as an augmentation of antipsychotic treatment or in cases when rapid symptom relief is indicated. Accumulating neuroimaging evidence suggests modulation of medial temporal lobe and prefrontal cortical regions in MDD by ECT. In SZ, ECT-effects on brain structure have not been systematically investigated so far. In this study, we investigated brain volume in 21 ECT-naïve patients (12 with MDD, 9 with SZ) who received right-sided unilateral ECT. Twenty-one healthy controls were included. Structural magnetic resonance imaging data were acquired before and after ECT. Healthy participants were scanned once. Source-based morphometry was used to investigate modulation of structural networks pre/post ECT. ECT had an impact on distinct structural networks in MDD and SZ. In both MDD and SZ SBM revealed a medial temporal lobe (MTL) network (including hippocampus and parahippocampal cortex) which showed a significant increase after ECT. The increase in MTL network strength was not associated with clinical improvement in either MDD or SZ. In SZ a lateral prefrontal/cingulate cortical network showed a volume increase after ECT, and this effect was accompanied by clinical improvement. These findings provide preliminary evidence for structural network change in response to ECT in MDD and SZ. The data suggest both diagnosis-specific and transdiagnostic ECT-effects on brain volume. In contrast to SZ, in MDD structural network modulation by ECT was not associated with clinical improvement.
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Affiliation(s)
- Robert Christian Wolf
- Center for Psychosocial Medicine, Department of Psychiatry, University of Heidelberg, 69115 Heidelberg, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Saarland University, Kirrberger Str. 1, 66421 Homburg, Germany.
| | - Henrike Maria Nolte
- Center for Psychosocial Medicine, Department of Psychiatry, University of Heidelberg, 69115 Heidelberg, Germany
| | - Dusan Hirjak
- Center for Psychosocial Medicine, Department of Psychiatry, University of Heidelberg, 69115 Heidelberg, Germany
| | - Stefan Hofer
- Department of Anesthesiology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Ulrich Seidl
- Center for Mental Health, Klinikum Stuttgart, 70374 Stuttgart, Germany
| | - Malte Sebastian Depping
- Center for Psychosocial Medicine, Department of Psychiatry, University of Heidelberg, 69115 Heidelberg, Germany
| | - Bram Stieltjes
- Department of Radiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Klaus Maier-Hein
- Medical Image Computing Group, Division of Medical and Biological Informatics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Fabio Sambataro
- Department of Experimental and Clinical Medical Sciences (DISM), University of Udine, Udine, Italy
| | - Philipp Arthur Thomann
- Center for Psychosocial Medicine, Department of Psychiatry, University of Heidelberg, 69115 Heidelberg, Germany
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52
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Grecucci A, Rubicondo D, Siugzdaite R, Surian L, Job R. Uncovering the Social Deficits in the Autistic Brain. A Source-Based Morphometric Study. Front Neurosci 2016; 10:388. [PMID: 27630538 PMCID: PMC5005369 DOI: 10.3389/fnins.2016.00388] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/09/2016] [Indexed: 11/17/2022] Open
Abstract
Autism is a neurodevelopmental disorder that mainly affects social interaction and communication. Evidence from behavioral and functional MRI studies supports the hypothesis that dysfunctional mechanisms involving social brain structures play a major role in autistic symptomatology. However, the investigation of anatomical abnormalities in the brain of people with autism has led to inconsistent results. We investigated whether specific brain regions, known to display functional abnormalities in autism, may exhibit mutual and peculiar patterns of covariance in their gray-matter concentrations. We analyzed structural MRI images of 32 young men affected by autistic disorder (AD) and 50 healthy controls. Controls were matched for sex, age, handedness. IQ scores were also monitored to avoid confounding. A multivariate Source-Based Morphometry (SBM) was applied for the first time on AD and controls to detect maximally independent networks of gray matter. Group comparison revealed a gray-matter source that showed differences in AD compared to controls. This network includes broad temporal regions involved in social cognition and high-level visual processing, but also motor and executive areas of the frontal lobe. Notably, we found that gray matter differences, as reflected by SBM, significantly correlated with social and behavioral deficits displayed by AD individuals and encoded via the Autism Diagnostic Observation Schedule scores. These findings provide support for current hypotheses about the neural basis of atypical social and mental states information processing in autism.
