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Social Stress and Psychosis Risk: Common Neurochemical Substrates? Neuropsychopharmacology 2016; 41:666-74. [PMID: 26346639 PMCID: PMC4707841 DOI: 10.1038/npp.2015.274] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 08/25/2015] [Accepted: 08/26/2015] [Indexed: 12/19/2022]
Abstract
Environmental risk factors have been implicated in the etiology of psychotic disorders, with growing evidence showing the adverse effects of migration, social marginalization, urbanicity, childhood trauma, social defeat, and other adverse experiences on mental health in vulnerable populations. Collectively, social stress may be one mechanism that could link these environmental risk factors. The exact mechanism(s) by which social stress can affect brain function, and in particular the molecular targets involved in psychosis (such as the dopaminergic (DA) system), is (are) not fully understood. In this review, we will discuss the interplay between social environmental risk factors and molecular changes in the human brain; in particular, we will highlight the impact of social stress on three specific neurochemical systems: DA, neuroinflammation/immune, and endocannabinoid (eCB) signaling. We have chosen the latter two molecular pathways based on emerging evidence linking schizophrenia to altered neuroinflammatory processes and cannabis use. We further identify key developmental periods in which social stress interacts with these pathways, suggesting window(s) of opportunities for novel interventions. Taken together, we suggest that they may have a key role in the pathogenesis and disease progression, possibly provide novel treatment options for schizophrenia, and perhaps even prevent it.
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102
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Hettige NC, Cole CB, Khalid S, De Luca V. Polygenic risk score prediction of antipsychotic dosage in schizophrenia. Schizophr Res 2016; 170:265-70. [PMID: 26778674 DOI: 10.1016/j.schres.2015.12.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 12/17/2015] [Accepted: 12/22/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Genetic variants have yet to be identified as reliable predictors of antipsychotic dosage. The purpose of this study is to quantify significant genetic risk variants prioritized from the Psychiatric GWAS Consortium (PGC2) study for schizophrenia as a polygenic score to test our hypothesis that it may represent symptom severity in patients and therefore predict antipsychotic dosage. METHODS Antipsychotic medication and dosage were collected in our sample of 83 patients with schizophrenia spectrum disorders of a homogeneous European background. Antipsychotic dosage was standardized according to the Product Monograph (PM%), chlorpromazine equivalents (CPZe), and Defined Daily Dose (DDD). We calculated polygenic risk scores (PRS) for the significant risk loci identified from the PGC2 GWAS to predict dosage using a linear regression model. RESULTS In our analysis, the PRS showed no significant association with PM%, CPZe, and DDD dosage. Considering symptom severity and overall functioning, our PRS was similarly not significantly associated with Global Assessment of Functioning (GAF) scores. DISCUSSION Our results do not provide evidence for a polygenic inheritance of schizophrenia that influences levels of antipsychotic dosage. To the best of our knowledge, this is one of the first studies of its kind to use the PRS from the PGC2 significant risk variants to predict a clinically relevant phenotype. The PRS offers a novel approach to analyzing the genetic liability for many clinically relevant phenotypes in schizophrenia.
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Affiliation(s)
- Nuwan C Hettige
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; EEG and Genetics Unit, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Christopher B Cole
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, 75 Laurier Ave E, Ottawa, ON K1N 6N5, Canada
| | - Sarah Khalid
- EEG and Genetics Unit, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Vincenzo De Luca
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; EEG and Genetics Unit, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
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Stephan KE, Bach DR, Fletcher PC, Flint J, Frank MJ, Friston KJ, Heinz A, Huys QJM, Owen MJ, Binder EB, Dayan P, Johnstone EC, Meyer-Lindenberg A, Montague PR, Schnyder U, Wang XJ, Breakspear M. Charting the landscape of priority problems in psychiatry, part 1: classification and diagnosis. Lancet Psychiatry 2016; 3:77-83. [PMID: 26573970 DOI: 10.1016/s2215-0366(15)00361-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 02/09/2023]
Abstract
Contemporary psychiatry faces major challenges. Its syndrome-based disease classification is not based on mechanisms and does not guide treatment, which largely depends on trial and error. The development of therapies is hindered by ignorance of potential beneficiary patient subgroups. Neuroscientific and genetics research have yet to affect disease definitions or contribute to clinical decision making. In this challenging setting, what should psychiatric research focus on? In two companion papers, we present a list of problems nominated by clinicians and researchers from different disciplines as candidates for future scientific investigation of mental disorders. These problems are loosely grouped into challenges concerning nosology and diagnosis (this Personal View) and problems related to pathogenesis and aetiology (in the companion Personal View). Motivated by successful examples in other disciplines, particularly the list of Hilbert's problems in mathematics, this subjective and eclectic list of priority problems is intended for psychiatric researchers, helping to re-focus existing research and providing perspectives for future psychiatric science.
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Affiliation(s)
- Klaas E Stephan
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland; Wellcome Trust Centre for Neuroimaging, University College London, London, UK; Max Planck Institute for Metabolism Research, Cologne, Germany.
| | - Dominik R Bach
- Wellcome Trust Centre for Neuroimaging, University College London, London, UK; Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Paul C Fletcher
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Jonathan Flint
- Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, UK
| | - Michael J Frank
- Brown Institute for Brain Science, Brown University, Providence, RI, USA
| | - Karl J Friston
- Wellcome Trust Centre for Neuroimaging, University College London, London, UK
| | - Andreas Heinz
- Department of Psychiatry, Humboldt University, Berlin, Germany
| | - Quentin J M Huys
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Michael J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics and Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Elisabeth B Binder
- Department of Translational Research in Psychiatry, Max Planck Institute for Psychiatry, Munich, Germany; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter Dayan
- Gatsby Computational Neuroscience Unit, University College London, London, UK
| | - Eve C Johnstone
- Department of Psychiatry, University of Edinburgh, Edinburgh, UK
| | | | - P Read Montague
- Wellcome Trust Centre for Neuroimaging, University College London, London, UK; Computational Psychiatry Unit, Virginia Tech Carilion Research Institute, Roanoke, VA, USA
| | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Xiao-Jing Wang
- Center for Neural Science, New York University, New York, NY, USA; Institute of Brain and Cognitive Science, NYU Shanghai, Shanghai, China
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Stickel A, Rohdemann M, Landes T, Engel K, Banas R, Heinz A, Müller CA. Changes in Nutrition-Related Behaviors in Alcohol-Dependent Patients After Outpatient Detoxification: The Role of Chocolate. Subst Use Misuse 2016; 51:545-52. [PMID: 27050118 DOI: 10.3109/10826084.2015.1117107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Previous studies have reported changes in nutrition-related behaviors in alcohol-dependent patients after alcohol detoxification, but prospective studies assessing the effects of these changes on maintaining abstinence are lacking. OBJECTIVES To assess changes in craving and consumption of chocolate and other sweets over time up to six months after outpatient alcohol detoxification treatment and to detect differences in abstinent versus nonabstinent patients. METHODS One hundred and fifty alcohol-dependent patients were included in this prospective observational study. Participants completed self-report questionnaires on nutrition-related behaviors and craving before detoxification treatment (baseline, t1), one week (t2), one month (t3), and six months later (t4). RESULTS Significant changes in craving for and consumption of chocolate as well as in craving for other sweets were observed over time. Increases were most prominent within the first month. Patients who remained abstinent until t3 consumed three times more chocolate than nonabstainers. One quarter of the patients switched from being rare (t1) to frequent (t3) chocolate eaters, and 84% of these remained abstinent until t3. No significant correlations were found between craving for alcohol and craving for or consumption of chocolate or other sweets. CONCLUSIONS/IMPORTANCE In the first month after outpatient alcohol detoxification treatment, significant changes in nutrition-related behaviors were observed. These changes were not associated with alcohol craving. For a subgroup, increasing the frequency of chocolate consumption might be a temporary protective factor with respect to alcohol relapse.
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Affiliation(s)
- Anna Stickel
- a Department of Psychiatry and Psychotherapy, Campus Charité Mitte , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Maren Rohdemann
- a Department of Psychiatry and Psychotherapy, Campus Charité Mitte , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Tom Landes
- b Institute of Psychology, Friedrich-Schiller-Universität Jena , Jena , Germany
| | - Katharina Engel
- a Department of Psychiatry and Psychotherapy, Campus Charité Mitte , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Roman Banas
- a Department of Psychiatry and Psychotherapy, Campus Charité Mitte , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Andreas Heinz
- a Department of Psychiatry and Psychotherapy, Campus Charité Mitte , Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Christian A Müller
- a Department of Psychiatry and Psychotherapy, Campus Charité Mitte , Charité-Universitätsmedizin Berlin , Berlin , Germany
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Pankow A, Katthagen T, Diner S, Deserno L, Boehme R, Kathmann N, Gleich T, Gaebler M, Walter H, Heinz A, Schlagenhauf F. Aberrant Salience Is Related to Dysfunctional Self-Referential Processing in Psychosis. Schizophr Bull 2016; 42. [PMID: 26194892 PMCID: PMC4681553 DOI: 10.1093/schbul/sbv098] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND A dysfunctional differentiation between self-relevant and irrelevant information may affect the perception of environmental stimuli as abnormally salient. The aberrant salience hypothesis assumes that positive symptoms arise from an attribution of salience to irrelevant stimuli accompanied by the feeling of self-relevance. Self-referential processing relies on the activation of cortical midline structures which was demonstrated to be impaired in psychosis. We investigated the neural correlates of self-referential processing, aberrant salience attribution, and the relationship between these 2 measures across the psychosis continuum. METHODS Twenty-nine schizophrenia patients, 24 healthy individuals with subclinical delusional ideation, and 50 healthy individuals participated in this study. Aberrant salience was assessed behaviorally in terms of reaction times to task irrelevant cues. Participants performed a self-reference task during fMRI in which they had to apply neutral trait words to them or to a public figure. The correlation between self-referential processing and aberrant salience attribution was tested. RESULTS Schizophrenia patients displayed increased aberrant salience attribution compared with healthy controls and individuals with subclinical delusional ideation, while the latter exhibited intermediate aberrant salience scores. In the self-reference task, schizophrenia patients showed reduced activation in the ventromedial prefrontal cortex (vmPFC), but individuals with subclinical delusional ideation did not differ from healthy controls. In schizophrenia patients, vmPFC activation correlated negatively with implicit aberrant salience attribution. CONCLUSIONS Higher aberrant salience attribution in schizophrenia patients is related to reduced vmPFC activation during self-referential judgments suggesting that aberrant relevance coding is reflected in decreased neural self-referential processing as well as in aberrant salience attribution.
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Affiliation(s)
- Anne Pankow
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany;
| | - Teresa Katthagen
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sarah Diner
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Rebecca Boehme
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nobert Kathmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tobias Gleich
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Gaebler
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Faculty of Medicine, Universität Leipzig, Leipzig, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Schlagenhauf
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany; Max Planck Fellow Group 'Cognitive and Affective Control of Behavioral Adaption', Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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106
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Bartholomeusz CF, Ganella EP, Labuschagne I, Bousman C, Pantelis C. Effects of oxytocin and genetic variants on brain and behaviour: Implications for treatment in schizophrenia. Schizophr Res 2015; 168:614-27. [PMID: 26123171 DOI: 10.1016/j.schres.2015.06.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 05/25/2015] [Accepted: 06/07/2015] [Indexed: 12/13/2022]
Abstract
Impairments in social cognition and poor social functioning are core features of schizophrenia-spectrum disorders. In recent years, there has been a move towards developing new treatment strategies that specifically target social cognitive and social behavioural deficits. Oxytocin (OXT) is one such strategy that has gained increasing attention. There is a strong rationale for studying OXT in psychosis, from both an evolutionary perspective and neurodevelopmental-cognitive model of schizophrenia. Thus, the aim of this review was to critique and examine the observational and clinical oxytocin trial literature in schizophrenia-spectrum disorders. A handful of clinical trials suggest that OXT treatment may be beneficial for remediating social cognitive impairments, psychiatric symptoms, and improving social outcomes. However, inconsistencies exist in this literature, which may be explained by individual differences in the underlying neural response to OXT treatment and/or variation in the oxytocin and oxytocin receptor genes. Therefore, we additionally reviewed the evidence for structural and functional neural intermediate phenotypes in humans that link genetic variants to social behaviour/thinking, and discuss the implications of such interactions in the context of dysfunctional brain networks in schizophrenia. Factors that pose challenges for future OXT clinical research include the impact of age, sex, and ancestry, task-specific effects, bioavailability and pharmacokinetics, as well as neurotransmitter and drug interactions. While initial findings from OXT single dose/clinical trial studies are promising, more interdisciplinary research in both healthy and psychiatric populations is needed before determining whether OXT is a viable treatment option/adjunct for addressing poor illness outcomes in psychotic disorders.
