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Progressive striatal and hippocampal volume loss in initially antipsychotic-naive, first-episode schizophrenia patients treated with quetiapine: relationship to dose and symptoms. Int J Neuropsychopharmacol 2011; 14:69-82. [PMID: 20701823 DOI: 10.1017/s1461145710000817] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
First-generation antipsychotics have been associated with striatal volume increases. The effects of second-generation antipsychotics (SGAs) on the striatum are unclear. Moreover, SGAs may have neuroprotective effects on the hippocampus. Dose-dependent volumetric effects of individual SGAs have scarcely been investigated. Here we investigated structural brain changes in antipsychotic-naive, first-episode schizophrenia patients after 6 months treatment with the SGA, quetiapine. We have recently reported on baseline volume reductions in the caudate nucleus and hippocampus. Baseline and follow-up T1-weighted images (3 T) from 22 patients and 28 matched healthy controls were analysed using tensor-based morphometry. Non-parametric voxel-wise group comparisons were performed. Small volume correction was employed for striatum, hippocampus and ventricles. Dose-dependent medication effects and associations with psychopathology were assessed. Patients had significant bilateral striatal and hippocampal loss over the 6-month treatment period. When compared to controls the striatal volume loss was most pronounced with low quetiapine doses and less apparent with high doses. Post-hoc analyses revealed that the striatal volume loss was most pronounced in the caudate and putamen, but not in accumbens. Conversely, hippocampal volume loss appeared more pronounced with high quetiapine doses than with low doses. Clinically, higher baseline positive symptoms were associated with more striatal and hippocampal loss over time. Although patients' ventricles did not change significantly, ventricular increases correlated with less improvement of negative symptoms. Progressive regional volume loss in quetiapine-treated, first-episode schizophrenia patients may be dose-dependent and clinically relevant. The mechanisms underlying progressive brain changes, specific antipsychotic compounds and clinical symptoms warrant further research.
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202
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Meyer U, Feldon J. To poly(I:C) or not to poly(I:C): advancing preclinical schizophrenia research through the use of prenatal immune activation models. Neuropharmacology 2011; 62:1308-21. [PMID: 21238465 DOI: 10.1016/j.neuropharm.2011.01.009] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 01/05/2011] [Accepted: 01/07/2011] [Indexed: 10/18/2022]
Abstract
The neurodevelopmental hypothesis of schizophrenia has been highly influential in shaping our current thinking about modeling the disease in animals. Based on the findings provided by human epidemiological studies, a great deal of recent interest has been centered upon the establishment of neurodevelopmental rodent models in which the basic experimental manipulation takes the form of prenatal exposure to infection and/or immune activation. One such model is based on prenatal treatment with the inflammatory agent poly(I:C) (=polyriboinosinic-polyribocytidilic acid), a synthetic analog of double-stranded RNA. Since its initial establishment and application to basic schizophrenia research, the poly(I:C) model has made a great impact on researchers concentrating on the neurodevelopmental and neuroimmunological basis of complex human brain disorders such as schizophrenia, and as a consequence, the model now enjoys wide recognition in the international scientific community. The present article emphasizes that the poly(I:C) model has gained such impact because it successfully accounts for several aspects of schizophrenia epidemiology, pathophysiology, symptomatology, and treatment. The numerous features of this experimental system make the poly(I:C) model a very powerful neurodevelopmental animal model of schizophrenia-relevant brain disease which is expected to be capable of critically advancing our knowledge of how the brain, following an (immune-associated) triggering event in early life, can develop into a "schizophrenia-like brain" over time. Furthermore, the poly(I:C) model seems highly suitable for the exploration of novel pharmacological and neuro-immunomodulatory strategies for both symptomatic and preventive treatments against psychotic disease, as well as for the identification of neurobiological mechanisms underlying gene-environment and environment-environment interactions presumably involved in the etiology of schizophrenia and related disorders.
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Affiliation(s)
- Urs Meyer
- Laboratory of Behavioral Neurobiology, Swiss Federal Institute of Technology (ETH) Zurich, Schorenstrasse 16, 8603 Schwerzenbach, Switzerland.
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203
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Cortical thickness, gray matter volume, and white matter anisotropy and diffusivity in schizophrenia. Neuroradiology 2011; 53:859-66. [PMID: 21212942 DOI: 10.1007/s00234-010-0830-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 12/21/2010] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The study was conducted to evaluate simultaneously gray matter changes and white matter changes in patients with schizophrenia. METHODS Cortical thickness, gray matter volume, and white matter anisotropy and diffusivity changes in schizophrenic patients (n = 21) were assessed relative to age-, gender-, and parental socioeconomic status-matched healthy controls (n = 21). We used a newly described semi-automated method (FreeSurfer version 4.5) to determine cortical thickness and gray matter volume and used the tract-based spatial statistics method to evaluate white matter anisotropy and diffusivity. RESULTS Schizophrenic patients showed a significant decrease in hippocampal volume compared with healthy controls. No significant thickness deficits or anisotropy and diffusivity changes were found in schizophrenic patients compared with healthy controls. Stepwise multivariate analysis revealed that hippocampal volume was positively related to duration of illness in schizophrenic patients. CONCLUSION Our results suggest that hippocampal volume is smaller in schizophrenic patients compared with healthy controls and that progressive hippocampal volume loss occurs in the early course of illness in schizophrenic patients but not in the more chronic stages.
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204
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Age-related cortical thinning in schizophrenia. Schizophr Res 2011; 125:21-9. [PMID: 21036016 DOI: 10.1016/j.schres.2010.10.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 09/27/2010] [Accepted: 10/05/2010] [Indexed: 11/24/2022]
Abstract
Although the effects of aging on the neural correlates of schizophrenia have been researched for many years, no clear conclusion has been reached. While some studies have demonstrated progressive age-related gray matter reductions in schizophrenia, other studies have not found evidence of progression. Moreover, it remains unclear whether the influence of aging on global or regional cortical thickness differs between schizophrenia patients and healthy controls. This study aimed to confirm previous reports of reduced cortical thickness in schizophrenia, and to investigate the effects of age on global and regional cortical thickness. Eighty-three patients with schizophrenia (six first-episode patients and 77 chronic patients; age range=18-55 years) and 90 age-, gender- and education-matched healthy controls (age range=19-56 years) underwent structural magnetic resonance imaging (MRI) using a 3-Tesla scanner. Surface-based analysis was applied to assess cortical thickness in the whole brain. The patient group exhibited both global and regional cortical thinning in regions including the prefrontal and temporal cortices. The correlation between age and cortical thickness showed a similar pattern in patients and controls, both globally and regionally. These results suggest that the reduction of cortical thickness in schizophrenia might not be progressive over the course of the illness, indicating that pathological processes occur in a relatively limited period of time around the onset of illness.
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205
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White T, Magnotta VA, Bockholt HJ, Williams S, Wallace S, Ehrlich S, Mueller BA, Ho BC, Jung RE, Clark VP, Lauriello J, Bustillo JR, Schulz SC, Gollub RL, Andreasen NC, Calhoun VD, Lim KO. Global white matter abnormalities in schizophrenia: a multisite diffusion tensor imaging study. Schizophr Bull 2011; 37:222-32. [PMID: 19770491 PMCID: PMC3004177 DOI: 10.1093/schbul/sbp088] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Emerging evidence implicates white matter (WM) abnormalities in the pathophysiology of schizophrenia. However, there is considerable heterogeneity in the presentation of WM abnormalities in the existing studies. The object of this study was to evaluate WM integrity in a large sample of patients with first-episode (FE) and chronic schizophrenia in comparison to matched control groups. Our goal was to assess whether WM findings occurred early in the illness or whether these abnormalities developed with the illness over time. METHODS Participants included 114 patients with schizophrenia (31 FE and 83 chronic patients) and 138 matched controls. High-resolution structural and diffusion tensor images were obtained on all participants. Measures of fractional anisotropy (FA) were calculated for the 4 cortical lobes and the cerebellum and brain stem. RESULTS FA was significant lower in patients vs controls in the whole brain and individually in the frontal, parietal, occipital, and temporal lobes. FA was not significantly different in the brain stem or cerebellum. FA differences were significant only in patients with chronic schizophrenia and not in the FE group. CONCLUSIONS We found global differences in the WM microstructure in patients with chronic but not FE schizophrenia. These findings suggest progressive alterations in WM microstructure.