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Affiliation(s)
- Alessandro Grecucci
- Department of Psychology and Cognitive Sciences, University of Trento Trento, Italy
| | - Danilo Rubicondo
- Department of Psychology and Cognitive Sciences, University of TrentoTrento, Italy; Center for Mind/Brain Sciences, University of TrentoTrento, Italy
| | - Roma Siugzdaite
- Department of Experimental Psychology, Faculty of Psychological and Pedagogical Sciences, Ghent University Ghent, Belgium
| | - Luca Surian
- Department of Psychology and Cognitive Sciences, University of Trento Trento, Italy
| | - Remo Job
- Department of Psychology and Cognitive Sciences, University of Trento Trento, Italy
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53
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Abstract
Although treatment-resistant schizophrenia (TRS) was described 50 years ago and has a gold standard treatment with clozapine based on well-defined criteria, there is still a matter of great interest and controversy. In terms of the underlying mechanisms of the development of TRS, progress has been made for the elucidation of the neurochemical mechanisms. Structural neuroimaging studies have shown that patients with TRS have significant reduction of the prefrontal cortex volume when compared with non- TRS. This article updates and enhances our previous review with new evidence mainly derived from new studies, clinical trials, systematic reviews, and meta-analyses.
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Affiliation(s)
- Helio Elkis
- Instituto de Psiquiatria HC- FMUSP, Rua Ovidio Pires de Campos 785-São Paulo, SP-05403-010, Brazil.
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54
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Mouchlianitis E, McCutcheon R, Howes OD. Brain-imaging studies of treatment-resistant schizophrenia: a systematic review. Lancet Psychiatry 2016; 3:451-63. [PMID: 26948188 PMCID: PMC5796640 DOI: 10.1016/s2215-0366(15)00540-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 02/05/2023]
Abstract
Around 30% of patients with schizophrenia show an inadequate response to antipsychotics-ie, treatment resistance. Neuroimaging studies can help to uncover the underlying neurobiological reasons for such resistance and identify these patients earlier. Additionally, studies examining the effect of clozapine on the brain can help to identify aspects of clozapine that make it uniquely effective in patients with treatment resistance. We did a systematic search of PubMed between Jan 1, 1980, and April 13, 2015, to identify all neuroimaging studies that examined treatment-resistant patients or longitudinally assessed the effects of clozapine treatment. We identified 330 articles, of which 61 met the inclusion criteria. Replicated differences between treatment-resistant and treatment-responsive patients include reductions in grey matter and perfusion of frontotemporal regions, and increases in white matter and basal ganglia perfusion, with effect sizes ranging from 0·4 to greater than 1. Clozapine treatment led to reductions in caudate nucleus volume in three separate studies. The available evidence supports the hypothesis that some of the neurobiological changes seen in treatment-resistant schizophrenia lie along a continuum with treatment-responsive schizophrenia, whereas other differences are categorical in nature and have potential to be used as biomarkers. However, further replication is needed, and for neuroimaging findings to be clinically translatable, future studies need to focus on a-priori hypotheses and be adequately powered.
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Affiliation(s)
- Elias Mouchlianitis
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Robert McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; Psychiatric Imaging Group, Medical Research Council Clinical Sciences Centre, Institute of Clinical Science, Imperial College London, London, UK.