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Affiliation(s)
- Cali F Bartholomeusz
- Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Carlton South, Victoria, Australia.
| | - Eleni P Ganella
- Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Carlton South, Victoria, Australia
| | - Izelle Labuschagne
- School of Psychology, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Chad Bousman
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Carlton South, Victoria, Australia; Florey Institute for Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Carlton South, Victoria, Australia; Florey Institute for Neuroscience and Mental Health, Parkville, Victoria, Australia
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107
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Heinz A, Majić T. Effective and Neurobiologically Sound. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:681-682. [PMID: 26554315 PMCID: PMC4643159 DOI: 10.3238/arztebl.2015.0681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Andreas Heinz
- />Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Campus Mitte
| | - Tomislav Majić
- Psychiatric University Hospital Charité at St. Hedwig Hospital, Berlin
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108
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Galderisi S, Merlotti E, Mucci A. Neurobiological background of negative symptoms. Eur Arch Psychiatry Clin Neurosci 2015; 265:543-58. [PMID: 25797499 DOI: 10.1007/s00406-015-0590-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 03/15/2015] [Indexed: 01/29/2023]
Abstract
Studies investigating neurobiological bases of negative symptoms of schizophrenia failed to provide consistent findings, possibly due to the heterogeneity of this psychopathological construct. We tried to review the findings published to date investigating neurobiological abnormalities after reducing the heterogeneity of the negative symptoms construct. The literature in electronic databases as well as citations and major articles are reviewed with respect to the phenomenology, pathology, genetics and neurobiology of schizophrenia. We searched PubMed with the keywords "negative symptoms," "deficit schizophrenia," "persistent negative symptoms," "neurotransmissions," "neuroimaging" and "genetic." Additional articles were identified by manually checking the reference lists of the relevant publications. Publications in English were considered, and unpublished studies, conference abstracts and poster presentations were not included. Structural and functional imaging studies addressed the issue of neurobiological background of negative symptoms from several perspectives (considering them as a unitary construct, focusing on primary and/or persistent negative symptoms and, more recently, clustering them into factors), but produced discrepant findings. The examined studies provided evidence suggesting that even primary and persistent negative symptoms include different psychopathological constructs, probably reflecting the dysfunction of different neurobiological substrates. Furthermore, they suggest that complex alterations in multiple neurotransmitter systems and genetic variants might influence the expression of negative symptoms in schizophrenia. On the whole, the reviewed findings, representing the distillation of a large body of disparate data, suggest that further deconstruction of negative symptomatology into more elementary components is needed to gain insight into underlying neurobiological mechanisms.
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Affiliation(s)
- Silvana Galderisi
- Department of Psychiatry, Second University of Naples (SUN), L.go Madonna delle Grazie, 1, 80138, Naples, Italy.
| | - Eleonora Merlotti
- Department of Psychiatry, Second University of Naples (SUN), L.go Madonna delle Grazie, 1, 80138, Naples, Italy
| | - Armida Mucci
- Department of Psychiatry, Second University of Naples (SUN), L.go Madonna delle Grazie, 1, 80138, Naples, Italy
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109
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Aberrant Salience Is Related to Reduced Reinforcement Learning Signals and Elevated Dopamine Synthesis Capacity in Healthy Adults. J Neurosci 2015; 35:10103-11. [PMID: 26180188 DOI: 10.1523/jneurosci.0805-15.2015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The striatum is known to play a key role in reinforcement learning, specifically in the encoding of teaching signals such as reward prediction errors (RPEs). It has been proposed that aberrant salience attribution is associated with impaired coding of RPE and heightened dopamine turnover in the striatum, and might be linked to the development of psychotic symptoms. However, the relationship of aberrant salience attribution, RPE coding, and dopamine synthesis capacity has not been directly investigated. Here we assessed the association between a behavioral measure of aberrant salience attribution, the salience attribution test, to neural correlates of RPEs measured via functional magnetic resonance imaging while healthy participants (n = 58) performed an instrumental learning task. A subset of participants (n = 27) also underwent positron emission tomography with the radiotracer [(18)F]fluoro-l-DOPA to quantify striatal presynaptic dopamine synthesis capacity. Individual variability in aberrant salience measures related negatively to ventral striatal and prefrontal RPE signals and in an exploratory analysis was found to be positively associated with ventral striatal presynaptic dopamine levels. These data provide the first evidence for a specific link between the constructs of aberrant salience attribution, reduced RPE processing, and potentially increased presynaptic dopamine function.
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Abstract
Gambling disorder recently was reclassified under the category “substance-related and addictive disorders.” With regard to the diagnostic criteria, it overlaps a great deal with substance use disorder, i.e., loss of control, craving/withdrawal, and neglect of other areas of life. However, the gambling disorder symptom “chasing one’s losses” is the only criterion absent from substance use disorder. Therefore, special forms of reward (i.e., gain/loss) processing, such as the processing of loss avoidance and loss aversion, have just recently attracted attention among gambling disorder researchers. Because gambling disorder might be considered an addiction in its “pure” form, i.e., without the influence of a drug of abuse, investigating brain volume changes in people with this behavioral addiction is an important task for neuroimaging researchers in exploring the neural signatures of addiction. Because the brain is a complex network, investigation of alterations in functional connectivity has gained interest among gambling disorder researchers in order to get a more complete picture of functional brain changes in people with gambling disorder. However, only a few studies on brain structure and functional connectivity in gambling disorder have been performed so far. This review focuses on brain imaging studies of reward and loss processing, with an emphasis on loss avoidance and aversion as well as brain volume and functional connectivity in gambling disorder.
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Affiliation(s)
- Saskia Quester
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Nina Romanczuk-Seiferth
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
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111
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Müller CA, Geisel O, Pelz P, Higl V, Krüger J, Stickel A, Beck A, Wernecke KD, Hellweg R, Heinz A. High-dose baclofen for the treatment of alcohol dependence (BACLAD study): a randomized, placebo-controlled trial. Eur Neuropsychopharmacol 2015; 25:1167-77. [PMID: 26048580 DOI: 10.1016/j.euroneuro.2015.04.002] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/13/2015] [Accepted: 04/01/2015] [Indexed: 01/17/2023]
Abstract
Previous randomized, placebo-controlled trials (RCTs) assessing the efficacy of the selective γ-aminobutyric acid (GABA)-B receptor agonist baclofen in the treatment of alcohol dependence have reported divergent results, possibly related to the low to medium dosages of baclofen used in these studies (30-80mg/d). Based on preclinical observations of a dose-dependent effect and positive case reports in alcohol-dependent patients, the present RCT aimed to assess the efficacy and safety of individually titrated high-dose baclofen for the treatment of alcohol dependence. Out of 93 alcohol-dependent patients initially screened, 56 were randomly assigned to a double-blind treatment with individually titrated baclofen or placebo using dosages of 30-270mg/d. The multiple primary outcome measures were (1) total abstinence and (2) cumulative abstinence duration during a 12-week high-dose phase. More patients of the baclofen group maintained total abstinence during the high-dose phase than those receiving placebo (15/22, 68.2% vs. 5/21, 23.8%, p=0.014). Cumulative abstinence duration was significantly higher in patients given baclofen compared to patients of the placebo group (mean 67.8 (SD 30) vs. 51.8 (SD 29.6) days, p=0.047). No drug-related serious adverse events were observed during the trial. Individually titrated high-dose baclofen effectively supported alcohol-dependent patients in maintaining alcohol abstinence and showed a high tolerability, even in the event of relapse. These results provide further evidence for the potential of baclofen, thereby possibly extending the current pharmacological treatment options in alcohol dependence.
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Affiliation(s)
- Christian A Müller
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Olga Geisel
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Patricia Pelz
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Verena Higl
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Josephine Krüger
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Anna Stickel
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Anne Beck
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Rainer Hellweg
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Stephan K, Iglesias S, Heinzle J, Diaconescu A. Translational Perspectives for Computational Neuroimaging. Neuron 2015; 87:716-32. [DOI: 10.1016/j.neuron.2015.07.008] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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113
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Mann K, Vollstädt-Klein S, Reinhard I, Leménager T, Fauth-Bühler M, Hermann D, Hoffmann S, Zimmermann US, Kiefer F, Heinz A, Smolka MN. Predicting naltrexone response in alcohol-dependent patients: the contribution of functional magnetic resonance imaging. Alcohol Clin Exp Res 2015; 38:2754-62. [PMID: 25421512 DOI: 10.1111/acer.12546] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 08/11/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Effect sizes of pharmacotherapy in alcoholism are modest. They might improve if subjects could be divided into more homogeneous subgroups and would then be treated targeted to their neurobiological profile. In such an effort, we tested neural cue reactivity as a potential predictor of treatment response to naltrexone. Alcohol-associated cues cause brain activations in mesocorticolimbic networks due to the positive reinforcing properties of alcohol. These activations were reported to be associated with relapse behavior. Naltrexone, an antagonist at the mu-opioid receptor, improves drinking behavior in some but not all patients probably by blocking the positive reinforcement of alcohol. Conversely, acamprosate is proposed to modulate negative reinforcement (withdrawal and cue-induced withdrawal). Identifying subjects with elevated cue reactivity and testing their response to medical treatment could thus improve our understanding of some of the mechanisms underlying pharmacotherapy response. METHODS A picture-perception task featuring alcohol-related and neutral stimuli was presented to 64 recently detoxified alcohol-dependent patients. Patients came from 1 center of a larger double-blind randomized multicenter clinical trial (the "PREDICT Study"). They were scanned prior to being randomized to either naltrexone or acamprosate. We examined the interaction between medication and functional magnetic resonance imaging (fMRI) cue reactivity, as measured by the percentage of voxels activated, using the time to the first severe relapse as the outcome criterion. Our a priori formulated hypothesis was that naltrexone but not acamprosate should be efficacious in subjects with high cue reactivity. RESULTS We observed an interaction effect between pretreatment brain activation induced by alcohol images and medication (acamprosate/naltrexone) on relapse behavior. In line with our hypothesis, this interaction was driven by treatment response to naltrexone in patients with elevated pretreatment cue reactivity in the ventral striatum. CONCLUSIONS fMRI has the potential for predicting treatment response to naltrexone in a subgroup of alcohol-dependent patients. However, this approach will be limited to researching the mechanisms and principles of treatment response.