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Affiliation(s)
- Tonya White
- Department of Child and Adolescent Psychiatry, Erasmus University, 3000 CB Rotterdam, the Netherlands.
| | | | | | | | - Stuart Wallace
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129
| | - Stefan Ehrlich
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129,Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02129
| | - Bryon A. Mueller
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454
| | - Beng-Choon Ho
- Department of Psychiatry, University of Iowa, Iowa City, IA 52242
| | - Rex E. Jung
- Department of Psychology, University of New Mexico, Albuquerque, NM 87106
| | - Vincent P. Clark
- The Mind Research Network, Albuquerque, NM 87106,Department of Psychology, University of New Mexico, Albuquerque, NM 87106
| | - John Lauriello
- Department of Psychiatry, University of Missouri, Columbia, MO 65212
| | - Juan R. Bustillo
- Department of Psychiatry, University of New Mexico, Albuquerque, NM 87106
| | - S. Charles Schulz
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454
| | - Randy L. Gollub
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129,Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02129
| | | | - Vince D. Calhoun
- The Mind Research Network, Albuquerque, NM 87106,Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM 87106
| | - Kelvin O. Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454,Center for Magnetic Resonance Research, Minneapolis, MN 55455,Minneapolis Veterans Administration Medical Center, Minneapolis, MN 55417
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206
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Wüstenberg T, Begemann M, Bartels C, Gefeller O, Stawicki S, Hinze-Selch D, Mohr A, Falkai P, Aldenhoff JB, Knauth M, Nave KA, Ehrenreich H. Recombinant human erythropoietin delays loss of gray matter in chronic schizophrenia. Mol Psychiatry 2011; 16:26-36, 1. [PMID: 20479759 DOI: 10.1038/mp.2010.51] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Neurodevelopmental abnormalities together with neurodegenerative processes contribute to schizophrenia, an etiologically heterogeneous, complex disease phenotype that has been difficult to model in animals. The neurodegenerative component of schizophrenia is best documented by magnetic resonance imaging (MRI), demonstrating progressive cortical gray matter loss over time. No treatment exists to counteract this slowly proceeding atrophy. The hematopoietic growth factor erythropoietin (EPO) is neuroprotective in animals. Here, we show by voxel-based morphometry in 32 human subjects in a placebo-controlled study that weekly high-dose EPO for as little as 3 months halts the progressive atrophy in brain areas typically affected in schizophrenia, including hippocampus, amygdala, nucleus accumbens, and several neocortical areas. Specifically, gray matter protection is highly associated with improvement in attention and memory functions. These findings suggest that a neuroprotective strategy is effective against common pathophysiological features of schizophrenic patients, and strongly encourage follow-up studies to optimize EPO treatment dose and duration.
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Affiliation(s)
- T Wüstenberg
- Department of Neuroradiology, Georg-August-University, Göttingen, Germany
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207
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Leung M, Cheung C, Yu K, Yip B, Sham P, Li Q, Chua S, McAlonan G. Gray matter in first-episode schizophrenia before and after antipsychotic drug treatment. Anatomical likelihood estimation meta-analyses with sample size weighting. Schizophr Bull 2011; 37:199-211. [PMID: 19759093 PMCID: PMC3004197 DOI: 10.1093/schbul/sbp099] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cerebral morphological abnormalities in schizophrenia may be modulated by treatment, chronicity, and duration of illness. Comparing brain imaging studies of individuals with first-episode schizophrenia and neuroleptic naive (NN-FES) with that of their neuroleptic-treated counterparts (NT-FES) can help to dissect out the effect of these potential confounders. METHODS We used the anatomical likelihood estimation method to compare voxel-based morphometric studies of NN-FES (n = 162 patients) and NT-FES (n = 336 patients) studies. The analysis included a sample size weighting step based on the Liptak-Stouffer method to reflect the greater power of larger studies. RESULTS Patient samples were matched for age, gender, and duration of illness. An extensive network of gray matter deficits in frontal, temporal, insular, striatal, posterior cingulate, and cerebellar regions was detected in the NN-FES samples as compared with healthy controls. Major deficits were detected in the frontal, superior temporal, insular, and parahippocampal regions for the NT-FES group compared with the NN-FES group. In addition, the NT-FES group showed minor deficits in the caudate, cingulate, and inferior temporal regions compared with the NN-FES group. There were no regions with gray matter volumetric excess in the NT-FES group. CONCLUSION Frontal, striato-limbic, and temporal morphological abnormalities are present in the early stage of schizophrenia and are unrelated to the effects of neuroleptic treatment, chronicity, and duration of illness. There may be dynamic effects of treatment on striato-limbic and temporal, but not frontal, regional gray matter volumes of the brain.
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Affiliation(s)
- Meikei Leung
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Charlton Cheung
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kevin Yu
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Benjamin Yip
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Pak Sham
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong,Centre for Reproduction, Development and Growth, The University of Hong Kong
| | - Qi Li
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong,Centre for Reproduction, Development and Growth, The University of Hong Kong
| | - Siew Chua
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong,Centre for Reproduction, Development and Growth, The University of Hong Kong
| | - Grainne McAlonan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong,Centre for Reproduction, Development and Growth, The University of Hong Kong,To whom correspondence should be addressed; tel: +852-28199564, fax: +852-28551345, e-mail:
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208
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Horga G, Bernacer J, Dusi N, Entis J, Chu K, Hazlett EA, Mehmet Haznedar M, Kemether E, Byne W, Buchsbaum MS. Correlations between ventricular enlargement and gray and white matter volumes of cortex, thalamus, striatum, and internal capsule in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2011; 261:467-76. [PMID: 21431919 PMCID: PMC3182327 DOI: 10.1007/s00406-011-0202-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 02/15/2011] [Indexed: 11/25/2022]
Abstract
Ventricular enlargement is one of the most consistent abnormal structural brain findings in schizophrenia and has been used to infer brain shrinkage. However, whether ventricular enlargement is related to local overlying cortex and/or adjacent subcortical structures or whether it is related to brain volume change globally has not been assessed. We systematically assessed interrelations of ventricular volumes with gray and white matter volumes of 40 Brodmann areas (BAs), the thalamus and its medial dorsal nucleus and pulvinar, the internal capsule, caudate and putamen. We acquired structural MRI ( patients with schizophrenia (n = 64) and healthy controls (n = 56)) and diffusion tensor fractional anisotropy (FA) (untreated schizophrenia n = 19, controls n = 32). Volumes were assessed by manual tracing of central structures and a semi-automated parcellation of BAs. Patients with schizophrenia had increased ventricular size associated with decreased cortical gray matter volumes widely across the brain; a similar but less pronounced pattern was seen in normal controls; local correlations (e.g. temporal horn with temporal lobe volume) were not appreciably higher than non-local correlations (e.g. temporal horn with prefrontal volume). White matter regions adjacent to the ventricles similarly did not reveal strong regional relationships. FA and center of mass of the anterior limb of the internal capsule also appeared differentially influenced by ventricular volume but findings were similarly not regional. Taken together, these findings indicate that ventricular enlargement is globally interrelated with gray matter volume diminution but not directly correlated with volume loss in the immediately adjacent caudate, putamen, or internal capsule.
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Affiliation(s)
- Guillermo Horga
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, 10029 New York, NY USA
- Schizophrenia Clinic Program, Department of Psychiatry, Hospital Clínic Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Javier Bernacer
- Laboratory of Functional Neuromorphology, Clinica Universitaria, Universidad de Navarra, Avda. Pío XII 36, 31008 Pamplona, Spain
| | - Nicola Dusi
- Department of Public Health and Community Medicine, Section of Psychiatry and Clinical Psychology, University of Verona, Policlinico Giambattista Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Jonathan Entis
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, 10029 New York, NY USA
| | - Kingwai Chu
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, 10029 New York, NY USA
| | - Erin A. Hazlett
- Department of Psychiatry, James J Peters VA Medical Center, 130 West Kingsbridge Road, 10468 Bronx, NY USA
| | - M. Mehmet Haznedar
- Department of Psychiatry, James J Peters VA Medical Center, 130 West Kingsbridge Road, 10468 Bronx, NY USA
| | - Eileen Kemether
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, 10029 New York, NY USA
| | - William Byne
- Department of Psychiatry, James J Peters VA Medical Center, 130 West Kingsbridge Road, 10468 Bronx, NY USA
| | - Monte S. Buchsbaum
- Departments of Psychiatry and Radiology, NeuroPET Center, University of California, 11388 Sorrento Valley Road, Suite #100, 92121 San Diego, CA USA
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209
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Aberrant frontal and temporal complex network structure in schizophrenia: a graph theoretical analysis. J Neurosci 2010; 30:15915-26. [PMID: 21106830 DOI: 10.1523/jneurosci.2874-10.2010] [Citation(s) in RCA: 503] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Brain regions are not independent. They are interconnected by white matter tracts, together forming one integrative complex network. The topology of this network is crucial for efficient information integration between brain regions. Here, we demonstrate that schizophrenia involves an aberrant topology of the structural infrastructure of the brain network. Using graph theoretical analysis, complex structural brain networks of 40 schizophrenia patients and 40 human healthy controls were examined. Diffusion tensor imaging was used to reconstruct the white matter connections of the brain network, with the strength of the connections defined as the level of myelination of the tracts as measured through means of magnetization transfer ratio magnetic resonance imaging. Patients displayed a preserved overall small-world network organization, but focusing on specific brain regions and their capacity to communicate with other regions of the brain revealed significantly longer node-specific path lengths (higher L) of frontal and temporal regions, especially of bilateral inferior/superior frontal cortex and temporal pole regions. These findings suggest that schizophrenia impacts global network connectivity of frontal and temporal brain regions. Furthermore, frontal hubs of patients showed a significant reduction of betweenness centrality, suggesting a less central hub role of these regions in the overall network structure. Together, our findings suggest that schizophrenia patients have a less strongly globally integrated structural brain network with a reduced central role for key frontal hubs, resulting in a limited structural capacity to integrate information across brain regions.