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; Psychiatric Imaging Group, Medical Research Council Clinical Sciences Centre, Institute of Clinical Science, Imperial College London, London, UK
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55
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Upthegrove R, Broome MR, Caldwell K, Ives J, Oyebode F, Wood SJ. Understanding auditory verbal hallucinations: a systematic review of current evidence. Acta Psychiatr Scand 2016; 133:352-67. [PMID: 26661730 DOI: 10.1111/acps.12531] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Auditory verbal hallucinations (AVHs) are core features of psychotic illness and remain significant in predicting poor outcome and risk. There has been a wide range of approaches to understanding these experiences. METHOD A systematic literature review summarizing different methods of investigation and their results; phenomenology, descriptive psychopathology, psychological, cognitive neurobiology, and neuroimaging. RESULTS A number of 764 papers and texts were screened and 113 reviewed. Phenomenological studies are comparably few in number, and psychopathology remains based on concepts defined in the early 20th century. Psychological models focus on voice content and emotional reaction, and suggest a continuum of AVHs from normal experience. Neuropsychological models include AVHs as misattribution of inner speech, whilst functional neuroimaging studies focus on the spontaneous activity and connectivity of auditory networks. CONCLUSION There has been a large growth in research on AVHs in recent decades dominated by neurobiological and neuroimaging studies. Future research should include focus on phenomenological aspects and AVHs change over the course of developing illness. Integration between branches of enquiry is needed, and the risk is that without this, models are proposed and investigated that bear scant relevance to the symptom itself.
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Affiliation(s)
- R Upthegrove
- Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK.,Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - M R Broome
- Department of Psychiatry, University of Oxford, Oxford, UK.,Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - K Caldwell
- Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK.,Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - J Ives
- Medicine, Ethics, Society and History, The University of Birmingham, Birmingham, UK
| | - F Oyebode
- Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK.,Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - S J Wood
- School of Psychology, University of Birmingham, Birmingham, UK.,Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Melbourne, Vic., Australia
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56
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Buoli M, Caldiroli A, Altamura AC. Psychiatric Conditions in Parkinson Disease: A Comparison With Classical Psychiatric Disorders. J Geriatr Psychiatry Neurol 2016; 29:72-91. [PMID: 26377851 DOI: 10.1177/0891988715606233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Psychiatric conditions often complicate the outcome of patients affected by Parkinson disease (PD), but they differ from classical psychiatric disorders in terms of underlying biological mechanisms, clinical presentation, and treatment response. The purpose of the present review is to illustrate the biological and clinical aspects of psychiatric conditions associated with PD, with particular reference to the differences with respect to classical psychiatric disorders. A careful search of articles on main databases was performed in order to obtain a comprehensive review about the main psychiatric conditions associated with PD. A manual selection of the articles was then performed in order to consider only those articles that concerned with the topic of the review. Psychiatric conditions in patients with PD present substantial differences with respect to classical psychiatric disorders. Their clinical presentation does not align with the symptom profiles represented by Diagnostic and Statistical Manual for Mental Disorders and International Classification of Diseases. Furthermore, psychiatry treatment guidelines are of poor help in managing psychiatric symptoms of patients with PD. Specific diagnostic tools and treatment guidelines are needed to allow early diagnosis and adequate treatment of psychiatric conditions in comorbidity with PD.