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Affiliation(s)
- Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
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Schott BH, Voss M, Wagner B, Wüstenberg T, Düzel E, Behr J. Fronto-limbic novelty processing in acute psychosis: disrupted relationship with memory performance and potential implications for delusions. Front Behav Neurosci 2015; 9:144. [PMID: 26082697 PMCID: PMC4450169 DOI: 10.3389/fnbeh.2015.00144] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/16/2015] [Indexed: 12/16/2022] Open
Abstract
Recent concepts have highlighted the role of the hippocampus and adjacent medial temporal lobe (MTL) in positive symptoms like delusions in schizophrenia. In healthy individuals, the MTL is critically involved in the detection and encoding of novel information. Here, we aimed to investigate whether dysfunctional novelty processing by the MTL might constitute a potential neural mechanism contributing to the pathophysiology of delusions, using functional magnetic resonance imaging (fMRI) in 16 unmedicated patients with paranoid schizophrenia and 20 age-matched healthy controls. All patients experienced positive symptoms at time of participation. Participants performed a visual target detection task with complex scene stimuli in which novel and familiar rare stimuli were presented randomly intermixed with a standard and a target picture. Presentation of novel relative to familiar images was associated with hippocampal activation in both patients and healthy controls, but only healthy controls showed a positive relationship between novelty-related hippocampal activation and recognition memory performance after 24 h. Patients, but not controls, showed a robust neural response in the orbitofrontal cortex (OFC) during presentation of novel stimuli. Functional connectivity analysis in the patients further revealed a novelty-related increase of functional connectivity of both the hippocampus and the OFC with the rostral anterior cingulate cortex (rACC) and the ventral striatum (VS). Notably, delusions correlated positively with the difference of the functional connectivity of the hippocampus vs. the OFC with the rACC. Taken together, our results suggest that alterations of fronto-limbic novelty processing may contribute to the pathophysiology of delusions in patients with acute psychosis.
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Affiliation(s)
- Björn H Schott
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité Universitätsmedizin Berlin Berlin, Germany ; Leibniz Institute for Neurobiology Magdeburg, Germany ; Department of Neurology and Institute for Cognitive Neurology and Dementia Research, Otto von Guericke University Magdeburg, Germany
| | - Martin Voss
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité Universitätsmedizin Berlin Berlin, Germany
| | - Benjamin Wagner
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité Universitätsmedizin Berlin Berlin, Germany
| | - Torsten Wüstenberg
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité Universitätsmedizin Berlin Berlin, Germany
| | - Emrah Düzel
- Department of Neurology and Institute for Cognitive Neurology and Dementia Research, Otto von Guericke University Magdeburg, Germany ; Helmholtz Center for Neurodegenerative Diseases Magdeburg, Germany
| | - Joachim Behr
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité Universitätsmedizin Berlin Berlin, Germany ; Department of Psychiatry and Psychotherapy, Medical School Brandenburg Neuruppin, Germany
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Lorenz RC, Gleich T, Kühn S, Pöhland L, Pelz P, Wüstenberg T, Raufelder D, Heinz A, Beck A. Subjective illusion of control modulates striatal reward anticipation in adolescence. Neuroimage 2015; 117:250-7. [PMID: 25988224 DOI: 10.1016/j.neuroimage.2015.05.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 05/06/2015] [Accepted: 05/09/2015] [Indexed: 11/16/2022] Open
Abstract
The perception of control over the environment constitutes a fundamental biological adaptive mechanism, especially during development. Previous studies comparing an active choice condition with a passive no-choice condition showed that the neural basis of this mechanism is associated with increased activity within the striatum and the prefrontal cortex. In the current study, we aimed to investigate whether subjective belief of control in an uncertain gambling situation induces elevated activation in a cortico-striatal network. We investigated 79 adolescents (age range: 13-16years) during reward anticipation with a slot machine task using functional magnetic resonance imaging. We assessed post-experimentally whether the participants experienced a subjective illusion of control on winning or losing in this task that was objectively not given. Nineteen adolescents experienced an illusion of control during slot machine gambling. This illusion of control group showed an increased neural activity during reward anticipation within a cortico-striatal network including ventral striatum (VS) as well as right inferior frontal gyrus (rIFG) relative to the group reporting no illusion of control. The rIFG activity was inversely associated with impulsivity in the no illusion of control group. The subjective belief about control led to an elevated ventral striatal activity, which is known to be involved in the processing of reward. This finding strengthens the notion that subjectively perceived control, not necessarily the objective presence of control, affects striatal reward-related processing.
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Affiliation(s)
- Robert C Lorenz
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany; Institute of Psychology, Humboldt Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany; Center for Adaptive Rationality, Max Planck Institute for Human Development, Lentzeallee 94, 14195 Berlin, Germany.
| | - Tobias Gleich
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany; NeuroCure Excellence Cluster, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany; Center for Lifespan Psychology, Max Planck Institute for Human Development, Lentzeallee 94, 14195 Berlin, Germany
| | - Lydia Pöhland
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Patricia Pelz
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Torsten Wüstenberg
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Diana Raufelder
- Department of Educational Science and Psychology, Free University, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Anne Beck
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
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Romanczuk-Seiferth N, Koehler S, Dreesen C, Wüstenberg T, Heinz A. Pathological gambling and alcohol dependence: neural disturbances in reward and loss avoidance processing. Addict Biol 2015; 20:557-69. [PMID: 24754423 DOI: 10.1111/adb.12144] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pathological gambling (PG) shares clinical characteristics such as craving and loss of control with substance use disorders and is thus considered a behavioral addiction. While functional alterations in the mesolimbic reward system have been correlated with craving and relapse in substance use disorders, only a few studies have examined this brain circuit in PG, and no direct comparison has been conducted so far. Thus, we investigated the neuronal correlates of reward processing in PG in contrast to alcohol-dependent (AD) patients and healthy subjects. Eighteen PG patients, 15 AD patients and 17 controls were investigated with a monetary incentive delay task, in which visual cues predict the consequence (monetary gain, avoidance of loss, none) of a fast response to a subsequent target stimulus. Functional magnetic resonance imaging data were analyzed to account for possible confounding factors such as local gray matter volume. Activity in the right ventral striatum during loss anticipation was increased in PG patients compared with controls and AD patients. Moreover, PG patients showed decreased activation in the right ventral striatum and right medial prefrontal cortex during successful loss avoidance compared with controls, which was inversely associated with severity of gambling behavior. Thus, despite neurobiological similarities to substance use disorders in reward processing, as reported by previous studies, we found relevant differences with respect to the anticipation of loss as well as its avoidance (negative reinforcement), which further contributes to the understanding of PG.
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Affiliation(s)
- Nina Romanczuk-Seiferth
- Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin Berlin, Campus Mitte; Berlin Germany
| | - Saskia Koehler
- Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin Berlin, Campus Mitte; Berlin Germany
- Berlin School of Mind and Brain and The Mind-Brain Institute; Humboldt-Universität zu Berlin; Berlin Germany
- Department of Psychology; Humboldt-Universität zu Berlin; Berlin Germany
| | - Caspar Dreesen
- Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin Berlin, Campus Mitte; Berlin Germany
| | - Torsten Wüstenberg
- Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin Berlin, Campus Mitte; Berlin Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin Berlin, Campus Mitte; Berlin Germany
- Berlin School of Mind and Brain and The Mind-Brain Institute; Humboldt-Universität zu Berlin; Berlin Germany
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Schmack K, Schnack A, Priller J, Sterzer P. Perceptual instability in schizophrenia: Probing predictive coding accounts of delusions with ambiguous stimuli. SCHIZOPHRENIA RESEARCH-COGNITION 2015; 2:72-77. [PMID: 29114455 PMCID: PMC5609639 DOI: 10.1016/j.scog.2015.03.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/13/2015] [Accepted: 03/16/2015] [Indexed: 11/29/2022]
Abstract
Background Delusions, a core symptom of schizophrenia, are thought to arise from an alteration in predictive coding mechanisms that underlie perceptual inference. Here, we aimed to empirically test the hypothesized link between delusions and perceptual inference. Method 28 patients with schizophrenia and 32 healthy controls matched for age and gender took part in a behavioral experiment that assessed the influence of stabilizing predictions on perception of an ambiguous visual stimulus. Results Participants with schizophrenia exhibited a weaker tendency towards percept stabilization during intermittent viewing of the ambiguous stimulus compared to healthy controls. The tendency towards percept stabilization in participants with schizophrenia correlated negatively with delusional ideation as measured with a validated questionnaire. Conclusion Our results indicate an association between a weakened effect of sensory predictions in perceptual inference and delusions in schizophrenia. We suggest that attenuated predictive signaling during perceptual inference in schizophrenia may yield the experience of aberrant salience, thereby providing the starting point for the formation of delusions.
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Affiliation(s)
- Katharina Schmack
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Alexandra Schnack
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Josef Priller
- Department of Neuropsychiatry, Charité Universitätsmedizin Berlin, NeuroCure, DZNE and BIH, Charitéplatz 1, 10117 Berlin, Germany
| | - Philipp Sterzer
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.,Bernstein Center for Computational Neuroscience, Charité Universitätsmedizin Berlin, Philippstrasse 13, Haus 6, 10117 Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
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Koch SP, Hägele C, Haynes JD, Heinz A, Schlagenhauf F, Sterzer P. Diagnostic classification of schizophrenia patients on the basis of regional reward-related FMRI signal patterns. PLoS One 2015; 10:e0119089. [PMID: 25799236 PMCID: PMC4370557 DOI: 10.1371/journal.pone.0119089] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 12/07/2014] [Indexed: 01/15/2023] Open
Abstract
Functional neuroimaging has provided evidence for altered function of mesolimbic circuits implicated in reward processing, first and foremost the ventral striatum, in patients with schizophrenia. While such findings based on significant group differences in brain activations can provide important insights into the pathomechanisms of mental disorders, the use of neuroimaging results from standard univariate statistical analysis for individual diagnosis has proven difficult. In this proof of concept study, we tested whether the predictive accuracy for the diagnostic classification of schizophrenia patients vs. healthy controls could be improved using multivariate pattern analysis (MVPA) of regional functional magnetic resonance imaging (fMRI) activation patterns for the anticipation of monetary reward. With a searchlight MVPA approach using support vector machine classification, we found that the diagnostic category could be predicted from local activation patterns in frontal, temporal, occipital and midbrain regions, with a maximal cluster peak classification accuracy of 93% for the right pallidum. Region-of-interest based MVPA for the ventral striatum achieved a maximal cluster peak accuracy of 88%, whereas the classification accuracy on the basis of standard univariate analysis reached only 75%. Moreover, using support vector regression we could additionally predict the severity of negative symptoms from ventral striatal activation patterns. These results show that MVPA can be used to substantially increase the accuracy of diagnostic classification on the basis of task-related fMRI signal patterns in a regionally specific way.
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Affiliation(s)
- Stefan P. Koch
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité–Universitätsmedizin Berlin, Germany
- * E-mail:
| | - Claudia Hägele
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité–Universitätsmedizin Berlin, Germany
| | - John-Dylan Haynes
- Bernstein Center for Computational Neuroscience Berlin, Charité–Universitätsmedizin Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité–Universitätsmedizin Berlin, Germany
| | - Florian Schlagenhauf
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité–Universitätsmedizin Berlin, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Philipp Sterzer
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité–Universitätsmedizin Berlin, Germany
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Hägele C, Schlagenhauf F, Rapp M, Sterzer P, Beck A, Bermpohl F, Stoy M, Ströhle A, Wittchen HU, Dolan RJ, Heinz A. Dimensional psychiatry: reward dysfunction and depressive mood across psychiatric disorders. Psychopharmacology (Berl) 2015; 232:331-41. [PMID: 24973896 PMCID: PMC4297301 DOI: 10.1007/s00213-014-3662-7] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 06/16/2014] [Indexed: 10/26/2022]
Abstract
RATIONALE A dimensional approach in psychiatry aims to identify core mechanisms of mental disorders across nosological boundaries. OBJECTIVES We compared anticipation of reward between major psychiatric disorders, and investigated whether reward anticipation is impaired in several mental disorders and whether there is a common psychopathological correlate (negative mood) of such an impairment. METHODS We used functional magnetic resonance imaging (fMRI) and a monetary incentive delay (MID) task to study the functional correlates of reward anticipation across major psychiatric disorders in 184 subjects, with the diagnoses of alcohol dependence (n = 26), schizophrenia (n = 44), major depressive disorder (MDD, n = 24), bipolar disorder (acute manic episode, n = 13), attention deficit/hyperactivity disorder (ADHD, n = 23), and healthy controls (n = 54). Subjects' individual Beck Depression Inventory-and State-Trait Anxiety Inventory-scores were correlated with clusters showing significant activation during reward anticipation. RESULTS During reward anticipation, we observed significant group differences in ventral striatal (VS) activation: patients with schizophrenia, alcohol dependence, and major depression showed significantly less ventral striatal activation compared to healthy controls. Depressive symptoms correlated with dysfunction in reward anticipation regardless of diagnostic entity. There was no significant correlation between anxiety symptoms and VS functional activation. CONCLUSION Our findings demonstrate a neurobiological dysfunction related to reward prediction that transcended disorder categories and was related to measures of depressed mood. The findings underline the potential of a dimensional approach in psychiatry and strengthen the hypothesis that neurobiological research in psychiatric disorders can be targeted at core mechanisms that are likely to be implicated in a range of clinical entities.