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210
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Salvador R, Sarró S, Gomar JJ, Ortiz-Gil J, Vila F, Capdevila A, Bullmore E, McKenna PJ, Pomarol-Clotet E. Overall brain connectivity maps show cortico-subcortical abnormalities in schizophrenia. Hum Brain Mapp 2010; 31:2003-14. [PMID: 20225222 PMCID: PMC6870792 DOI: 10.1002/hbm.20993] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 11/27/2009] [Accepted: 12/17/2009] [Indexed: 11/08/2022] Open
Abstract
Abnormal interactions between areas of the brain have been pointed as possible causes for schizophrenia. However, the nature of these disturbances and the anatomical location of the regions involved are still unclear. Here, we describe a method to estimate maps of net levels of connectivity in the resting brain, and we apply it to look for differential patterns of connectivity in schizophrenia. This method uses partial coherences as a basic measure of covariability, and it minimises the effect of major physiological noise. When overall (net) connectivity maps of a sample of 40 patients with schizophrenia were compared with the maps from a matched sample of 40 controls, a single area of abnormality was found. It is an area of patient hyper-connectivity and is located frontally, in medial and orbital structures, clearly overlapping the anterior node of the default mode network (DMN). When this area is used as a region of interest in a second-level analysis, it shows functional hyper-connections with several cortical and subcortical structures. Interestingly, the most significant abnormality is found with the caudate, which has a bilateral pattern of abnormality, pointing to a possible DMN-striatum deviant relation in schizophrenia. However, hyper-connectivity observed with other regions (right hippocampus and amygdala, and other cortical structures) suggests a more pervasive alteration of brain connectivity in this disease.
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Affiliation(s)
- Raymond Salvador
- Benito Menni C.A.S.M.-CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain.
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211
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Shenton ME, Whitford TJ, Kubicki M. Structural neuroimaging in schizophrenia: from methods to insights to treatments. DIALOGUES IN CLINICAL NEUROSCIENCE 2010. [PMID: 20954428 PMCID: PMC3181976 DOI: 10.31887/dcns.2010.12.3/mshenton] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Historically, Kraepelin speculated that dementia praecox resulted from damage to the cerebral cortex, most notably the frontal and temporal cortices. It is only recently, however, that tools have been available to test this hypothesis. Now, more than a century later, we know that schizophrenia is a brain disorder. This knowledge comes from critical advances in imaging technology--including computerized axial tomography, magnetic resonance imaging, and diffusion imaging--all of which provide an unprecedented view of neuroanatomical structures, in vivo. Here, we review evidence for structural neuroimaging abnormalities, beginning with evidence for focal brain abnormalities, primarily in gray matter, and proceeding to the quest to identify abnormalities in brain systems and circuits by focusing on damage to white matter connections in the brain. We then review future prospects that need to be explored and pursued in order to translate our current knowledge into an understanding of the neurobiology of schizophrenia, which can then be translated into novel treatments.
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Affiliation(s)
- Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, 1249 Boylston Street Boston, MA 02215, USA.
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212
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Penttilä M, Jääskeläinen E, Haapea M, Tanskanen P, Veijola J, Ridler K, Murray GK, Barnes A, Jones PB, Isohanni M, Koponen H, Miettunen J. Association between duration of untreated psychosis and brain morphology in schizophrenia within the Northern Finland 1966 Birth Cohort. Schizophr Res 2010; 123:145-52. [PMID: 20832996 DOI: 10.1016/j.schres.2010.08.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 07/27/2010] [Accepted: 08/10/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Duration of untreated psychosis (DUP) has been linked with poor prognosis and changes in the brain structure in schizophrenia at least at the beginning of the disease, but it is still unknown whether DUP relates to brain morphometry in the longer term. Our aim was to analyze the relation between DUP and the brain structure in schizophrenia in the general population, after several years of illness. METHODS Brains of subjects with psychosis from the Northern Finland 1966 Birth Cohort (NFBC 1966) were scanned with MRI during 1999-2001 after an 11-year follow-up. DUP was assessed from medical records and regressed against global and local tissue density measurements. The brain morphometric and the DUP information were available for 46 subjects with DSM-III-R schizophrenia. RESULTS The DUP did not correlate with volumes of the total gray or white matter or the cerebrospinal fluid. The length of DUP associated positively with reduced densities of the right limbic area and the right hippocampus. CONCLUSIONS Long DUP was slightly associated with reductions of gray matter densities in the limbic area and especially the hippocampus after several years follow-up, supporting the hypothesis that, compared to short DUP, long DUP might be a marker of different disease trajectories including subtle morphometric changes.
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Affiliation(s)
- Matti Penttilä
- University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, P.O. Box 5000, FIN-90014 Oulu, Finland.
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213
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Abstract
OBJECTIVE Previous studies have shown that patients with schizophrenia have less modulation of the task-positive and default mode neural networks during novelty detection. The diminished modulation may be interpreted as less functional activation of the task-positive network and less functional deactivation of the default mode network. The relationship between network modulation and age has not been assessed in patients with a long duration of illness. METHOD Seventeen patients with schizophrenia (age range, from 34 to 60 years) with minimum disorder duration of 15 years and 28 demographically similar comparison subjects (age range, from 36 to 58 years) from the Mind Clinical Imaging Consortium database completed the auditory oddball discrimination task. Independent component analysis identified temporally cohesive but spatially distributed neural networks. RESULTS Group membership (F[1, 41] = 7.17, p = 0.011) and the interaction of group and age (F[1, 41] = 6.92, p = 0.012) affected the modulation of the anterior default mode network. Duration of illness was also significantly related to the modulation of the anterior default mode network (t[2, 15] = 2.24, p <0.042). These results were selective for the anterior default mode network and were not replicated with the posterior default mode network. CONCLUSIONS These findings show evidence of changes in the temporal modulation of the anterior default mode network with age and duration of illness in patients with schizophrenia. The loss of negative modulation of the anterior default mode network suggests that neural functions in schizophrenia may not be "static" later in the disease course.
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214
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van Veelen NMJ, Vink M, Ramsey NF, Kahn RS. Left dorsolateral prefrontal cortex dysfunction in medication-naive schizophrenia. Schizophr Res 2010; 123:22-9. [PMID: 20724113 DOI: 10.1016/j.schres.2010.07.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 06/23/2010] [Accepted: 07/12/2010] [Indexed: 11/18/2022]
Abstract
Abnormalities in the frontal lobe are considered to be central to the pathology of schizophrenia. Neuroimaging studies indeed report abnormal function of the frontal lobe in schizophrenia patients. However, the nature of these functional abnormalities is unclear, in particular whether they are affected by medication. We therefore investigated whether frontal functioning is already abnormal in first-episode medication-naive schizophrenia, and if so, if this dysfunction is related to symptomatology. Thirty medication-naive male patients with first-episode schizophrenia and 36 matched healthy controls performed a modified working memory task while fMRI data were acquired. During the task, subjects were presented with novel task (NT) and practiced task (PT) memory sets. Compared to controls, patients showed reduced performance during NT and PT. However, both groups performed better during PT, indicating that practice improved performance. Importantly, practice reduced brain activation in both patients and controls, but this effect of practice was significantly smaller in patients compared to controls, specifically in the left dorsolateral prefrontal cortex (DLPFC; p=0.01). The reduced effect of practice on brain activation was related to the severity of negative symptoms and disorganization. These results suggest that DLPFC function is deficient in the early phases of schizophrenia and cannot be attributed to the use of antipsychotics.