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Affiliation(s)
- Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alice Caldiroli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfredo Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
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57
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Yun JY, Kim SN, Lee TY, Chon MW, Kwon JS. Individualized covariance profile of cortical morphology for auditory hallucinations in first-episode psychosis. Hum Brain Mapp 2015; 37:1051-65. [PMID: 26678706 DOI: 10.1002/hbm.23083] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 10/08/2015] [Accepted: 12/02/2015] [Indexed: 12/29/2022] Open
Abstract
Neocortical phenotype of cortical surface area (CSA) and thickness (CT) are influenced by distinctive genetic factors and undergo differential developmental trajectories, which could be captured using the individualized cortical structural covariance (ISC). Disturbed patterns of neocortical development and maturation underlie the perceptual disturbance of psychosis including auditory hallucination (AH). To demonstrate the utility of selected ISC features as primal biomarker of AH in first-episode psychosis (FEP) subjects experiencing AH (FEP-AH), we employed herein a support vector machine (SVM). A total of 147 subjects (FEP-AH, n = 27; FEP-NAH, n = 24; HC, n = 96) underwent T1 -weighted magnetic resonance imaging at 3T. The FreeSurfer software suite was used for cortical parcellation, with the CSA-ISC and CT-ISC then calculated. The most informative ISCs showing statistical significance (P < 0.001) across every run of leave-one-out group-comparison were aligned according to the absolute value of averaged t-statistics and were packaged into candidate feature sets for classification analysis using the SVM. An optimal feature set comprising three CSA-ISCs, including the intraparietal sulcus, Broca's complex, and the anterior insula, distinguished FEP-AH from FEP-NAH subjects with 83.6% accuracy (sensitivity = 82.8%; specificity = 85.7%). Furthermore, six CT-ISCs encompassing the executive control network and Wernicke's module classified FEP-AH from FEP-NAH subjects with 82.3% accuracy (sensitivity = 79.5%; specificity = 88.6%). Finally, extended sets of ISCs related to the default-mode network distinguished FEP-AH or FEP-NAH from HC subjects with 89.0-93.0% accuracy (sensitivity = 88.4-93.4%; specificity = 89.0-94.1%). This study established a distinctive intermediate phenotype of biological proneness for AH in FEP using CSA-ISCs as well as a state marker of disease progression using CT-ISCs.
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Affiliation(s)
- Je-Yeon Yun
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Nyun Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Young Lee
- SNU-MRC, Institute of Human Behavioral Medicine, Seoul, Republic of Korea
| | - Myong-Wuk Chon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,SNU-MRC, Institute of Human Behavioral Medicine, Seoul, Republic of Korea.,Department of Brain and Cognitive Sciences, College of Natural Science, Seoul National University, Seoul, Republic of Korea
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58
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Cortical Anatomical Variations and Efficacy of rTMS in the Treatment of Auditory Hallucinations. Brain Stimul 2015; 8:1162-7. [DOI: 10.1016/j.brs.2015.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 04/23/2015] [Accepted: 06/07/2015] [Indexed: 11/20/2022] Open
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59
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Kubera KM, Barth A, Hirjak D, Thomann PA, Wolf RC. Noninvasive brain stimulation for the treatment of auditory verbal hallucinations in schizophrenia: methods, effects and challenges. Front Syst Neurosci 2015; 9:131. [PMID: 26528145 PMCID: PMC4601083 DOI: 10.3389/fnsys.2015.00131] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 09/07/2015] [Indexed: 12/12/2022] Open
Abstract
This mini-review focuses on noninvasive brain stimulation techniques as an augmentation method for the treatment of persistent auditory verbal hallucinations (AVH) in patients with schizophrenia. Paradigmatically, we place emphasis on transcranial magnetic stimulation (TMS). We specifically discuss rationales of stimulation and consider methodological questions together with issues of phenotypic diversity in individuals with drug-refractory and persistent AVH. Eventually, we provide a brief outlook for future investigations and treatment directions. Taken together, current evidence suggests TMS as a promising method in the treatment of AVH. Low-frequency stimulation of the superior temporal cortex (STC) may reduce symptom severity and frequency. Yet clinical effects are of relatively short duration and effect sizes appear to decrease over time along with publication of larger trials. Apart from considering other innovative stimulation techniques, such as transcranial Direct Current Stimulation (tDCS), and optimizing stimulation protocols, treatment of AVH using noninvasive brain stimulation will essentially rely on accurate identification of potential responders and non-responders for these treatment modalities. In this regard, future studies will need to consider distinct phenotypic presentations of AVH in patients with schizophrenia, together with the putative functional neurocircuitry underlying these phenotypes.