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Affiliation(s)
- Claudia Hägele
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany,
| | - Florian Schlagenhauf
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Michael Rapp
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Philipp Sterzer
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,Berlin School of Mind and Brain, Berlin, Germany
| | - Anne Beck
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,Berlin School of Mind and Brain, Berlin, Germany
| | - Meline Stoy
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,Berlin School of Mind and Brain, Berlin, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Raymond J. Dolan
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, WC1N 3BG UK ,Visiting Einstein Fellow, Mind and Brain Centre, Humboldt University, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,Berlin School of Mind and Brain, Berlin, Germany
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Zaytseva Y, Korsakova N, Gurovich IY, Heinz A, Rapp MA. Luria revisited: complex motor phenomena in first episode schizophrenia and schizophrenia spectrum disorders. Psychiatry Res 2014; 220:145-51. [PMID: 25200763 DOI: 10.1016/j.psychres.2014.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 08/04/2014] [Accepted: 08/08/2014] [Indexed: 11/17/2022]
Abstract
Patients with schizophrenia frequently exhibit motor deficits. However, to date, there are no studies comparing motor performance in first episode patients with schizophrenia and schizophrenia spectrum disorders (SSD; e.g. schizoaffective and brief psychosis). Participants comprised 57 first episode patients with schizophrenia, 32 first episode patients with SSD, and 51 healthy controls who underwent neuropsychological testing based on Luria׳s systematic approach, including the following tests on complex motor sequencing: the Fist-Edge-Palm (FEP) test and the bimanual probe (BP). Schizophrenia patients performed worse than SSD patients in FEP and BP, and both patient groups showed decreased scores compared to healthy controls. Furthermore, we found that a higher proportion of schizophrenia cases failed to correct their motor performance and needed external error correction, while SSD cases exhibited a higher proportion of self-correction in FEP and in BP. Lack of insight and poor executive functioning correlated with motor performance in schizophrenia, while impulse control and difficulties in abstract thinking were related to motor performance in schizophrenia spectrum disorder. Thus, psychomotor impairments appear already in first episode patients with schizophrenia and differ from impairments in SSD. Especially the inability to self-correct errors may be characteristic of schizophrenia, suggesting that impairments in error monitoring are related to psychomotor dysfunction in schizophrenia.
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Affiliation(s)
- Yuliya Zaytseva
- Moscow Research Institute of Psychiatry, Moscow, Russia; Human Science Centre, Institute of Medical Psychology, Ludwig Maximilian University, Munich, Germany; Prague Psychiatric Centre, 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
| | | | | | - Andreas Heinz
- Department of Psychiatry, Charité Campus Mitte, Berlin, Germany
| | - Michael A Rapp
- Department of Psychiatry, Charité Campus Mitte, Berlin, Germany; Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
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Effects of eye dominance (left vs. right) and cannabis use on intermanual coordination and negative symptoms in schizophrenia patients. Eur Arch Psychiatry Clin Neurosci 2014; 264:683-95. [PMID: 24792218 DOI: 10.1007/s00406-014-0503-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 04/13/2014] [Indexed: 10/25/2022]
Abstract
Based on the previous findings, it has been assumed that in schizophrenia patients, eye dominance and cannabis use will affect negative symptoms and intermanual coordination (IMC), an index of interhemispheric communication. But eye dominance, specifically the clinical findings for it, has been neglected in schizophrenia research. We therefore investigated its effects in 52 right-handed (36 right-eyed and 16 left-eyed) and 51 left-handed (35 left-eyed and 16 right-eyed) schizophrenia in-patients without and with drug use. Eye dominance affected IMC in all schizophrenia patients. When comparing right- and left-handers, we found that this result was only significant in the right-handed patients and in the smaller subgroup without drug use. In the right-handers, left eye dominance-like left-handedness-was associated with higher values in IMC and less pronounced manifestation of negative symptoms, right eye dominance was not. Thus, left-eyed right-handers may be more closely related to left-handers than to right-handers. In accordance with the results from the literature, we suggest that these findings are due to better interhemispheric connections and less impairment of white matter structures, especially in right-hemispheric regions. Moreover, cannabis use was related to higher scores in IMC and less pronounced negative symptoms, but only in the right-eyed and not in the left-eyed right-handers or in the left-handers. Hence, differences in eye dominance and handedness may be partially responsible for different results in interhemispheric connections among cannabis users. In conclusion, both eye dominance and use of cannabis should be taken into account when assessing clinical symptoms in schizophrenia patients.
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Bonoldi I, Howes OD. Presynaptic dopaminergic function: implications for understanding treatment response in psychosis. CNS Drugs 2014; 28:649-63. [PMID: 24919790 DOI: 10.1007/s40263-014-0177-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
All current antipsychotic drugs block dopamine (DA) receptors, but the nature of the DA dysfunction in schizophrenia has not been clear. However, consistent evidence now shows that presynaptic dopaminergic function is altered in schizophrenia, specifically in terms of increased DA synthesis capacity, baseline synaptic DA levels, and DA release. Furthermore, presynaptic dopaminergic function is already elevated in prodromal patients who later developed the disorder. Currently available antipsychotics act on postsynaptic receptors, not targeting presynaptic DA abnormalities. This has implications for understanding response and developing new treatments. The lack of normalization of the abnormal presynaptic function could explain why discontinuation is likely to lead to relapse, because the major dopaminergic function persists, meaning that once treatment stops there is nothing to oppose the dysregulated dopamine function reinstating symptoms. Furthermore, it suggests that drugs that target presynaptic dopaminergic function may constitute new treatment possibilities for schizophrenic patients, in particular, for those in whom antipsychotics are poorly effective. In addition, the longitudinal changes with the onset of psychosis indicate the potential to target a defined dynamic neurochemical abnormality to prevent the onset of psychosis.
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Affiliation(s)
- I Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, King's College of London, De Crespigny Park 16, London, SE5 8AF, UK,
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Müller CA, Geisel O, Banas R, Heinz A. Current pharmacological treatment approaches for alcohol dependence. Expert Opin Pharmacother 2014; 15:471-81. [PMID: 24456374 DOI: 10.1517/14656566.2014.876008] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION At present, the substances acamprosate, naltrexone and disulfiram are available for pharmacotherapy in alcohol dependence, but clinical studies found only modest effect sizes of these treatment options. AREAS COVERED This article focuses on current pharmacological treatment approaches for alcohol dependence, which have been evaluated in randomized, placebo-controlled trials (RCTs). EXPERT OPINION Besides the opioid system modulator nalmefene, which has recently been approved as a medication for the reduction of alcohol consumption, several compounds have been investigated in patients with alcohol dependence using a randomized, placebo-controlled design. In these studies, the antiepileptic drugs topiramate and gabapentin were found to be effective in improving several drinking-related outcomes, whereas levetiracetam failed to show efficacy in the treatment of alcohol dependence. Clinical studies using (low-dose) baclofen, a selective GABA-B receptor agonist, produced conflicting results, so that results of further trials are needed. Varenicline has also shown mixed results in two RCTs, but might possibly be useful in patients with comorbid nicotine dependence. The α1 adrenergic antagonist prazosin is currently under investigation in alcohol dependence with and without comorbid posttraumatic stress disorder (PTSD). Finally, first clinical evidence suggests that the 5-HT3 antagonist ondansetron might possibly be used in future within a pharmacogenetic treatment approach in alcohol dependence.
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Affiliation(s)
- Christian A Müller
- Charité - Universitätsmedizin Berlin, Department of Psychiatry, Campus Charité Mitte , Charitéplatz 1, 10117 Berlin , Germany
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Nirogi R, Kandikere V, Jayarajan P, Bhyrapuneni G, Saralaya R, Muddana N, Abraham R. Aripiprazole in an animal model of chronic alcohol consumption and dopamine D₂ receptor occupancy in rats. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 39:72-9. [PMID: 23421566 DOI: 10.3109/00952990.2012.730590] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Epidemiologic studies and clinical assessment of schizophrenic population have revealed a high incidence of overlap between schizophrenia and addictive disorders. OBJECTIVE The aim of the present investigation was to study the effect of aripiprazole in a preclinical animal model of chronic alcohol self-administration (CASA) and also to evaluate the influence of CASA on plasma pharmacokinetics and dopamine D₂ receptor (D₂R) occupancy in rats. METHODS The effect of oral administration of aripiprazole (1, 3, and 10 mg/kg) on 4% alcohol intake in CASA was studied for a period of 45 min after a post-dosing interval of 60 min. Brain penetration, pharmacokinetics, and D₂R occupancy of aripiprazole were evaluated in normal and CASA rats. RESULTS Aripiprazole reduced alcohol consumption in CASA rats by 13, 28, and 86% at 1, 3, and 10 mg/kg, respectively, and the effect reached statistical significance at 10 mg/kg (p < .01). At this behavioral effective dose, a decrease (75%) in total plasma apparent clearance and an increase in oral area under the concentration-time curve (3.98-fold) and bioavailability (3.50-fold) of aripiprazole was observed in CASA rats. Striatal D₂R occupancy and brain exposure of aripiprazole were significantly higher (∼twofold) in CASA rats when compared to normal rats (p < .01). CONCLUSION Chronic alcohol intake results in a significant increase in exposure of aripiprazole in plasma and brain and striatal D₂R occupancy. SCIENTIFIC SIGNIFICANCE Chronic alcohol intake would increase aripiprazole exposure, thus aripiprazole dose might have to be decreased (assuming this same phenomenon occurs in humans).
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Affiliation(s)
- Ramakrishna Nirogi
- Department of ADME, Discovery Research, Suven Life Sciences Ltd ., Hyderabad - 500055, India.