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Rosa PGP, Schaufelberger MS, Uchida RR, Duran FLS, Lappin JM, Menezes PR, Scazufca M, McGuire PK, Murray RM, Busatto GF. Lateral ventricle differences between first-episode schizophrenia and first-episode psychotic bipolar disorder: A population-based morphometric MRI study. World J Biol Psychiatry 2010; 11:873-87. [PMID: 20545464 DOI: 10.3109/15622975.2010.486042] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The extent to which psychotic disorders fall into distinct diagnostic categories or can be regarded as lying on a single continuum is controversial. We compared lateral ventricle volumes between a large sample of patients with first-episode schizophrenia or bipolar disorder and a healthy control group from the same neighbourhood. METHODS Population-based MRI study with 88 first-episode psychosis (FEP) patients, grouped into those with schizophrenia/schizophreniform disorder (N=62), bipolar disorder (N=26) and 94 controls. RESULTS Right and left lateral ventricular and right temporal horn volumes were larger in FEP subjects than controls. Within the FEP sample, post-hoc tests revealed larger left lateral ventricles and larger right and left temporal horns in schizophrenia subjects relative to controls, while there was no difference between patients with bipolar disorder and controls. None of the findings was attributable to effects of antipsychotics. CONCLUSIONS This large-sample population-based MRI study showed that neuroanatomical abnormalities in subjects with schizophrenia relative to controls from the same neighbourhood are evident at the first episode of illness, but are not detectable in bipolar disorder patients. These data are consistent with a model of psychosis in which early brain insults of neurodevelopmental origin are more relevant to schizophrenia than to bipolar disorder.
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Affiliation(s)
- Pedro G P Rosa
- Department & Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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216
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Hope S, Melle I, Aukrust P, Agartz I, Lorentzen S, Steen NE, Djurovic S, Ueland T, Andreassen OA. Osteoprotegerin levels in patients with severe mental disorders. J Psychiatry Neurosci 2010; 35:304-10. [PMID: 20569643 PMCID: PMC2928283 DOI: 10.1503/jpn.090088] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Severe mental disorders are associated with elevated levels of inflammatory markers. In the present study, we investigated whether osteoprotegerin (OPG), a member of the tumour necrosis factor receptor family involved in calcification and inflammation, is elevated in patients with severe mental disorders. METHODS We measured the plasma levels of OPG in patients with severe mental disorders (n = 312; 125 with bipolar disorder and 187 with schizophrenia) and healthy volunteers (n = 239). RESULTS The mean plasma levels of OPG were significantly higher in patients than in controls (t531 = 2.6, p = 0.01), with the same pattern in bipolar disorder and schizophrenia. The increase was significant after adjustment for possible confounding variables, including age, sex, ethnic background, alcohol consumption, liver and kidney function, diabetes, cardiovascular disease, autoimmune diseases and levels of cholesterol, glucose and C-reactive protein. LIMITATIONS Owing to the cross-sectional design, it is difficult to determine causality. CONCLUSION Our results indicate that elevated OPG levels are associated with severe mental disorders and suggest that mechanisms related to calcification and inflammation may play a role in disease development.
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Affiliation(s)
- Sigrun Hope
- Department of Psychiatry, Østfold Hospital, Fredrikstad, Norway.
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217
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Abstract
BACKGROUND People with schizophrenia are often found to have smaller brains and larger brain ventricles than normal, but the role of antipsychotic medication remains unclear. METHOD We conducted a systematic review of magnetic resonance imaging (MRI) studies. We included longitudinal studies of brain changes in patients taking antipsychotic drugs and we examined studies of antipsychotic-naive patients for comparison purposes. RESULTS Fourteen out of 26 longitudinal studies showed a decline in global brain or grey-matter volume or an increase in ventricular or cerebrospinal fluid (CSF) volume during the course of drug treatment, including the largest studies conducted. The frontal lobe was most consistently affected, but overall changes were diffuse. One large study found different degrees of volume loss with different antipsychotics, and another found that volume changes were associated with taking medication compared with taking none. Analyses of linear associations between drug exposure and brain volume changes produced mixed results. Five out of 21 studies of patients who were drug naive, or had only minimal prior treatment, showed some differences from controls in volumes of interest. No global differences were reported in three studies of drug-naive patients with long-term illness. Studies of high-risk groups have not demonstrated differences from controls in global or lobar brain volumes. CONCLUSIONS Some evidence points towards the possibility that antipsychotic drugs reduce the volume of brain matter and increase ventricular or fluid volume. Antipsychotics may contribute to the genesis of some of the abnormalities usually attributed to schizophrenia.
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Affiliation(s)
- J Moncrieff
- Department of Mental Health Sciences, University College London, UK.
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218
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Tanskanen P, Ridler K, Murray GK, Haapea M, Veijola JM, Jääskeläinen E, Miettunen J, Jones PB, Bullmore ET, Isohanni MK. Morphometric brain abnormalities in schizophrenia in a population-based sample: relationship to duration of illness. Schizophr Bull 2010; 36:766-77. [PMID: 19015212 PMCID: PMC2894604 DOI: 10.1093/schbul/sbn141] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Biased recruitment and sample selection may cause variability in neuroimaging studies. Epidemiologically principled population-based magnetic resonance imaging (MRI) studies of schizophrenia are very rare. We gathered structural MRI data on 154 subjects from the Northern Finland 1966 Birth Cohort, aged 33-35 (100 controls, 54 schizophrenia patients). Regional differences in density of gray matter, white matter, and cerebrospinal fluid (CSF) were identified between groups using nonparametric statistical analysis, and the relationship of the regional differences to duration of illness was explored. Gray matter reductions were found bilaterally in the cerebellum, thalamus, basal ganglia, middle frontal gyrus, inferior frontal gyrus, precentral gyrus, insula, superior temporal gyrus, fusiform gyrus, parahippocampal gyrus, cuneus, and lingual gyrus; in the left posterior cingulate, superior frontal gyrus, transverse temporal gyrus, and precuneus; and in the right postcentral gyrus. Gray matter excesses were observed bilaterally in the basal ganglia, anterior cingulate, and medial orbitofrontal cortices. There were white matter deficits in an extensive network including inter- and intrahemispheric tracts bilaterally in the frontal, temporal, parietal, and occipital lobes, subcortical structures, cerebellum, and brain stem. CSF excesses were found bilaterally in the lateral ventricles, third ventricle, interhemispheric, and left Sylvian fissure. We replicated the previous findings of structural brain abnormalities in schizophrenia on a general population level. Gray and white matter deficits were associated with duration of illness suggesting either that developmental brain deficits relate to an earlier age of onset or that brain abnormalities in schizophrenia are progressive in nature.
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Affiliation(s)
- Päivikki Tanskanen
- Department of Diagnostic Radiology, University of Oulu, FIN-90029 OYS, Oulu, Finland.
| | - Khanum Ridler
- GlaxoSmithKline Clinical Imaging Centre, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK,Brain Mapping Unit, Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 2QQ, UK
| | - Graham K. Murray
- Brain Mapping Unit, Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 2QQ, UK
| | - Marianne Haapea
- Department of Diagnostic Radiology, University of Oulu, FIN-90029 OYS, Oulu, Finland,Department of Psychiatry, University of Oulu, FIN-90014 Oulu, Finland
| | - Juha M. Veijola
- Department of Psychiatry, University of Oulu, FIN-90014 Oulu, Finland,Academy of Finland, PL 99, FIN-00501 Helsinki, Finland
| | | | - Jouko Miettunen
- Department of Psychiatry, University of Oulu, FIN-90014 Oulu, Finland
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK
| | - Edward T. Bullmore
- Brain Mapping Unit, Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 2QQ, UK
| | - Matti K. Isohanni
- Department of Psychiatry, University of Oulu, FIN-90014 Oulu, Finland,University of Oulu, Department of Public Health Science and General Practice, FIN-90014 Oulu, Finland
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Van Haren NEM, Koolschijn PCMP, Cahn W, Schnack HG, Hulshoff Pol HE, Kahn RS. Cigarette smoking and progressive brain volume loss in schizophrenia. Eur Neuropsychopharmacol 2010; 20:454-8. [PMID: 20227855 DOI: 10.1016/j.euroneuro.2010.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 12/21/2009] [Accepted: 02/13/2010] [Indexed: 10/19/2022]
Abstract
It is unknown whether the reported brain loss in schizophrenia can be attributed to the effects of tobacco smoking. 96 Patients (54 smokers/42 non-smokers) and 113 control subjects (35/78) were included in a 5-year longitudinal MRI study. Despite the higher prevalence of smoking behavior and the higher number of cigarettes consumed per day in the patients, cigarette smoking did not explain the excessive cerebral (gray matter) volume decreases in the patients. Moreover, smoking was not associated with brain volume change over time in the healthy subjects. However, extremely heavy smoking may contribute to excessive gray matter volume loss in schizophrenia.
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Affiliation(s)
- N E M Van Haren
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Centre Utrecht, The Netherlands.