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Affiliation(s)
- Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany
| | - Anja Barth
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany
| | - Dusan Hirjak
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany
| | - Philipp A Thomann
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany
| | - Robert C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany ; Department of Psychiatry, Psychotherapy and Psychosomatics, Saarland University Homburg, Germany
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60
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Palaniyappan L, Mahmood J, Balain V, Mougin O, Gowland PA, Liddle PF. Structural correlates of formal thought disorder in schizophrenia: An ultra-high field multivariate morphometry study. Schizophr Res 2015; 168:305-12. [PMID: 26232240 PMCID: PMC4604249 DOI: 10.1016/j.schres.2015.07.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 06/28/2015] [Accepted: 07/13/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Persistent formal thought disorder (FTD) is one of the most characteristic features of schizophrenia. Several neuroimaging studies report spatially distinct neuroanatomical changes in association with FTD. Given that most studies so far have employed a univariate localisation approach that obscures the study of covarying interregional relationships, the present study focussed on the multivariate systemic pattern of anatomical changes that contribute to FTD. METHODS Speech samples from nineteen medicated clinically stable schizophrenia patients and 20 healthy controls were evaluated for subtle formal thought disorder. Ultra high-field (7T) anatomical Magnetic Resonance Imaging scans were obtained from all subjects. Multivariate morphometric patterns were identified using an independent component approach (source based morphometry). Using multiple regression analysis, the morphometric patterns predicting positive and negative FTD scores were identified. RESULTS Morphometric variations in grey matter predicted a substantial portion of inter-individual variance in negative but not positive FTD. A pattern of concomitant striato-insular/precuneus reduction along with frontocingular grey matter increase had a significant association with negative FTD. CONCLUSIONS These results suggest that concomitant increase and decrease in grey matter occur in association with persistent negative thought disorder in clinically stable individuals with schizophrenia.
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Affiliation(s)
- Lena Palaniyappan
- Translational Neuroimaging for Mental Health, Division of Psychiatry & Applied Psychology, Institute of Mental Health, University of Nottingham, UK; Early Intervention in Psychosis, Nottinghamshire Healthcare NHS Trust, Nottingham, UK.
| | - Jenaid Mahmood
- Translational Neuroimaging for Mental Health, Division of Psychiatry & Applied Psychology, Institute of Mental Health, University of Nottingham, UK
| | - Vijender Balain
- Penticton Regional Hospital, Penticton, British Columbia, Canada
| | - Olivier Mougin
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics, University of Nottingham, UK
| | - Penny A. Gowland
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics, University of Nottingham, UK
| | - Peter F. Liddle
- Translational Neuroimaging for Mental Health, Division of Psychiatry & Applied Psychology, Institute of Mental Health, University of Nottingham, UK
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Emotion processing in treatment-resistant schizophrenia patients treated with clozapine: An fMRI study. Schizophr Res 2015; 168:377-80. [PMID: 26255082 DOI: 10.1016/j.schres.2015.07.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/20/2015] [Accepted: 07/26/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To examine the neural correlates of emotion processing in treatment-resistant patients with schizophrenia (SCZ-TR). METHODS Twenty-two SCZ-TR patients on clozapine, 24 schizophrenia patients on antipsychotics other than clozapine, and 39 healthy controls were scanned using functional neuroimaging while viewing positive, negative and neutral images. RESULTS Emotionally-laden images (positive and negative) elicited hyper-activations in the dorso-medial prefrontal cortex and left cerebellum in SCZ-TR patients, compared to the two other groups. Similarly, neutral images prompted hyper-activations in the cingulate gyrus in SCZ-TR patients, relative to the two other groups. CONCLUSIONS Treatment resistance is associated with neuro-functional hyper-activations in schizophrenia patients during emotion processing.