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125
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Schumann G, Binder EB, Holte A, de Kloet ER, Oedegaard KJ, Robbins TW, Walker-Tilley TR, Bitter I, Brown VJ, Buitelaar J, Ciccocioppo R, Cools R, Escera C, Fleischhacker W, Flor H, Frith CD, Heinz A, Johnsen E, Kirschbaum C, Klingberg T, Lesch KP, Lewis S, Maier W, Mann K, Martinot JL, Meyer-Lindenberg A, Müller CP, Müller WE, Nutt DJ, Persico A, Perugi G, Pessiglione M, Preuss UW, Roiser JP, Rossini PM, Rybakowski JK, Sandi C, Stephan KE, Undurraga J, Vieta E, van der Wee N, Wykes T, Haro JM, Wittchen HU. Stratified medicine for mental disorders. Eur Neuropsychopharmacol 2014; 24:5-50. [PMID: 24176673 DOI: 10.1016/j.euroneuro.2013.09.010] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/09/2013] [Accepted: 09/26/2013] [Indexed: 12/13/2022]
Abstract
There is recognition that biomedical research into the causes of mental disorders and their treatment needs to adopt new approaches to research. Novel biomedical techniques have advanced our understanding of how the brain develops and is shaped by behaviour and environment. This has led to the advent of stratified medicine, which translates advances in basic research by targeting aetiological mechanisms underlying mental disorder. The resulting increase in diagnostic precision and targeted treatments may provide a window of opportunity to address the large public health burden, and individual suffering associated with mental disorders. While mental health and mental disorders have significant representation in the "health, demographic change and wellbeing" challenge identified in Horizon 2020, the framework programme for research and innovation of the European Commission (2014-2020), and in national funding agencies, clear advice on a potential strategy for mental health research investment is needed. The development of such a strategy is supported by the EC-funded "Roadmap for Mental Health Research" (ROAMER) which will provide recommendations for a European mental health research strategy integrating the areas of biomedicine, psychology, public health well being, research integration and structuring, and stakeholder participation. Leading experts on biomedical research on mental disorders have provided an assessment of the state of the art in core psychopathological domains, including arousal and stress regulation, affect, cognition social processes, comorbidity and pharmacotherapy. They have identified major advances and promising methods and pointed out gaps to be addressed in order to achieve the promise of a stratified medicine for mental disorders.
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Affiliation(s)
- Gunter Schumann
- MRC-Social Genetic Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, PO80, 16 De Crespigny Park, London SE5 8AF, UK.
| | | | - Arne Holte
- Norwegian Institute of Public Health, Oslo, Norway
| | - E Ronald de Kloet
- Department of Endocrinology and Metabolism, Leiden University Medical Centre and Medical Pharmacology, LACDR, Leiden University, The Netherlands
| | - Ketil J Oedegaard
- Department of Clinical Medicine, Section of Psychiatry, University of Bergen and Psychiatric division, Health Bergen, Norway
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute and Department of Psychology, Cambridge University, Cambridge, UK
| | - Tom R Walker-Tilley
- MRC-Social Genetic Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, PO80, 16 De Crespigny Park, London SE5 8AF, UK
| | - Istvan Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Verity J Brown
- Department of Psychology, University of St Andrews, St Andrews, UK
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, University Medical Center, St Radboud and Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands
| | - Roberto Ciccocioppo
- Department of Experimental Medicine and Public Health, University of Camerino, Camerino, Macerata, Italy
| | | | - Carles Escera
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - Wolfgang Fleischhacker
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Chris D Frith
- Wellcome Trust Centre for Neuroimaging, University College London, London, UK
| | - Andreas Heinz
- Berlin School of Mind and Brain, Bernstein Center for Computational Neuroscience (BCCN), Clinic for Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Berlin, Germany
| | - Erik Johnsen
- Department of Clinical Medicine, Section of Psychiatry, University of Bergen and Psychiatric division, Health Bergen, Norway
| | - Clemens Kirschbaum
- Technische Universität Dresden, Department of Psychology, Dresden, Germany
| | | | - Klaus-Peter Lesch
- Division of Molecular Psychiatry, Laboratory of Translational Neuroscience, University of Würzburg, Würzburg, Germany and Department of Neuroscience, School of Mental Health and Neuroscience (MHENS), Maastricht University, Maastricht, The Netherlands
| | - Shon Lewis
- University of Manchester, Manchester, UK
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Karl Mann
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Mannheim, Germany
| | - Jean-Luc Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM CEA Unit 1000 "Imaging & Psychiatry", University Paris Sud, Orsay; AP-HP Department of Adolescent Psychopathology and Medicine, Maison de Solenn, University Paris Descartes, Paris, France
| | - Andreas Meyer-Lindenberg
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian P Müller
- Psychiatric University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Walter E Müller
- Department of Pharmacology, Biocenter Niederursel, University of Frankfurt, Frankfurt, Germany
| | - David J Nutt
- Neuropsychopharmacology Unit, Division of Brain Sciences, Imperial College, London, UK
| | - Antonio Persico
- Child and Adolescent Neuropsychiatry Unit & Laboratory of Molecular Psychiatry and Neurogenetics, University Campus Bio-Medico, Rome, Italy
| | - Giulio Perugi
- Department of Psychiatry, University of Pisa, Pisa, Italy
| | - Mathias Pessiglione
- Institut du Cerveau et de la Moelle épinière (ICM), Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Ulrich W Preuss
- Department of Psychiatry, Psychotherapy and Psychosomatics, Martin-Luther-University of Halle-Wittenberg, Halle/Saale, Germany
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Paolo M Rossini
- Department of Geriatrics, Neuroscience & Orthopaedics, Catholic University of Sacred Heart, Policlinico A. Gemelli, Rome, Italy
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Carmen Sandi
- Laboratory of Behavioural Genetics, Brain Mind Institute, EPFL, Lausanne, Switzerland
| | - Klaas E Stephan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Juan Undurraga
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Eduard Vieta
- Bipolar Disorders Programme, Institute of Neuroscience, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Nic van der Wee
- Leiden Institute for Brain and Cogntion/Psychiatric Neuroimaging, Dept. of Psychiatry, Leiden University Medical Center, The Netherlands
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, King's College London, UK
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - Hans Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
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126
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Dauvermann MR, Whalley HC, Schmidt A, Lee GL, Romaniuk L, Roberts N, Johnstone EC, Lawrie SM, Moorhead TWJ. Computational neuropsychiatry - schizophrenia as a cognitive brain network disorder. Front Psychiatry 2014; 5:30. [PMID: 24723894 PMCID: PMC3971172 DOI: 10.3389/fpsyt.2014.00030] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 03/10/2014] [Indexed: 11/13/2022] Open
Abstract
Computational modeling of functional brain networks in fMRI data has advanced the understanding of higher cognitive function. It is hypothesized that functional networks mediating higher cognitive processes are disrupted in people with schizophrenia. In this article, we review studies that applied measures of functional and effective connectivity to fMRI data during cognitive tasks, in particular working memory fMRI studies. We provide a conceptual summary of the main findings in fMRI data and their relationship with neurotransmitter systems, which are known to be altered in individuals with schizophrenia. We consider possible developments in computational neuropsychiatry, which are likely to further our understanding of how key functional networks are altered in schizophrenia.
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Affiliation(s)
- Maria R Dauvermann
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh , Edinburgh , UK
| | - Heather C Whalley
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh , Edinburgh , UK
| | - André Schmidt
- Department of Psychiatry, University of Basel , Basel , Switzerland ; Medical Image Analysis Center, University Hospital Basel , Basel , Switzerland
| | - Graham L Lee
- McGovern Institute for Brain Research, Massachusetts Institute of Technology , Cambridge, MA , USA
| | - Liana Romaniuk
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh , Edinburgh , UK
| | - Neil Roberts
- Clinical Research Imaging Centre, QMRI, University of Edinburgh , Edinburgh , UK
| | - Eve C Johnstone
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh , Edinburgh , UK
| | - Stephen M Lawrie
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh , Edinburgh , UK
| | - Thomas W J Moorhead
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh , Edinburgh , UK
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127
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Deserno L, Boehme R, Heinz A, Schlagenhauf F. Reinforcement learning and dopamine in schizophrenia: dimensions of symptoms or specific features of a disease group? Front Psychiatry 2013; 4:172. [PMID: 24391603 PMCID: PMC3870301 DOI: 10.3389/fpsyt.2013.00172] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 12/07/2013] [Indexed: 01/26/2023] Open
Abstract
Abnormalities in reinforcement learning are a key finding in schizophrenia and have been proposed to be linked to elevated levels of dopamine neurotransmission. Behavioral deficits in reinforcement learning and their neural correlates may contribute to the formation of clinical characteristics of schizophrenia. The ability to form predictions about future outcomes is fundamental for environmental interactions and depends on neuronal teaching signals, like reward prediction errors. While aberrant prediction errors, that encode non-salient events as surprising, have been proposed to contribute to the formation of positive symptoms, a failure to build neural representations of decision values may result in negative symptoms. Here, we review behavioral and neuroimaging research in schizophrenia and focus on studies that implemented reinforcement learning models. In addition, we discuss studies that combined reinforcement learning with measures of dopamine. Thereby, we suggest how reinforcement learning abnormalities in schizophrenia may contribute to the formation of psychotic symptoms and may interact with cognitive deficits. These ideas point toward an interplay of more rigid versus flexible control over reinforcement learning. Pronounced deficits in the flexible or model-based domain may allow for a detailed characterization of well-established cognitive deficits in schizophrenia patients based on computational models of learning. Finally, we propose a framework based on the potentially crucial contribution of dopamine to dysfunctional reinforcement learning on the level of neural networks. Future research may strongly benefit from computational modeling but also requires further methodological improvement for clinical group studies. These research tools may help to improve our understanding of disease-specific mechanisms and may help to identify clinically relevant subgroups of the heterogeneous entity schizophrenia.
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Affiliation(s)
- Lorenz Deserno
- Max Planck Institute for Human Cognitive and Brain Sciences , Leipzig , Germany ; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Rebecca Boehme
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Florian Schlagenhauf
- Max Planck Institute for Human Cognitive and Brain Sciences , Leipzig , Germany ; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin , Berlin , Germany
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128
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Schlagenhauf F, Huys QJM, Deserno L, Rapp MA, Beck A, Heinze HJ, Dolan R, Heinz A. Striatal dysfunction during reversal learning in unmedicated schizophrenia patients. Neuroimage 2013; 89:171-80. [PMID: 24291614 PMCID: PMC3991847 DOI: 10.1016/j.neuroimage.2013.11.034] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 10/31/2013] [Accepted: 11/17/2013] [Indexed: 11/24/2022] Open
Abstract
Subjects with schizophrenia are impaired at reinforcement-driven reversal learning from as early as their first episode. The neurobiological basis of this deficit is unknown. We obtained behavioral and fMRI data in 24 unmedicated, primarily first episode, schizophrenia patients and 24 age-, IQ- and gender-matched healthy controls during a reversal learning task. We supplemented our fMRI analysis, focusing on learning from prediction errors, with detailed computational modeling to probe task solving strategy including an ability to deploy an internal goal directed model of the task. Patients displayed reduced functional activation in the ventral striatum (VS) elicited by prediction errors. However, modeling task performance revealed that a subgroup did not adjust their behavior according to an accurate internal model of the task structure, and these were also the more severely psychotic patients. In patients who could adapt their behavior, as well as in controls, task solving was best described by cognitive strategies according to a Hidden Markov Model. When we compared patients and controls who acted according to this strategy, patients still displayed a significant reduction in VS activation elicited by informative errors that precede salient changes of behavior (reversals). Thus, our study shows that VS dysfunction in schizophrenia patients during reward-related reversal learning remains a core deficit even when controlling for task solving strategies. This result highlights VS dysfunction is tightly linked to a reward-related reversal learning deficit in early, unmedicated schizophrenia patients. Probabilistic reversal learning was examined in unmedicated schizophrenia patients. Computational modeling assessed subjects ability to use the latent task structure. SZ patients showed lower reinforcement sensitivity and higher switch tendency. Blunted striatal prediction error signal in unmedicated schizophrenia patients. PFC activation during reversal errors intact in SZ patients able to do the task.