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220
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Horn H, Federspiel A, Wirth M, Müller TJ, Wiest R, Walther S, Strik W. Gray matter volume differences specific to formal thought disorder in schizophrenia. Psychiatry Res 2010; 182:183-6. [PMID: 20418073 DOI: 10.1016/j.pscychresns.2010.01.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 01/25/2010] [Accepted: 01/28/2010] [Indexed: 11/28/2022]
Abstract
Formal thought disorder (FTD) is one of the main symptoms of schizophrenia. To date there are no whole brain volumetric studies investigating gray matter (GM) differences specifically associated with FTD. Here, we studied 20 right-handed schizophrenia patients that differed in the severity of formal thought disorder and 20 matched healthy controls, using voxel-based morphometry (VBM). The severity of FTD was measured with the Scale for the Assessment of Thought, Language, and Communication. The severity was negatively correlated with the GM volume of the left superior temporal sulcus, the left temporal pole, the right middle orbital gyrus and the right cuneus/lingual gyrus. Structural abnormalities specific for FTD were found to be unrelated to GM differences associated with schizophrenia in general. The specific GM abnormalities within the left temporal lobe may help to explain language disturbances included in FTD.
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Affiliation(s)
- Helge Horn
- University Hospital of Psychiatry, University of Bern, Murtenstrasse 21, Bern, Switzerland.
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221
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Borgwardt SJ, Picchioni MM, Ettinger U, Toulopoulou T, Murray R, McGuire PK. Regional gray matter volume in monozygotic twins concordant and discordant for schizophrenia. Biol Psychiatry 2010; 67:956-64. [PMID: 20006324 DOI: 10.1016/j.biopsych.2009.10.026] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 10/08/2009] [Accepted: 10/11/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Alterations in gray matter volume (GMV) are a robust feature of schizophrenia. However, it is not clear to what extent these abnormalities are correlates of the genetic liability to the disorder, as opposed to environmental factors and the disorder itself. We investigated the influence of genetic and environmental risk on GMV in monozygotic (MZ) twin pairs concordant and discordant for schizophrenia. METHODS Total and regional GMVs were measured from magnetic resonance images of 80 twins: 14 MZ pairs concordant for schizophrenia, 9 pairs discordant for schizophrenia, and 17 healthy MZ twin pairs. RESULTS Total GMV was smaller in twins with schizophrenia (t = -3.17, p = .003) and nonpsychotic cotwins from discordant pairs (t = -2.66, p = .011) than in healthy control twins. Twin pairs concordant for schizophrenia displayed reduced regional GMV in the inferior frontal, medial frontal, and anterior cingulate gyri; the caudate; lingual gyrus; and cerebellum relative to healthy twins (p < .05, corrected). Within discordant pairs, twins with schizophrenia had less GMV than their nonpsychotic cotwins in the insula; superior/medial frontal, pre/postcentral, cingulate, and superior temporal gyri; and the paracentral lobule. There were no significant differences in regional GMV between nonpsychotic cotwins and healthy control subjects. CONCLUSIONS The presence of schizophrenia was specifically related to reduced GMV in frontal, insular, cingulate, medial parietal, and temporal cortex, over and above effects of genetic risk for the disorder. These changes could be related to the pathophysiology of the disorder itself or to unique environmental factors acting etiologically or because of the illness.
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Affiliation(s)
- Stefan J Borgwardt
- Section of Neuroimaging, Institute of Psychiatry, King's College London, London, United Kingdom.
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222
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Abstract
Although the adult brain is considered to be fully developed and stable until senescence when its size steadily decreases, such stability seems at odds with continued human (intellectual) development throughout life. Moreover, although variation in human brain size is highly heritable, we do not know the extent to which genes contribute to individual differences in brain plasticity. In this longitudinal magnetic resonance imaging study in twins, we report considerable thinning of the frontal cortex and thickening of the medial temporal cortex with increasing age and find this change to be heritable and partly related to cognitive ability. Specifically, adults with higher intelligence show attenuated cortical thinning and more pronounced cortical thickening over time than do subjects with average or below average IQ. Genes influencing variability in both intelligence and brain plasticity partly drive these associations. Thus, not only does the brain continue to change well into adulthood, these changes are functionally relevant because they are related to intelligence.
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223
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Sponheim S, Jung R, Seidman L, Mesholam-Gately R, Manoach D, O'Leary D, Ho B, Andreasen N, Lauriello J, Schulz S. Cognitive deficits in recent-onset and chronic schizophrenia. J Psychiatr Res 2010; 44:421-8. [PMID: 19878956 PMCID: PMC3940967 DOI: 10.1016/j.jpsychires.2009.09.010] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 09/23/2009] [Accepted: 09/28/2009] [Indexed: 01/26/2023]
Abstract
Although cognitive dysfunction is a primary characteristic of schizophrenia, only recently have investigations begun to pinpoint when the dysfunction develops in the individual afflicted by the disorder. Research to date provides evidence for significant cognitive impairments prior to disorder onset. Less is known about the course of cognitive dysfunction from onset to the chronic phase of schizophrenia. Although longitudinal studies are optimal for assessing stability of cognitive deficits, practice effects often confound assessments, and large and representative subject samples have not been followed over long periods of time. We report results of a cross-sectional study of cognitive deficits early and late in the course of schizophrenia carried out at four different geographic locations to increase sample size and generalizability of findings. We examined a broad set of cognitive functions in 41 recent-onset schizophrenia patients and 106 chronic schizophrenia patients. The study included separate groups of 43 matched controls for the recent-onset sample and 105 matched controls for the chronic schizophrenia sample in order to evaluate the effects of cohort (i.e., age) and diagnosis (i.e., schizophrenia) on cognitive functions. All measures of cognitive function showed effects of diagnosis; however, select time-based measures of problem solving and fine motor dexterity exhibited interactions of diagnosis and cohort indicating that these deficits may progress beyond what is expected with normal aging. Also, worse recall of material in episodic memory was associated with greater length of illness. Nevertheless, findings indicate that nearly all cognitive deficits are comparably impaired across recent-onset and chronic schizophrenia.
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Affiliation(s)
- S.R. Sponheim
- VA Medical Center, One Veterans Drive, Minneapolis MN 55417, United States, Department of Psychiatry, F282/2A West, 2450 Riverside, Minneapolis, MN 55454, United States, Corresponding author. Address: 116B, VA Medical Center, One Veterans Drive, Minneapolis, MN 55417, United States. Tel.: +1 612 467 3916; fax: +1 612 727 5964. (S.R. Sponheim)
| | - R.E. Jung
- The Mind Research Network, 1101 Yale Blvd. NE Albuquerque, New Mexico 87106, United States, Department of Psychiatry, The University of New Mexico, Albuquerque, NM 87131, United States
| | - L.J. Seidman
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Boston, MA 02215, United States, Massachusetts General Hospital, 55 Fruit Street Boston, MA 02114, United States
| | - R.I. Mesholam-Gately
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Boston, MA 02215, United States
| | - D.S. Manoach
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States, Massachusetts General Hospital, 55 Fruit Street Boston, MA 02114, United States
| | - D.S. O'Leary
- Department of Psychiatry, UI Hospitals and Clinics, 200 Hawkins Drive – 2880 JPP, IOWA City, IOWA 52242, United States
| | - B.C. Ho
- Department of Psychiatry, UI Hospitals and Clinics, 200 Hawkins Drive – 2880 JPP, IOWA City, IOWA 52242, United States
| | - N.C. Andreasen
- Department of Psychiatry, UI Hospitals and Clinics, 200 Hawkins Drive – 2880 JPP, IOWA City, IOWA 52242, United States
| | - J. Lauriello
- Department of Psychiatry, The University of New Mexico, Albuquerque, NM 87131, United States
| | - S.C. Schulz
- Department of Psychiatry, F282/2A West, 2450 Riverside, Minneapolis, MN 55454, United States
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224
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Abstract
The duration of untreated illness (DUI), defined as the interval between the onset of a psychiatric disorder and the administration of the first pharmacological treatment, has been increasingly investigated in the last decade as a predictor of outcome across different psychiatric conditions including schizophrenia and psychotic disorders (duration of untreated psychosis), and mood and anxiety disorders. Converging evidence indicates that a prolonged DUI may be viewed as a negative prognostic factor in schizophrenia and increasing data point toward a similar conclusion in mood and anxiety disorders. Through a Medline search, the present article highlights the role of the DUI in this group of psychiatric disorders, focusing on social and psychopathological determinants of the DUI, as well as the clinical consequences related to a longer DUI in terms of outcome. Hypotheses on neurobiological mechanisms underpinning outcome differences in relation to a prolonged DUI are provided and methodological limitations related to the assessment of the DUI in published studies and clinical practice discussed. Finally, given that DUI is supposed to be a potentially modifiable prognostic factor, intervention programs aimed to reduce this variable are briefly considered and discussed.