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Decreased bilateral thalamic gray matter volume in first-episode schizophrenia with prominent hallucinatory symptoms: A volumetric MRI study. Sci Rep 2015; 5:14505. [PMID: 26403064 PMCID: PMC4585923 DOI: 10.1038/srep14505] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 08/26/2015] [Indexed: 01/19/2023] Open
Abstract
Studies comparing gray matter (GM) volume of schizophrenic patients with or without auditory verbal hallucinations (AVHs) to that of normal controls remain controversial. This project aims to investigate changes of GM volumes of drug-naïve schizophrenic patients with and without AVHs. Eighteen first episode schizophrenic (FES) patients with AVHs, 18 FES patients without AVHs, and 18 healthy controls were scanned using structural MRI. Voxel-based morphometry (VBM) analysis was conducted to investigate changes of GM volume among the three groups. Patients with and without AVHs exhibited reduced GM volumes relative to normal controls in the left superior temporal gyrus, frontal regions, cerebellum and caudate. Further analysis of the GM of subcortical structures found that patients with AVHs had reduced thalamic volume than healthy controls. No significant difference was found between patients with and without AVHs. Significant correlation was found between the total scores of the Positive and Negative Syndrome Scale and bilateral thalamic volume. ROC analysis of thalamic volumes of the patients with AVHs and normal controls showed that the area under the curve was 0.698 (P = 0.043). The decreased thalamic volumes might serve as a biomarker for discriminating FES AVHs patients from normals.
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63
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Chen X, Liang S, Pu W, Song Y, Mwansisya TE, Yang Q, Liu H, Liu Z, Shan B, Xue Z. Reduced cortical thickness in right Heschl's gyrus associated with auditory verbal hallucinations severity in first-episode schizophrenia. BMC Psychiatry 2015; 15:152. [PMID: 26149490 PMCID: PMC4493802 DOI: 10.1186/s12888-015-0546-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/30/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Auditory verbal hallucinations (AVHs) represent one of the most intriguing phenomena in schizophrenia, however, brain abnormalities underlying AVHs remain unclear. The present study examined the association between cortical thickness and AVHs in first-episode schizophrenia. METHOD High-resolution MR images were obtained in 49 first-episode schizophrenia (FES) patients and 50 well-matched healthy controls (HCs). Among the FES patients, 18 suffered persistent AVHs ("auditory hallucination" AH group), and 31 never experienced AVHs ("no hallucination" NH group). The severity of AVHs was rated by the Auditory Hallucinations Rating Scale (AHRS). Cortical thickness differences among the three groups and their association with AVHs severity were examined. RESULTS Compared to both HCs and NH patients, AH patients showed lower cortical thickness in the right Heschl's gyrus. The degree of reduction in the cortical thickness was correlated with AVH severity in the AH patients. CONCLUSIONS Abnormalities of cortical thickness in the Heschl's gyrus may be a physiological factor underlying auditory verbal hallucinations in schizophrenia.
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Affiliation(s)
- Xudong Chen
- Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, 410011, People's Republic of China.
| | - Shengxiang Liang
- Key Laboratory of Nuclear Analysis Techniques, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, People's Republic of China.
| | - Weidan Pu
- Medical Psychological Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
| | - Yinnan Song
- Key Laboratory of Nuclear Analysis Techniques, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, People's Republic of China.
| | - Tumbwene E. Mwansisya
- Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan 410011 People’s Republic of China ,Department of Clinical Nursing and Community Health, the University of Dodoma, Dodoma, Tanzania
| | - Qing Yang
- Department of Medicine, Yale-New Haven Hospital, Yale School of Medicine, New Haven, CT, USA.
| | - Haihong Liu
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
| | - Zhening Liu
- Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, 410011, People's Republic of China.
| | - Baoci Shan
- Key Laboratory of Nuclear Analysis Techniques, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, People's Republic of China.
| | - Zhimin Xue
- Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, 410011, People's Republic of China.