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Affiliation(s)
- Florian Schlagenhauf
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany; Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Quentin J M Huys
- Gatsby Computational Neuroscience Unit and Wellcome Trust Centre for Neuroimaging, University College London, London WC1N 3BG, UK; Translational Neuromodeling Unit, Department of Biomedical Engineering, ETH Zurich and University of Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Lorenz Deserno
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany; Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Michael A Rapp
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany; Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Anne Beck
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany
| | - Hans-Joachim Heinze
- Leibniz Institute for Neurobiology, Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Ray Dolan
- Wellcome Trust Centre for Neuroimaging, University College London, London WC1N 3BG, UK; Humboldt-Universität zu Berlin School of Mind and Brain, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany; Cluster of Excellence NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany
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129
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Abstract
Delusions are unfounded yet tenacious beliefs and a symptom of psychotic disorder. Varying degrees of delusional ideation are also found in the healthy population. Here, we empirically validated a neurocognitive model that explains both the formation and the persistence of delusional beliefs in terms of altered perceptual inference. In a combined behavioral and functional neuroimaging study in healthy participants, we used ambiguous visual stimulation to probe the relationship between delusion-proneness and the effect of learned predictions on perception. Delusional ideation was associated with less perceptual stability, but a stronger belief-induced bias on perception, paralleled by enhanced functional connectivity between frontal areas that encoded beliefs and sensory areas that encoded perception. These findings suggest that weakened lower-level predictions that result in perceptual instability are implicated in the emergence of delusional beliefs. In contrast, stronger higher-level predictions that sculpt perception into conformity with beliefs might contribute to the tenacious persistence of delusional beliefs.
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130
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Anti-anhedonic effect of deep brain stimulation of the prefrontal cortex and the dopaminergic reward system in a genetic rat model of depression: an intracranial self-stimulation paradigm study. Brain Stimul 2013; 7:21-8. [PMID: 24139146 DOI: 10.1016/j.brs.2013.09.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 08/16/2013] [Accepted: 09/10/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND One of the two core symptoms of major depression (MD), whether uni- or bipolar, is the inability to experience pleasure, suggested to be triggered by dysregulation within the brain reward system. In recent years, deep brain stimulation (DBS) has evolved as a potential tool to modulate pathological neural activity; stimulation of the subgenual cingulate (Cg25) has been shown to reduce depressive symptoms, including anhedonia. In rodents, the ventromedial prefrontal cortex (vmPFC) is likely to represent the correlate of Cg25 and accordingly, stimulation of vmPFC reduces anhedonia-like behavior in rats. OBJECTIVE/HYPOTHESIS The present study addresses the question of whether the anti-anhedonic effect of vmPFC-DBS is mediated by the brain reward system. METHODS Rats of the Flinders Sensitive Line (FSL), a validated genetic animal model of depression, and its controls, the Flinders Resistant Line (FRL), were stimulated in the vmPFC and tested in the forced swim test (FST), sucrose consumption test (SCT) and the intracranial self-stimulation (ICSS) paradigm. The curve-shift paradigm of ICSS was used in combination with vmPFC-DBS, d-amphetamine and fluoxetine to quantify reward-facilitating or -attenuating treatment effects. RESULTS Our findings support anti-depressive efficacy of vmPFC-DBS with respect to despair- and anhedonia-like behavior, as shown in the FST and SCT, respectively. However, DBS did not elicit reward-facilitating or reward-attenuating effects on ICSS behavior. CONCLUSION These data suggest that it is unlikely that the anti-anhedonic effect of vmPFC-DBS depends on the mesolimbic dopaminergic reward system.
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131
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Abstract
In recent years, there has been increasing interest in research on geographical variation in the incidence of schizophrenia and other psychoses. In this paper, we review the evidence on variation in incidence of schizophrenia and other psychoses in terms of place, as well as the individual- and area-level factors that account for this variation. We further review findings on potential mechanisms that link adverse urban environment and psychosis. There is evidence from earlier and more recent studies that urbanicity is associated with an increased incidence of schizophrenia and non-affective psychosis. In addition, considerable variation in incidence across neighbourhoods has been observed for these disorders. Findings suggest it is unlikely that social drift alone can fully account for geographical variation in incidence. Evidence further suggests that the impact of adverse social contexts - indexed by area-level exposures such as population density, social fragmentation and deprivation - on risk of psychosis is explained (confounding) or modified (interaction) by environmental exposures at the individual level (i.e., cannabis use, social adversity, exclusion and discrimination). On a neurobiological level, several studies suggest a close link between social adversity, isolation and stress on the one hand, and monoamine dysfunction on the other, which resembles findings in schizophrenia patients. However, studies directly assessing correlations between urban stress or discrimination and neurobiological alterations in schizophrenia are lacking to date.
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Affiliation(s)
- Andreas Heinz
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
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132
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Pankow A, Friedel E, Sterzer P, Seiferth N, Walter H, Heinz A, Schlagenhauf F. Altered amygdala activation in schizophrenia patients during emotion processing. Schizophr Res 2013; 150:101-6. [PMID: 23911256 DOI: 10.1016/j.schres.2013.07.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 06/15/2013] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
Abstract
Dysfunctional emotion processing in patients suffering from schizophrenia is a prominent clinical feature of great importance for social functioning and subjective well-being. The neurobiological underpinnings are still poorly understood. Here we investigated a large sample of schizophrenia patients and matched healthy controls with an event-related fMRI task during emotion processing using emotional pictures from the International Affective Picture System (IAPS). Schizophrenia patients revealed stronger right amygdala activation during negative and attenuated response during positive affective picture processing compared to healthy controls. Further analysis indicated that medication status influences activation of the ventral anterior cingulate cortex during negative affective stimuli processing. These results might represent a correlate of altered emotional experience in schizophrenia patients who are known to report less positive and more negative affective states in daily life situations.
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Affiliation(s)
- Anne Pankow
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Germany.
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133
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Jäger M, Frasch K, Becker T. [Syndromal versus nosological diagnosis]. DER NERVENARZT 2012; 84:1081-2, 1084-90. [PMID: 23247993 DOI: 10.1007/s00115-012-3675-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Against the background of the current preparation of ICD-11 and DSM-5, there is a discussion whether syndromal approaches should replace the traditional nosological diagnosis in psychiatry. From a historical point of view the syndromal approach results from a reaction to the nosological model of Emil Kraepelin. Later the syndromal diagnostic approach became more important because it enabled a quantitative-dimensional assessment and analysis of psychopathological data using modern statistical procedures. However, attempts to ascribe the traditional nosological categories to psychopathological syndromes using multivariate statistical methods have failed. The syndromal approach allows a differentiated recording of the cross-sectional symptomatology; however, a plurality of different syndromes might be registered without considering meaningful principles of classification and longitudinal aspects. The syndromal approach should be complemented by a nosological classification based mainly on the psychopathological course due to the absence of consistent neurobiological findings.
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Affiliation(s)
- M Jäger
- Klinik für Psychiatrie und Psychotherapie II, Bezirkskrankenhaus Günzburg, Universität Ulm, Deutschland.
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134
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Pankow A, Knobel A, Voss M, Heinz A. Neurobiological correlates of delusion: beyond the salience attribution hypothesis. Neuropsychobiology 2012; 66:33-43. [PMID: 22797275 DOI: 10.1159/000337132] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 01/30/2012] [Indexed: 11/19/2022]
Abstract
Dopamine dysfunction is a mainstay of theories aimed to explain the neurobiological correlates of schizophrenia symptoms, particularly positive symptoms such as delusions and passivity phenomena. Based on studies revealing dopamine dysfunction in addiction research, it has been suggested that phasic or chaotic firing of dopaminergic neurons projecting to the (ventral) striatum attribute salience to otherwise irrelevant stimuli and thus contribute to delusional mood and delusion formation. Indeed, several neuroimaging studies revealed that neuronal encoding of usually irrelevant versus relevant stimuli is blunted in unmedicated schizophrenia patients, suggesting that some stimuli that are irrelevant for healthy controls acquire increased salience for psychotic patients. However, salience attribution per se may not suffice to explain anxieties and feelings of threat that often accompany paranoid ideation. Here, we suggest that beyond ventral striatal dysfunction, dopaminergic dysregulation in limbic areas such as the amygdala in interaction with prefrontal and temporal cortex may contribute to the formation of delusions and negative symptoms. Neuroleptic medication, on the other hand, appears to interfere with anticipation of reward in the ventral striatum and can thus contribute to secondary negative symptoms such as apathy and avolition.
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Affiliation(s)
- Anne Pankow
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte,Charité-Universitätsmedizin Berlin, Berlin, Germany.
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135
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Juckel G, Friedel E, Koslowski M, Witthaus H, Ozgürdal S, Gudlowski Y, Knutson B, Wrase J, Brüne M, Heinz A, Schlagenhauf F. Ventral striatal activation during reward processing in subjects with ultra-high risk for schizophrenia. Neuropsychobiology 2012; 66:50-6. [PMID: 22797277 DOI: 10.1159/000337130] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 12/12/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Early dysfunction of the brain reward system in schizophrenia might be already recognized in the prodromal phase of this illness. We used functional magnetic resonance imaging to assess the blood oxygen level-dependent response in the ventral striatum (VS) of subjects with ultra-high risk for psychosis during the presentation of reward-indicating and loss-indicating stimuli. METHODS Thirteen prodromal patients (mean age: 25.5 ± 4.6 years) and 13 age-matched healthy volunteers participated in an incentive monetary delay task, in which visual cues predicted that a rapid response to a subsequent target stimulus will gain money, avoid losing money or have no consequence. RESULTS Compared with the neutral condition, anticipation of reward loss-avoidance elicited significant activation of the VS in both healthy subjects and subjects with ultra-high risk for psychosis, but there was only a statistical tendency for less activation during loss-avoidance anticipation in prodromal compared to healthy subjects. DISCUSSION This study provides a first weak hint, as revealed by functional magnetic resonance imaging, for impaired activation of a central area of the mesolimbic dopaminergic brain reward system, the VS, already in subjects with ultra-high risk for psychosis, which is in line with results of patients with full-blown schizophrenic psychosis. This pilot study has, however, strong limitations, and its results need to be replicated first before they can be used e.g. for early recognition of patients in the schizophrenic prodrome.
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Affiliation(s)
- Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany.
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136
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Bell RL, Sable HJ, Colombo G, Hyytia P, Rodd ZA, Lumeng L. Animal models for medications development targeting alcohol abuse using selectively bred rat lines: neurobiological and pharmacological validity. Pharmacol Biochem Behav 2012; 103:119-55. [PMID: 22841890 PMCID: PMC3595005 DOI: 10.1016/j.pbb.2012.07.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 07/07/2012] [Accepted: 07/18/2012] [Indexed: 02/04/2023]
Abstract
The purpose of this review paper is to present evidence that rat animal models of alcoholism provide an ideal platform for developing and screening medications that target alcohol abuse and dependence. The focus is on the 5 oldest international rat lines that have been selectively bred for a high alcohol-consumption phenotype. The behavioral and neurochemical phenotypes of these rat lines are reviewed and placed in the context of the clinical literature. The paper presents behavioral models for assessing the efficacy of pharmaceuticals for the treatment of alcohol abuse and dependence in rodents, with particular emphasis on rats. Drugs that have been tested for their effectiveness in reducing alcohol/ethanol consumption and/or self-administration by these rat lines and their putative site of action are summarized. The paper also presents some current and future directions for developing pharmacological treatments targeting alcohol abuse and dependence.
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Affiliation(s)
- Richard L. Bell
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Helen J.K. Sable
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Giancarlo Colombo
- Neuroscience Institute, National Research Council of Italy, Section of Cagliari, Monserrato, Italy
| | - Petri Hyytia
- Institute of Biomedicine, University of Helsinki, Finland
| | - Zachary A. Rodd
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lawrence Lumeng
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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137
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Bell RL, Franklin KM, Hauser SR, Zhou FC. Introduction to the special issue "Pharmacotherapies for the treatment of alcohol abuse and dependence" and a summary of patents targeting other neurotransmitter systems. RECENT PATENTS ON CNS DRUG DISCOVERY 2012; 7:93-112. [PMID: 22574678 PMCID: PMC3868366 DOI: 10.2174/157488912800673155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 03/02/2012] [Accepted: 03/13/2012] [Indexed: 12/19/2022]
Abstract
This paper introduces the Special Section: Pharmacotherapies for the Treatment of Alcohol Abuse and Dependence and provides a summary of patents targeting neurotransmitter systems not covered in the other four chapters. The World Health Organization notes that alcoholic-type drinking results in 2.5 million deaths per year, and these deaths occur to a disproportionately greater extent among adolescents and young adults. Developing a pharmacological treatment targeting alcohol abuse and dependence is complicated by (a) the heterogeneous nature of the disease(s), (b) alcohol affecting multiple neurotransmitter and neuromodulator systems, and (c) alcohol affecting multiple organ systems which in turn influence the function of the central nervous system. Presently, the USA Federal Drug Administration has approved three pharmacotherapies for alcoholism: disulfiram, naltrexone, and acamprosate. This chapter provides a summary of the following systems, which are not covered in the accompanying chapters; alcohol and acetaldehyde metabolism, opioid, glycinergic, GABA-A, neurosteroid, dopaminergic, serotonergic, and endocannabinoid, as well as patents targeting these systems for the treatment of alcoholism. Finally, an overview is presented on the use of pharmacogenetics and pharmacogenomics in tailoring treatments for certain subpopulations of alcoholics, which is expected to continue in the future.