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225
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Reduced laterality as a trait marker of schizophrenia--evidence from structural and functional neuroimaging. J Neurosci 2010; 30:2289-99. [PMID: 20147555 DOI: 10.1523/jneurosci.4575-09.2010] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Laterality is a characteristic principle of the organization of the brain systems for language, and reduced hemispheric asymmetry has been considered a risk factor for schizophrenia. Here we sought support for the risk factor hypothesis by investigating whether reduced asymmetry of temporal lobe structure and function is also present in unaffected relatives. Sixteen schizophrenia patients, 16 age-matched first-degree relatives, and 15 healthy controls underwent high-resolution three-dimensional anatomical imaging and functional magnetic resonance imaging during auditory stimulation. Both the overall auditory cortex and planum temporale volumes and the lateralization to the left hemisphere were markedly reduced in patients. The decrease of lateralization correlated with increased severity of symptoms. In addition, both the overall functional activation in response to auditory stimulation and its asymmetry were reduced in the patients. Relatives had intermediate values between patients and controls on both structural and functional measures. This study provides added support for the idea that reduced hemispheric asymmetry is a biological risk factor for schizophrenia.
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226
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Meyer U, Feldon J. Epidemiology-driven neurodevelopmental animal models of schizophrenia. Prog Neurobiol 2010; 90:285-326. [DOI: 10.1016/j.pneurobio.2009.10.018] [Citation(s) in RCA: 261] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 09/30/2009] [Accepted: 10/14/2009] [Indexed: 12/17/2022]
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227
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van den Noort M, Bosch P, Mondt K, Lim S. Progressive volume reduction and its relation to the different stages of schizophrenia. Schizophr Res 2010; 117:99-100. [PMID: 20079612 DOI: 10.1016/j.schres.2009.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 11/13/2009] [Accepted: 12/28/2009] [Indexed: 11/28/2022]
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228
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Jaaro-Peled H, Ayhan Y, Pletnikov MV, Sawa A. Review of pathological hallmarks of schizophrenia: comparison of genetic models with patients and nongenetic models. Schizophr Bull 2010; 36:301-13. [PMID: 19903746 PMCID: PMC2833125 DOI: 10.1093/schbul/sbp133] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Schizophrenia is a condition that impairs higher brain functions, some of which are specific to humans. After identification of susceptibility genes for schizophrenia, many efforts have been made to generate genetics-based models for the disease. It is under debate whether behavioral deficits observed in rodents are sufficient to characterize these models. Alternatively, anatomical and neuropathological changes identified in brains of patients with schizophrenia may be utilized as translatable characteristics between humans and rodents, which are important for validation of the models. Here, we overview such anatomical and neuropathological changes in humans: enlarged ventricles, dendritic changes in the pyramidal neurons, and alteration of specific subtypes of interneurons. In this review, we will overview such morphological changes in brains from patients with schizophrenia. Then, we will describe that some of these alterations are already recapitulated even in classic nongenetic models for schizophrenia. Finally, in comparison with the changes in patients and nongenetic models, we will discuss the anatomical and neuropathological manifestation in genetic models for schizophrenia.
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Affiliation(s)
- Hanna Jaaro-Peled
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287
| | - Yavuz Ayhan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287
| | - Mikhail V. Pletnikov
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287
| | - Akira Sawa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287,To whom correspondence should be addressed; tel: 1-410-9554726, fax: 410-6141792, e-mail:
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229
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Shenton ME, Whitford TJ, Kubicki M. Structural neuroimaging in schizophrenia: from methods to insights to treatments. DIALOGUES IN CLINICAL NEUROSCIENCE 2010; 12:317-32. [PMID: 20954428 PMCID: PMC3181976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
Historically, Kraepelin speculated that dementia praecox resulted from damage to the cerebral cortex, most notably the frontal and temporal cortices. It is only recently, however, that tools have been available to test this hypothesis. Now, more than a century later, we know that schizophrenia is a brain disorder. This knowledge comes from critical advances in imaging technology--including computerized axial tomography, magnetic resonance imaging, and diffusion imaging--all of which provide an unprecedented view of neuroanatomical structures, in vivo. Here, we review evidence for structural neuroimaging abnormalities, beginning with evidence for focal brain abnormalities, primarily in gray matter, and proceeding to the quest to identify abnormalities in brain systems and circuits by focusing on damage to white matter connections in the brain. We then review future prospects that need to be explored and pursued in order to translate our current knowledge into an understanding of the neurobiology of schizophrenia, which can then be translated into novel treatments.
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Affiliation(s)
- Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, 1249 Boylston Street Boston, MA 02215, USA.
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230
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Brain structural changes associated with chronicity and antipsychotic treatment in schizophrenia. Eur Neuropsychopharmacol 2009; 19:835-40. [PMID: 19717283 DOI: 10.1016/j.euroneuro.2009.07.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 07/22/2009] [Indexed: 12/19/2022]
Abstract
Accumulating evidence suggest a life-long impact of disease related mechanisms on brain structure in schizophrenia which may be modified by antipsychotic treatment. The aim of the present study was to investigate in a large sample of patients with schizophrenia the effect of illness duration and antipsychotic treatment on brain structure. Seventy-one schizophrenic patients and 79 age and gender matched healthy participants underwent brain magnetic resonance imaging (MRI). All images were processed with voxel based morphometry, using SPM5. Compared to healthy participants, patients showed decrements in gray matter volume in the left medial and left inferior frontal gyrus. In addition, duration of illness was negatively associated with gray matter volume in prefrontal regions bilaterally, in the temporal pole on the left and the caudal superior temporal gyrus on the right. Cumulative exposure to antipsychotics correlated positively with gray matter volumes in the cingulate gyrus for typical agents and in the thalamus for atypical drugs. These findings (a) indicate that structural abnormalities in prefrontal and temporal cortices in schizophrenia are progressive and, (b) suggest that antipsychotic medication has a significant impact on brain morphology.
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231
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Carpenter WT, Bustillo JR, Thaker GK, van Os J, Krueger RF, Green MJ. The psychoses: cluster 3 of the proposed meta-structure for DSM-V and ICD-11. Psychol Med 2009; 39:2025-2042. [PMID: 19796428 DOI: 10.1017/s0033291709990286] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In an effort to group mental disorders on the basis of etiology, five clusters have been proposed. Here we consider the validity of the cluster comprising selected psychotic and related disorders. METHOD A group of diagnostic entities classified under schizophrenia and other psychotic disorders in DSM-IV-TR were assigned to this cluster and the bordering disorders, bipolar (BD) and schizotypal personality disorders (SPD), were included. We then reviewed the literature in relation to 11 validating criteria proposed by the DSM-V Task Force Study Group. RESULTS Relevant comparisons on the 11 spectrum criteria are rare for the included disorders except for schizophrenia and the two border conditions, BD and SPD. The core psychosis group is congruent at the level of shared psychotic psychopathology and response to antipsychotic medication. BD and SPD are exceptions in that psychosis is not typical in BD-II disorder and frank psychosis is excluded in SPD. There is modest similarity between schizophrenia and BD relating to risk factors, neural substrates, cognition and endophenotypes, but key differences are noted. There is greater support for a spectrum relationship of SPD and schizophrenia. Antecedent temperament, an important validator for other groupings, has received little empirical study in the various psychotic disorders. CONCLUSIONS The DSM-IV-TR grouping of psychotic disorders is supported by tradition and shared psychopathology, but few data exist across these diagnoses relating to the 11 spectrum criteria. The case for including BD is modest, and the relationship of BD to other mood disorders is addressed elsewhere. Evidence is stronger for inclusion of SPD, but the relationship with other personality disorders along the 11 criteria is not addressed and the absence of psychosis presents a conceptual problem. There are no data along the 11 spectrum criteria that are decisive for a cluster based on etiology, and inclusion of BD and SPD is questionable.
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Affiliation(s)
- W T Carpenter
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD 21228, USA.
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van den Heuvel MP, Mandl RCW, Kahn RS, Hulshoff Pol HE. Functionally linked resting-state networks reflect the underlying structural connectivity architecture of the human brain. Hum Brain Mapp 2009; 30:3127-41. [PMID: 19235882 DOI: 10.1002/hbm.20737] [Citation(s) in RCA: 744] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
During rest, multiple cortical brain regions are functionally linked forming resting-state networks. This high level of functional connectivity within resting-state networks suggests the existence of direct neuroanatomical connections between these functionally linked brain regions to facilitate the ongoing interregional neuronal communication. White matter tracts are the structural highways of our brain, enabling information to travel quickly from one brain region to another region. In this study, we examined both the functional and structural connections of the human brain in a group of 26 healthy subjects, combining 3 Tesla resting-state functional magnetic resonance imaging time-series with diffusion tensor imaging scans. Nine consistently found functionally linked resting-state networks were retrieved from the resting-state data. The diffusion tensor imaging scans were used to reconstruct the white matter pathways between the functionally linked brain areas of these resting-state networks. Our results show that well-known anatomical white matter tracts interconnect at least eight of the nine commonly found resting-state networks, including the default mode network, the core network, primary motor and visual network, and two lateralized parietal-frontal networks. Our results suggest that the functionally linked resting-state networks reflect the underlying structural connectivity architecture of the human brain.