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64
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Nakajima S, Takeuchi H, Plitman E, Fervaha G, Gerretsen P, Caravaggio F, Chung JK, Iwata Y, Remington G, Graff-Guerrero A. Neuroimaging findings in treatment-resistant schizophrenia: A systematic review: Lack of neuroimaging correlates of treatment-resistant schizophrenia. Schizophr Res 2015; 164:164-75. [PMID: 25684554 PMCID: PMC4409508 DOI: 10.1016/j.schres.2015.01.043] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/28/2015] [Accepted: 01/30/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recent developments in neuroimaging have advanced the understanding of biological mechanisms underlying schizophrenia. However, neuroimaging correlates of treatment-resistant schizophrenia (TRS) and superior effects of clozapine on TRS remain unclear. METHODS Systematic search was performed to identify neuroimaging characteristics unique to TRS and ultra-resistant schizophrenia (i.e. clozapine-resistant [URS]), and clozapine's efficacy in TRS using Embase, Medline, and PsychInfo. Search terms included (schizophreni*) and (resistan* OR refractory OR clozapine) and (ASL OR CT OR DTI OR FMRI OR MRI OR MRS OR NIRS OR PET OR SPECT). RESULTS 25 neuroimaging studies have investigated TRS and effects of clozapine. Only 5 studies have compared TRS and non-TRS, collectively providing no replicated neuroimaging finding specific to TRS. Studies comparing TRS and healthy controls suggest that hypometabolism in the prefrontal cortex, hypermetabolism in the basal ganglia, and structural anomalies in the corpus callosum contribute to TRS. Clozapine may increase prefrontal hypoactivation in TRS although this was not related to clinical improvement; in contrast, evidence has suggested a link between clozapine efficacy and decreased metabolism in the basal ganglia and thalamus. CONCLUSION Existing literature does not elucidate neuroimaging correlates specific to TRS or URS, which, if present, might also shed light on clozapine's efficacy in TRS. This said, leads from other lines of investigation, including the glutamatergic system can prove useful in guiding future neuroimaging studies focused on, in particular, the frontocortical-basal ganglia-thalamic circuits. Critical to the success of this work will be precise subtyping of study subjects based on treatment response/nonresponse and the use of multimodal neuroimaging.
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Affiliation(s)
- Shinichiro Nakajima
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.
| | - Hiroyoshi Takeuchi
- Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan; Schizophrenia Division, Complex Mental Illness Program, Centre for Addiction and Mental Health, Toronto, Canada.
| | - Eric Plitman
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Gagan Fervaha
- Schizophrenia Division, Complex Mental Illness Program, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Philip Gerretsen
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Fernando Caravaggio
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Jun Ku Chung
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Yusuke Iwata
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.
| | - Gary Remington
- Department of Psychiatry, University of Toronto, Toronto, Canada; Schizophrenia Division, Complex Mental Illness Program, Centre for Addiction and Mental Health, Toronto, Canada; Campbell Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Campbell Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
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Chyzhyk D, Graña M, Öngür D, Shinn AK. Discrimination of schizophrenia auditory hallucinators by machine learning of resting-state functional MRI. Int J Neural Syst 2015; 25:1550007. [PMID: 25753600 DOI: 10.1142/s0129065715500070] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Auditory hallucinations (AH) are a symptom that is most often associated with schizophrenia, but patients with other neuropsychiatric conditions, and even a small percentage of healthy individuals, may also experience AH. Elucidating the neural mechanisms underlying AH in schizophrenia may offer insight into the pathophysiology associated with AH more broadly across multiple neuropsychiatric disease conditions. In this paper, we address the problem of classifying schizophrenia patients with and without a history of AH, and healthy control (HC) subjects. To this end, we performed feature extraction from resting state functional magnetic resonance imaging (rsfMRI) data and applied machine learning classifiers, testing two kinds of neuroimaging features: (a) functional connectivity (FC) measures computed by lattice auto-associative memories (LAAM), and (b) local activity (LA) measures, including regional homogeneity (ReHo) and fractional amplitude of low frequency fluctuations (fALFF). We show that it is possible to perform classification within each pair of subject groups with high accuracy. Discrimination between patients with and without lifetime AH was highest, while discrimination between schizophrenia patients and HC participants was worst, suggesting that classification according to the symptom dimension of AH may be more valid than discrimination on the basis of traditional diagnostic categories. FC measures seeded in right Heschl's gyrus (RHG) consistently showed stronger discriminative power than those seeded in left Heschl's gyrus (LHG), a finding that appears to support AH models focusing on right hemisphere abnormalities. The cortical brain localizations derived from the features with strong classification performance are consistent with proposed AH models, and include left inferior frontal gyrus (IFG), parahippocampal gyri, the cingulate cortex, as well as several temporal and prefrontal cortical brain regions. Overall, the observed findings suggest that computational intelligence approaches can provide robust tools for uncovering subtleties in complex neuroimaging data, and have the potential to advance the search for more neuroscience-based criteria for classifying mental illness in psychiatry research.