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Affiliation(s)
- Richard L. Bell
- Indiana University School of Medicine, Department of Psychiatry, Institute of Psychiatric Research, 791 Union Drive, Indianapolis, Indiana, 46202, USA
| | - Kelle M. Franklin
- Indiana University School of Medicine, Department of Psychiatry, Institute of Psychiatric Research, 791 Union Drive, Indianapolis, Indiana, 46202, USA
| | - Sheketha R. Hauser
- Indiana University School of Medicine, Department of Psychiatry, Institute of Psychiatric Research, 791 Union Drive, Indianapolis, Indiana, 46202, USA
| | - Feng C. Zhou
- Indiana University School of Medicine, Department of Anatomy and Cell Biology, 635 Barnhill Drive MS-508, Indian-apolis, Indiana, 46202, USA
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138
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Sanders LLO, Muckli L, de Millas W, Lautenschlager M, Heinz A, Kathmann N, Sterzer P. Detection of visual events along the apparent motion trace in patients with paranoid schizophrenia. Psychiatry Res 2012; 198:216-23. [PMID: 22546415 DOI: 10.1016/j.psychres.2012.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 01/07/2012] [Accepted: 03/05/2012] [Indexed: 11/25/2022]
Abstract
Dysfunctional prediction in sensory processing has been suggested as a possible causal mechanism in the development of delusions in patients with schizophrenia. Previous studies in healthy subjects have shown that while the perception of apparent motion can mask visual events along the illusory motion trace, such motion masking is reduced when events are spatio-temporally compatible with the illusion, and, therefore, predictable. Here we tested the hypothesis that this specific detection advantage for predictable target stimuli on the apparent motion trace is reduced in patients with paranoid schizophrenia. Our data show that, although target detection along the illusory motion trace is generally impaired, both patients and healthy control participants detect predictable targets more often than unpredictable targets. Patients had a stronger motion masking effect when compared to controls. However, patients showed the same advantage in the detection of predictable targets as healthy control subjects. Our findings reveal stronger motion masking but intact prediction of visual events along the apparent motion trace in patients with paranoid schizophrenia and suggest that the sensory prediction mechanism underlying apparent motion is not impaired in paranoid schizophrenia.
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Affiliation(s)
- Lia Lira Olivier Sanders
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
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139
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Rössler W, Hengartner MP, Angst J, Ajdacic-Gross V. Linking substance use with symptoms of subclinical psychosis in a community cohort over 30 years. Addiction 2012; 107:1174-84. [PMID: 22151745 DOI: 10.1111/j.1360-0443.2011.03760.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS The aim of the study was to examine the temporal associations between substance use and subclinical psychosis symptoms. DESIGN Data from a prospective community study sampled within a single cohort over 30 years (1978-2008) were analysed with discrete-time hazard models. SETTING General population-based sample. PARTICIPANTS At initial sampling in 1978 males (n = 292) were 19 and females (n = 299) were 20 years old. MEASUREMENTS Two psychosis syndromes representing 'schizotypal signs' and 'schizophrenia nuclear symptoms' and various substance use variables including cannabis, alcohol, tobacco and multiple-drug use (i.e. cannabis combined with other drugs). FINDINGS In bivariate analyses, schizotypal signs were predominantly associated with regular cannabis use in adolescence (OR = 2.29, 95% CI 1.32-3.97). Schizophrenia nuclear symptoms were mainly related to alcohol (OR = 1.84, 95% CI 1.00-3.38) and multiple-drug use (OR = 2.35, 95% CI 1.38-4.02) during adolescence. Multivariate analyses showed that, in particular, regular cannabis use during adolescence was associated with the occurrence of subsequent schizotypal symptoms over a 30-year period (OR = 2.60, 95% CI; 1.59-4.23), whereas multiple-drug use in adolescence was associated predominantly with schizophrenia nuclear symptoms (OR = 1.75, 95% CI 1.01-3.03). Alcohol misuse was only slightly associated with the onset of such symptoms. CONCLUSIONS A significant portion of the occurrence of subclinical psychosis symptoms in adulthood can be attributed to excessive cannabis and multiple-drug use during adolescence. This is in line with the hypothesis that long-term sensitization of dopaminergic brain receptors plays a role in developing psychotic symptoms.
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Affiliation(s)
- Wulf Rössler
- Department of General and Social Psychiatry, Psychiatric University Hospital Zurich, Zurich, Switzerland.
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140
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Nielsen MØ, Rostrup E, Wulff S, Bak N, Lublin H, Kapur S, Glenthøj B. Alterations of the brain reward system in antipsychotic naïve schizophrenia patients. Biol Psychiatry 2012; 71:898-905. [PMID: 22418013 DOI: 10.1016/j.biopsych.2012.02.007] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 02/03/2012] [Accepted: 02/03/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Various schizophrenic symptoms are suggested to be linked to a dysfunction of the brain reward system. Several studies have found alterations in the reward processing in patients with schizophrenia; however, most previous findings might be confounded by medication effects. METHODS Thirty-one antipsychotic-naïve schizophrenia patients and 31 age- and gender-matched healthy control subjects were examined with functional magnetic resonance imaging while playing a variant of the monetary incentive delay task. The task variant made it possible to separate overall salience (defined as arousing events) into behavioral salience (events where a predicted reward requires performance) and valence anticipation (the anticipation of a monetarily significant outcome). Furthermore, the evaluation of monetary gain and loss was assessed. RESULTS During reward anticipation, patients had a significant attenuation of the activation in ventral tegmentum, ventral striatum, and anterior cingulate cortex during presentation of salient cues. This signal attenuation in ventral striatum was correlated with the degree of positive symptoms. Signal attenuation was most pronounced for behavioral salience and nonsignificant for value anticipation. Furthermore, patients showed a changed activation pattern during outcome evaluation in right prefrontal cortex. CONCLUSION Our results suggest that changes during reward anticipation in schizophrenia are present from the beginning of the disease. This supports a possible involvement of reward disturbances in the pathophysiology of schizophrenia. The most pronounced changes were seen in relation to overall salience. In ventral striatum these changes were associated with the degree of positive symptoms.
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Affiliation(s)
- Mette Ødegaard Nielsen
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Center for Neuropsychiatric Schizophrenia Research, Copenhagen University Hospital, Glostrup, Denmark.
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141
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Zschucke E, Heinz A, Ströhle A. Exercise and physical activity in the therapy of substance use disorders. ScientificWorldJournal 2012; 2012:901741. [PMID: 22629222 PMCID: PMC3354725 DOI: 10.1100/2012/901741] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 12/08/2011] [Indexed: 11/17/2022] Open
Abstract
Exercise and physical activity are constantly gaining attention as adjuvant treatment for substance use disorders, supplementing classical pharmacological and psychotherapeutic approaches. The present work reviews studies addressing the therapeutic effects of exercise in alcohol abuse/dependence, nicotine abuse/dependence, and illicit drug abuse/dependence. In the field of smoking cessation, evidence is strong for exercise as an effective adjuvant treatment, whereas no generalizable and methodologically strong studies have been published for alcohol and drug treatment so far, allowing only preliminary conclusions about the effectiveness of exercise in these disorders. A couple of potential mechanisms are discussed, by which exercise may act as an effective treatment, as well as future directions for studies investigating exercise as a treatment strategy for substance use disorders.
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Affiliation(s)
- Elisabeth Zschucke
- Klinik für Psychiatrie und Psychotherapie, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 101117 Berlin, Germany.
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142
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Stoy M, Schlagenhauf F, Sterzer P, Bermpohl F, Hägele C, Suchotzki K, Schmack K, Wrase J, Ricken R, Knutson B, Adli M, Bauer M, Heinz A, Ströhle A. Hyporeactivity of ventral striatum towards incentive stimuli in unmedicated depressed patients normalizes after treatment with escitalopram. J Psychopharmacol 2012; 26:677-88. [PMID: 21926423 DOI: 10.1177/0269881111416686] [Citation(s) in RCA: 181] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Major Depressive Disorder (MDD) involves deficits in the reward system. While neuroimaging studies have focused on affective stimulus processing, few investigations have directly addressed deficits in the anticipation of incentives. We examined neural responses during gain and loss anticipation in patients with MDD before and after treatment with a selective serotonin reuptake inhibitor (SSRI). Fifteen adults with MDD and 15 healthy participants, matched for age, verbal IQ and smoking habits, were investigated in a functional magnetic resonance imaging (fMRI) study using a monetary incentive delay task. Patients were scanned drug-free and after 6 weeks of open-label treatment with escitalopram; controls were scanned twice at corresponding time points. We compared the blood oxygenation level dependent (BOLD) response during the anticipation of gain and loss with a neutral condition. A repeated measures ANOVA was calculated to identify effects of group (MDD vs. controls), time (first vs. second scan) and group-by-time interaction. Severity of depression was measured with the Hamilton Rating Scale of Depression and the Beck Depression Inventory. MDD patients showed significantly less ventral striatal activation during anticipation of gain and loss compared with controls before, but not after, treatment. There was a significant group-by-time interaction during anticipation of loss in the left ventral striatum due to a signal increase in patients after treatment. Ventral striatal hyporesponsiveness was associated with the severity of depression and in particular anhedonic symptoms. These findings suggest that MDD patients show ventral striatal hyporesponsiveness during incentive cue processing, which normalizes after successful treatment.
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Affiliation(s)
- Meline Stoy
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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143
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Corcoran C, Smith C, McLaughlin D, Auther A, Malaspina D, Cornblatt B. HPA axis function and symptoms in adolescents at clinical high risk for schizophrenia. Schizophr Res 2012; 135:170-4. [PMID: 22226904 PMCID: PMC3716011 DOI: 10.1016/j.schres.2011.11.035] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 11/27/2011] [Accepted: 11/30/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Stress sensitivity and HPA axis activity may be relevant to the development and expression of psychotic disorders. Cortisol secretion has been associated with positive symptoms both in patients with psychotic disorders and in young people at clinical risk for psychosis. Herein, we aimed to replicate these findings, to determine which positive symptoms may be associated with cortisol levels, and to explore any associations with affective symptoms and impaired stress tolerance. METHODS Thirty-one clinical high risk patients were evaluated in cross-section for associations between salivary cortisol levels upon clinic entry at 11 am, demographic variables, and clinical symptoms. RESULTS Salivary cortisol levels were unrelated to medication exposure or demographics, except for higher levels in the ten females studied. Salivary cortisol bore no relationship to overall positive symptom severity but was associated with anxiety, as well as with suspiciousness and impaired stress tolerance, which were themselves highly intercorrelated. CONCLUSIONS Cortisol secretion in the context of a putative novel social situation (i.e. clinic entry) may be a biological correlate of suspiciousness, impaired stress tolerance and affective symptoms in individuals vulnerable to developing psychosis. These associations are consistent with findings from experience sampling studies in individuals at risk for psychosis as well as basic studies of animal models of schizophrenia.