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Kasparek T, Prikryl R, Schwarz D, Kucerova H, Marecek R, Mikl M, Vanicek J, Ceskova E. Gray matter morphology and the level of functioning in one-year follow-up of first-episode schizophrenia patients. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:1438-46. [PMID: 19647777 DOI: 10.1016/j.pnpbp.2009.07.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 07/22/2009] [Accepted: 07/23/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED Schizophrenia is a condition with a highly variable course that is hard to predict. The aim of the present study was to investigate if local gray matter volume (GMV) can differentiate poor (PF) and good (GF) functioning patients using voxel-wise analysis in a group of first-episode schizophrenia subjects (FES). METHOD 32 FES male patients were assessed twice: at the time of the first episode of schizophrenia and one year later. 18 healthy controls matched for age, gender, and handedness were also included. Local gray matter volume was analyzed using voxel-wise full-factorial design with factors group (GF, PF) and time. RESULTS FES subjects had bilateral gray matter reduction in the lateral prefrontal cortex as compared with healthy controls. PF subjects had smaller GMV in the left orbitofrontal and frontopolar cortex. CONCLUSION GMV in the left prefrontal cortex differentiates later poor and good functioning schizophrenia patients. Morphological analysis might be considered a candidate for a biological marker in outcome prediction. However, the small sample size, and the lack of female subjects limit generalization of results. Moreover, studies analyzing the predictive value of brain morphology on a single-subject level should be performed to assess its real usefulness in outcome prediction.
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Affiliation(s)
- Tomas Kasparek
- Department of Psychiatry, Masaryk University, Faculty of Medicine and Faculty Hospital Brno-Bohunice, Brno, Czech Republic.
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234
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Hope S, Melle I, Aukrust P, Steen NE, Birkenaes AB, Lorentzen S, Agartz I, Ueland T, Andreassen OA. Similar immune profile in bipolar disorder and schizophrenia: selective increase in soluble tumor necrosis factor receptor I and von Willebrand factor. Bipolar Disord 2009; 11:726-34. [PMID: 19839997 DOI: 10.1111/j.1399-5618.2009.00757.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Alterations in the inflammatory system have been associated with schizophrenia and major depression, while bipolar disorder has been less studied. Most previous studies examined small samples, and the literature is inconsistent with regard to specific underlying immune mechanisms. In the present study, we examined markers representing different inflammatory pathways, and the aim was to investigate whether the levels of inflammatory parameters in a representative sample of bipolar disorder and schizophrenia are elevated compared to healthy controls, and to investigate whether the inflammatory profile is different between the groups. METHODS Plasma levels of soluble tumor necrosis factor receptor 1 (sTNF-R1), interleukin-1 receptor antagonist (IL-1Ra), interleukin-6 (IL-6), high-sensitivity CRP (hs-CRP), soluble CD40L ligand (sCD40L), and von Willebrand factor (vWf) were measured with ELISA techniques in a catchment area based sample of consecutively referred patients with severe mental disorders [N = 311, comprising bipolar disorder (n = 125) and schizophrenia (n = 186)] and in healthy volunteers (n = 244). RESULTS Plasma levels of sTNF-R1 and vWf were statistically significantly increased in both bipolar disorder and schizophrenia compared to controls (p < 0.00001), and were also increased in unmedicated patients, but there were no major differences between the two diagnostic groups. Controlling for age, gender, ethnicity, cardiovascular disorders, kidney and liver function, and other confounders did not affect the results. There were no differences in other inflammation factors between the groups. CONCLUSION The present results indicate specific alterations of endothelium-related inflammation processes in both bipolar disorder and schizophrenia.
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Affiliation(s)
- Sigrun Hope
- Department of Psychiatry, Østfold Hospital, Eidsberg, Norway.
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235
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Navari S, Dazzan P. Do antipsychotic drugs affect brain structure? A systematic and critical review of MRI findings. Psychol Med 2009; 39:1763-1777. [PMID: 19338710 DOI: 10.1017/s0033291709005315] [Citation(s) in RCA: 250] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The potential effects of antipsychotic drugs on brain structure represent a key factor in understanding neuroanatomical changes in psychosis. This review addresses two issues: (1) do antipsychotic medications induce changes in total or regional human brain volumes and (2) do such effects depend on antipsychotic type? METHOD A systematic review of studies reporting structural brain magnetic resonance imaging (MRI) measures: (1) directly in association with antipsychotic use; and (2) in patients receiving lifetime treatment with antipsychotics in comparison with drug-naive patients or healthy controls. We searched Medline and EMBASE databases using the medical subject heading terms: 'antipsychotics' AND 'brain' AND (MRI NOT functional). The search included studies published up to 31 January 2007. Wherever possible, we reported the effect size of the difference observed. RESULTS Thirty-three studies met our inclusion criteria. The results suggest that antipsychotics act regionally rather than globally on the brain. These volumetric changes are of a greater magnitude in association with typical than with atypical antipsychotic use. Indeed, there is evidence of a specific effect of antipsychotic type on the basal ganglia, with typicals specifically increasing the volume of these structures. Differential effects of antipsychotic type may also be present on the thalamus and the cortex, but data on these and other brain areas are more equivocal. CONCLUSIONS Antipsychotic treatment potentially contributes to the brain structural changes observed in psychosis. Future research should take into account these potential effects, and use adequate sample sizes, to allow improved interpretation of neuroimaging findings in these disorders.
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Affiliation(s)
- S Navari
- Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, UK.
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236
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Rund BR. Is there a degenerative process going on in the brain of people with Schizophrenia? Front Hum Neurosci 2009; 3:36. [PMID: 19893755 PMCID: PMC2773152 DOI: 10.3389/neuro.09.036.2009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Accepted: 10/05/2009] [Indexed: 11/15/2022] Open
Abstract
Schizophrenia is a biological and behavioural disorder which manifests itself in neurocognitive dysfunctions. The question of whether these key characteristics of the disorder are due to schizophrenia being a degenerative disorder has been discussed for more than 100 years. Neuropsychological data indicate that neurocognitive functions are relatively stable over time after illness onset. Several studies show that there is a decline in neurocognitive functioning prior to and in connection with onset of illness. There is no convincing evidence, however, that there is a progressive neurodegenerative process after onset of illness. Morphological data, on the other hand, indicate a degenerative process. Several novel longitudinal studies indicate a rapid reduction of vital brain tissues after onset of illness. In this paper some ideas about compensatory reactions and Cognitive Reserve Theory is outlined as possible explanations of the recent magnetic resonance imaging studies that show structural changes in the brain after the onset of schizophrenia, at the same time as cognitive functioning does not become more impaired. Determining whether schizophrenia is a neurodegenerative illness with progressive structural changes in the brain after debut of the illness, or a neurodevelopmental disorder starting in early life, is of significant importance for understanding the pathophysiology of the illness and its treatments.
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Abstract
AIM This review examines the use of antipsychotic medication during the early years of psychosis. METHODS A selective literature review was conducted. RESULTS The early years of schizophrenia represent a critical period for intervention. Importantly, first-episode patients differ from those with chronic schizophrenia in several important respects. While treatment response to antipsychotic medication is better, the risk of relapse is also higher. While both first- and second-generation antipsychotics are very effective in reducing symptoms, there are tolerability and some efficacy advantages for the second-generation antipsychotics in first-episode psychosis. Poor medication adherence is a significant problem in early psychosis that is linked to relapse and poses a major barrier to optimizing outcomes. Treatment strategies should focus on, among other things, improving antipsychotic medication adherence. CONCLUSIONS The early years of psychosis offer the best opportunity for achieving optimal outcomes. Maintaining symptomatic remission is central to achieving functional recovery.
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Affiliation(s)
- Robin Emsley
- Department of Psychiatry, Faculty of Health Sciences, University of Stellenbosch, Tygerberg, Cape Town, South Africa.