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Affiliation(s)
- Darya Chyzhyk
- Computational Intelligence Group, Universidad del Pais Vasco (UPV/EHU), San Sebastian 20018, Spain
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Kim EJ, Yeo S, Hwang I, Park JI, Cui Y, Jin HM, Kim HT, Hwang TY, Chung YC. Bilateral Repetitive Transcranial Magnetic Stimulation for Auditory Hallucinations in Patients with Schizophrenia: A Randomized Controlled, Cross-over Study. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2014; 12:222-8. [PMID: 25598827 PMCID: PMC4293169 DOI: 10.9758/cpn.2014.12.3.222] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 09/06/2014] [Accepted: 09/28/2014] [Indexed: 01/18/2023]
Abstract
Objective A randomized double-blind cross-over trial was conducted in patients with persistent auditory hallucinations (AHs) to investigate whether bilateral repetitive transcranial magnetic stimulation (rTMS) at the temporoparietal area or Broca's area is more effective at high- or low-frequencies compared to a sham condition. Methods Twenty three patients with persistent AHs who remained stable on the same medication for 2 months were enrolled. They were randomized to one of four conditions: low-frequency (1 Hz)-rTMS to the temporoparietal area (L-TP), high-frequency (20 Hz)-rTMS to the temporoparietal area (H-TP), high-frequency (20 Hz)-rTMS to Broca's area (H-B), or sham. Results All the four rTMS conditions resulted in significant decrease in the scores under the auditory hallucination rating scale and hallucination change scale over time. However, there were no significant treatment effects or interaction between time and treatment, suggesting no superior effects of the new paradigms over the sham condition. Conclusion Our findings suggest that bilateral rTMS at the temporoparietal area or Broca's area with high- or low-frequency does not produce superior effects in reducing AHs compared to sham stimulation.
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Affiliation(s)
- Eun-Ji Kim
- Department of Psychiatry, Chonbuk National University Hospital, Jeonju, Korea
| | - Seonguk Yeo
- Department of Psychiatry, Chonbuk National University Hospital, Jeonju, Korea
| | - Inho Hwang
- Department of Psychiatry, Chonbuk National University Hospital, Jeonju, Korea
| | - Jong-Il Park
- Department of Psychiatry, Chonbuk National University Hospital, Jeonju, Korea
| | - Yin Cui
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea. ; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Hong-Mei Jin
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea. ; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Hyung Tae Kim
- Department of Psychiatry, Chonbuk Provincial Maeumsarang Hospital, Wanju, Korea
| | - Tae-Young Hwang
- Department of Psychiatry, Chonbuk Provincial Maeumsarang Hospital, Wanju, Korea
| | - Young-Chul Chung
- Department of Psychiatry, Chonbuk National University Hospital, Jeonju, Korea. ; Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea. ; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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