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Affiliation(s)
- C.M. Corcoran
- New York State Psychiatric Institute at Columbia University, 1051 Riverside Drive, New York, NY 10032, USA
| | - C. Smith
- The RAP Program, Zucker Hillside Hospital Psychiatry Research, 75-59 263rd Street, Glen Oaks, NY 11004, USA
| | - D. McLaughlin
- The RAP Program, Zucker Hillside Hospital Psychiatry Research, 75-59 263rd Street, Glen Oaks, NY 11004, USA
| | - A. Auther
- The RAP Program, Zucker Hillside Hospital Psychiatry Research, 75-59 263rd Street, Glen Oaks, NY 11004, USA
| | - D. Malaspina
- New York State Psychiatric Institute at Columbia University, 1051 Riverside Drive, New York, NY 10032, USA
| | - B. Cornblatt
- The RAP Program, Zucker Hillside Hospital Psychiatry Research, 75-59 263rd Street, Glen Oaks, NY 11004, USA
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144
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Chen G, Cuzon Carlson VC, Wang J, Beck A, Heinz A, Ron D, Lovinger DM, Buck KJ. Striatal involvement in human alcoholism and alcohol consumption, and withdrawal in animal models. Alcohol Clin Exp Res 2011; 35:1739-48. [PMID: 21615425 DOI: 10.1111/j.1530-0277.2011.01520.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Different regions of the striatum may have distinct roles in acute intoxication, alcohol seeking, dependence, and withdrawal. METHODS The recent advances are reviewed and discussed in our understanding of the role of the dorsolateral striatum (DLS), dorsomedial striatum (DMS), and ventral striatum in behavioral responses to alcohol, including alcohol craving in abstinent alcoholics, and alcohol consumption and withdrawal in rat, mouse, and nonhuman primate models. RESULTS Reduced neuronal activity as well as dysfunctional connectivity between the ventral striatum and the dorsolateral prefrontal cortex is associated with alcohol craving and impairment of new learning processes in abstinent alcoholics. Within the DLS of mice and nonhuman primates withdrawn from alcohol after chronic exposure, glutamatergic transmission in striatal projection neurons is increased, while GABAergic transmission is decreased. Glutamatergic transmission in DMS projection neurons is also increased in ethanol withdrawn rats. Ex vivo or in vivo ethanol exposure and withdrawal causes a long-lasting increase in NR2B subunit-containing NMDA receptor activity in the DMS, contributing to ethanol drinking. Analyses of neuronal activation associated with alcohol withdrawal and site-directed lesions in mice implicate the rostroventral caudate putamen, a ventrolateral segment of the DMS, in genetically determined differences in risk for alcohol withdrawal involved in physical association of the multi-PDZ domain protein, MPDZ, with 5-HT(2C) receptors and/or NR2B. CONCLUSIONS Alterations of dopaminergic, glutamatergic, and GABAergic signaling within different regions of the striatum by alcohol is critical for alcohol craving, consumption, dependence, and withdrawal in humans and animal models.
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Affiliation(s)
- Gang Chen
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, Oregon, USA.
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145
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Montag C, Dziobek I, Richter IS, Neuhaus K, Lehmann A, Sylla R, Heekeren HR, Heinz A, Gallinat J. Different aspects of theory of mind in paranoid schizophrenia: evidence from a video-based assessment. Psychiatry Res 2011; 186:203-9. [PMID: 20947175 DOI: 10.1016/j.psychres.2010.09.006] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 09/13/2010] [Accepted: 09/17/2010] [Indexed: 11/25/2022]
Abstract
In schizophrenia, impairments of theory of mind (ToM) may be due to excessive ('overmentalizing') or defective ('undermentalizing') attribution of mental states. However, most ToM tests differentiate neither between 'overmentalizing' and 'undermentalizing' nor between cognitive and affective ToM in schizophrenia. This study aimed at differentiating these aspects of ToM in 80 patients diagnosed with paranoid schizophrenia and 80 matched healthy controls using the 'Movie for the Assessment of Social Cognition' (MASC). Outcome parameters comprised 1) error counts representing 'undermentalizing' or 'overmentalizing', 2) decoding of cognitive or emotional mental states and 3) non-social inferencing. Multivariate analysis of covariance (MANCOVA) showed significantly abnormal scores for two dimensions of 'undermentalizing' as well as for cognitive and emotional ToM that were not explained by global cognitive deficits. Scores for 'overmentalizing' did not differ between groups, when age, gender, non-social reasoning and memory were controlled. In schizophrenic patients, negative symptoms were associated with a lack of a mental state concept, while positive symptoms like delusions were associated with 'overmentalizing', supporting respective etiological concepts of delusions.
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Affiliation(s)
- Christiane Montag
- Charité University Medicine Berlin, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany.
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146
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Huys QJM, Cools R, Gölzer M, Friedel E, Heinz A, Dolan RJ, Dayan P. Disentangling the roles of approach, activation and valence in instrumental and pavlovian responding. PLoS Comput Biol 2011; 7:e1002028. [PMID: 21556131 PMCID: PMC3080848 DOI: 10.1371/journal.pcbi.1002028] [Citation(s) in RCA: 219] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 02/22/2011] [Indexed: 11/18/2022] Open
Abstract
Hard-wired, Pavlovian, responses elicited by predictions of rewards and punishments exert significant benevolent and malevolent influences over instrumentally-appropriate actions. These influences come in two main groups, defined along anatomical, pharmacological, behavioural and functional lines. Investigations of the influences have so far concentrated on the groups as a whole; here we take the critical step of looking inside each group, using a detailed reinforcement learning model to distinguish effects to do with value, specific actions, and general activation or inhibition. We show a high degree of sophistication in Pavlovian influences, with appetitive Pavlovian stimuli specifically promoting approach and inhibiting withdrawal, and aversive Pavlovian stimuli promoting withdrawal and inhibiting approach. These influences account for differences in the instrumental performance of approach and withdrawal behaviours. Finally, although losses are as informative as gains, we find that subjects neglect losses in their instrumental learning. Our findings argue for a view of the Pavlovian system as a constraint or prior, facilitating learning by alleviating computational costs that come with increased flexibility.
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Affiliation(s)
- Quentin J M Huys
- Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom.
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147
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Bermpohl F, Kahnt T, Dalanay U, Hägele C, Sajonz B, Wegner T, Stoy M, Adli M, Krüger S, Wrase J, Ströhle A, Bauer M, Heinz A. Altered representation of expected value in the orbitofrontal cortex in mania. Hum Brain Mapp 2010; 31:958-69. [PMID: 19950195 DOI: 10.1002/hbm.20909] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Increased responsiveness to appetitive and reduced responsiveness to aversive anticipatory cues may be associated with dysfunction of the brain reward system in mania. Here we studied neural correlates of gain and loss expectation in mania using functional magnetic resonance imaging (fMRI). METHOD Fifteen manic patients and 26 matched healthy control individuals performed a monetary incentive delay task, during which subjects anticipated to win or lose a varying amount of money. Varying both magnitude and valence (win, loss) of anticipatory cues allowed us to isolate the effects of magnitude, valence and expected value (magnitude-by-valence interaction). RESULTS Response times and total gain amount did not differ significantly between groups. FMRI data indicated that the ventral striatum responded according to cued incentive magnitude in both groups, and this effect did not significantly differ between groups. However, a significant group difference was observed for expected value representation in the left lateral orbitofrontal cortex (OFC; BA 11 and 47). In this region, patients showed increasing BOLD responses during expectation of increasing gain and decreasing responses during expectation of increasing loss, while healthy subjects tended to show the inverse effect. In seven patients retested after remission OFC responses adapted to the response pattern of healthy controls. CONCLUSIONS The observed alterations are consistent with a state-related affective processing bias during the expectation of gains and losses which may contribute to clinical features of mania, such as the enhanced motivation for seeking rewards and the underestimation of risks and potential punishments.
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Affiliation(s)
- Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
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148
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Systematic analysis of dopamine receptor genes (DRD1-DRD5) in antipsychotic-induced weight gain. THE PHARMACOGENOMICS JOURNAL 2010; 12:156-64. [PMID: 20714340 DOI: 10.1038/tpj.2010.65] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Antipsychotic-induced weight gain has emerged as a serious complication in the treatment of patients with most antipsychotics. We have conducted the first in-depth examination of dopamine receptor genes in antipsychotic-induced weight gain. A total of 206 patients (139 of European descent and 56 African Americans) who underwent treatment for chronic schizophrenia or schizoaffective disorder were evaluated after on average over 6 weeks of treatment. Thirty-six tag single nucleotide polymorphisms (SNPs) and one variable-number tandem repeat, spanning the five dopamine receptor genes (DRD1-DRD5) were analyzed. In the total sample, we found a nominally significant association between the DRD2 rs1079598 marker and weight change using a cutoff of 7% gain (P=0.03). When stratifying the sample according to ethnicity and antipsychotics with highest risk for weight gain, we found significant associations in three DRD2 SNPs: rs6277 (C957T), rs1079598 and rs1800497 (TaqIA). The other genes were primarily negative. We provide evidence that dopamine receptor DRD2 gene variants might be associated with antipsychotic-induced weight gain in chronic schizophrenia patients.
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149
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Voss M, Moore J, Hauser M, Gallinat J, Heinz A, Haggard P. Altered awareness of action in schizophrenia: a specific deficit in predicting action consequences. ACTA ACUST UNITED AC 2010; 133:3104-12. [PMID: 20685805 DOI: 10.1093/brain/awq152] [Citation(s) in RCA: 216] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patients suffering from schizophrenia may report unusual experiences of their own actions. They may either feel that external forces are controlling their actions or even their thoughts, or they may feel in control of events that in fact are not caused by their actions. Most theories link these disturbances in the sense of agency to deficits in motor prediction, resulting in a mismatch between predicted and actual sensory feedback at a central comparator mechanism. Such theories therefore can account for situations in which the sense of agency is reduced. However, other experiments as well as clinical observations show an enhanced rather than reduced sense of agency in schizophrenic patients. Here, we distinguish between a predictive and a retrospective mechanism where both contribute to the experience of agency, and show that schizophrenia is associated with a specific impairment to the predictive component. We measured subjective time estimates of self-initiated voluntary action (a key press) that were followed by a sensory effect (a tone). When the voluntary actions had a high probability of causing tones, healthy volunteers showed a predictive shift of the perceptual estimate of the action towards the tone, even on occasional trials where the tone was omitted. No such shift occurred in the absence of the tone on blocks when tones were less frequent. The predictive component of action awareness was calculated as the difference between time estimates on 'action only' trials from blocks with lower and higher tone probabilities. Schizophrenic patients lacked this predictive component of action awareness, showing a shift on 'action only' trials, regardless of the probability of the tone. Importantly, the schizophrenic deficit in predicting the relation between action and effect was strongly correlated with severity of positive psychotic symptoms, specifically delusions and hallucinations. Furthermore, the patients showed an exaggerated retrospective binding between action and tone, shifting the perceived time of action whenever the tone occurred, relative to when it did not occur. Our quantitative, implicit measures show how basic sensory and motor experience may be altered in acute psychosis. The enhanced sense of agency in schizophrenia reflects reliance on retrospection, rather than prediction, to associate actions with external events. The failure to predict the effects of one's own actions may underlie the blurring and confusion in the relationship between the self and the world that characterizes acute psychosis.
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Affiliation(s)
- Martin Voss
- Department of Psychiatry and Psychotherapy, Charité University Hospital, St. Hedwig Hospital, Grosse Hamburger Strasse 5-11, Berlin, Germany.
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150
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Heinz A, Beck A, Mir J, Grüsser S, Grace A, Wrase J. Alcohol Craving and Relapse Prediction. ACTA ACUST UNITED AC 2010. [DOI: 10.1201/9781420007350-c4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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