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A prospective longitudinal volumetric MRI study of superior temporal gyrus gray matter and amygdala-hippocampal complex in chronic schizophrenia. Schizophr Res 2009; 113:84-94. [PMID: 19524408 PMCID: PMC2776716 DOI: 10.1016/j.schres.2009.05.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 04/15/2009] [Accepted: 05/03/2009] [Indexed: 11/22/2022]
Abstract
A progressive post-onset decrease in gray matter volume 1.5 years after first hospitalization in schizophrenia has been shown in superior temporal gyrus (STG). However, it is still controversial whether progressive volume reduction occurs in chronic schizophrenia in the STG and amygdala-hippocampal complex (AHC), structures found to be abnormal in chronic schizophrenia. These structures were measured at two time points in 16 chronic schizophrenia patients and 20 normal comparison subjects using manual tracing with high spatial resolution magnetic resonance imaging (MRI). Average interscan interval was 3.1 years for schizophrenia patients and 1.4 years for healthy comparison subjects. Cross-sectional comparisons showed smaller relative volumes in schizophrenia compared with controls in posterior STG and AHC. An ANCOVA with interscan interval as a covariate showed there was no statistically significant progression of volume reduction in either the STG or AHC in the schizophrenia group compared with normal subjects. In the schizophrenia group, volume change in the left anterior AHC significantly correlated with PANSS negative symptoms. These data, and separately reported first episode data from our laboratory, suggest marked progression at the initial stage of schizophrenia, but less in chronic schizophrenia.
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240
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Stober G, Ben-Shachar D, Cardon M, Falkai P, Fonteh AN, Gawlik M, Glenthoj BY, Grunblatt E, Jablensky A, Kim YK, Kornhuber J, McNeil TF, Muller N, Oranje B, Saito T, Saoud M, Schmitt A, Schwartz M, Thome J, Uzbekov M, Durany N, Riederer P. Schizophrenia: from the brain to peripheral markers. A consensus paper of the WFSBP task force on biological markers. World J Biol Psychiatry 2009; 10:127-55. [PMID: 19396704 DOI: 10.1080/15622970902898980] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective. The phenotypic complexity, together with the multifarious nature of the so-called "schizophrenic psychoses", limits our ability to form a simple and logical biologically based hypothesis for the disease group. Biological markers are defined as biochemical, physiological or anatomical traits that are specific to particular conditions. An important aim of biomarker discovery is the detection of disease correlates that can be used as diagnostic tools. Method. A selective review of the WFSBP Task Force on Biological Markers in schizophrenia is provided from the central nervous system to phenotypes, functional brain systems, chromosomal loci with potential genetic markers to the peripheral systems. Results. A number of biological measures have been proposed to be correlated with schizophrenia. At present, not a single biological trait in schizophrenia is available which achieves sufficient specificity, selectivity and is based on causal pathology and predictive validity to be recommended as diagnostic marker. Conclusions. With the emergence of new technologies and rigorous phenotypic subclassification the identification of genetic bases and assessment of dynamic disease related alterations will hopefully come to a new stage in the complex field of psychiatric research.
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Affiliation(s)
- Gerald Stober
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wurzburg, Wurzburg, Germany.
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241
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Borgwardt SJ, Dickey C, Hulshoff Pol H, Whitford TJ, DeLisi LE. Workshop on defining the significance of progressive brain change in schizophrenia: December 12, 2008 American College of Neuropsychopharmacology (ACNP) all-day satellite, Scottsdale, Arizona. The rapporteurs' report. Schizophr Res 2009; 112:32-45. [PMID: 19477100 DOI: 10.1016/j.schres.2009.04.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 04/19/2009] [Accepted: 04/21/2009] [Indexed: 10/20/2022]
Abstract
In 1990 a satellite session of the American College of Neuropsychopharmacology (ACNP) Annual Meeting was held that focused on the question of whether progressive changes in brain structure occur in schizophrenia and this session raised considerable controversy. Eighteen years later, on December 12, 2008, after much data have since accumulated on this topic, a group of approximately 45 researchers gathered after the annual ACNP meeting to participate in a similar workshop on several unresolved questions still remaining: (1) How strong and consistent is the evidence? (2) Is there anatomic specificity to changes and is it disease specific or subject specific? (3) What is the time course? (4) What is the underlying pathophysiology (i.e. is it central to the disease process or is it due to neuroleptic treatment or other epiphenomena? (5) What is its clinical significance? and (6) Are there treatment implications? The day was chaired by Lynn E. DeLisi and co-chaired by Stephen J. Wood. Christos Pantelis and Jeffrey A. Lieberman extensively helped with its planning. The ACNP assisted in its organization as an official satellite of its annual meeting and several pharmaceutical companies provided support with unrestricted educational grants. The following is a summary of the sessions as recounted by rapporteurs whose job was to record as closely as possible the outcome of discussions on the above outlined questions.
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Affiliation(s)
- Stefan J Borgwardt
- University Hospital Basel, Psychiatric Outpatient Department, Petersgraben 4, Basel, Switzerland
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242
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Molteni R, Calabrese F, Racagni G, Fumagalli F, Riva MA. Antipsychotic drug actions on gene modulation and signaling mechanisms. Pharmacol Ther 2009; 124:74-85. [PMID: 19540875 DOI: 10.1016/j.pharmthera.2009.06.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 06/09/2009] [Indexed: 12/14/2022]
Abstract
Schizophrenia is a debilitating chronic mental disorder characterized by significant lifetime risk and high social costs. Although its etiology remains unknown, many of its symptoms may be mitigated by treatment with antipsychotic drugs (APDs). These compounds, generally classified as first- or second-generation antipsychotics, have complex receptor profiles that may account for short-term clinical response and normalization of acute manifestation of the disease. However, APDs have additional therapeutic properties that may not be directly related to receptor mechanisms, but rather involve neuroadaptive changes in selected brain regions. Indeed the neurodevelopmental origin of schizophrenia suggests that the disease is characterized by neuroanatomical and pathophysiological impairments that, at molecular level, may reflect compromised neuroplasticity; the process by which the brain adapts to changes in a specific environment. Accordingly, it is possible that the long-term clinical efficacy of APDs might result from their ability in modulating systems crucially involved in neuroplasticity and cellular resilience. We have reviewed and discussed the results of several studies investigating the post-receptor mechanisms in the action of APDs. We specifically focused on intracellular signaling cascades (PKA, DARPP-32, MAPK, Akt/GSK-3, beta arrestin-2), neurotrophic factors and the glutamatergic system as important mediators for antipsychotic drug induced-neuroplasticity. Altogether, these data highlight the possibility that post-receptor mechanisms will eventually be promising targets for the development of novel drugs that, through their impact on neuroplasticity, may contribute to the improved treatment of patients diagnosed with schizophrenia.
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Affiliation(s)
- Raffaella Molteni
- Center of Neuropharmacology, Department of Pharmacological Sciences, Universita' degli Studi di Milano, Milan, Italy
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243
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Abstract
The etiology of schizophrenia remains unclear, while there has been a growing amount of evidence for the neuroinflammation and immunogenetics, which are characterized by an increased serum concentration of several pro-inflammatory cytokines. Despite the fact that microglia comprise only <10% of the total brain cells, microglia respond rapidly to even minor pathological changes in the brain and may contribute directly to the neuronal degeneration by producing various pro-inflammatory cytokines and free radicals. In many aspects, the neuropathology of schizophrenia has recently been reported to be closely associatedwith microglial activation. Previous studies have shown the inhibitory effects of some typical/atypical antipsychotics on the release of inflammatory cytokines and free radicals from activated microglia, both of which have recently been known to cause a decrease in neurogenesis as well as white matter abnormalities in the brains of patients with schizophrenia. The microglia hypothesis of schizophrenia may shed new light on the therapeutic strategy for schizophrenia.
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Affiliation(s)
- Akira Monji
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Tang B, Chang WL, Lanigan CM, Dean B, Sutcliffe JG, Thomas EA. Normal human aging and early-stage schizophrenia share common molecular profiles. Aging Cell 2009; 8:339-42. [PMID: 19245676 DOI: 10.1111/j.1474-9726.2009.00468.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We examined genome-wide expression datasets from human prefrontal cortex of normal and schizophrenic individuals ranging from 19 to 81 years of age. We found that changes in gene expression that are correlated with aging in normal subjects differ dramatically from those observed with aging in schizophrenic subjects. Only 2.5% of genes were correlated with age in both groups. Surprisingly, we also found a significant overlap (29-34%) between those genes whose expression was correlated with aging in normal subjects and those significantly altered in subjects with early-stage schizophrenia (within 4 years of diagnosis). This suggests that schizophrenia onset anticipates the normal aging process, and further, that some symptoms of aging, i.e. dementia and psychosis, might be explained by these common molecular profiles.
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Affiliation(s)
- Bin Tang
- Department of Molecular Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
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245
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Mitelman SA, Canfield EL, Newmark RE, Brickman AM, Torosjan Y, Chu KW, Hazlett EA, Haznedar MM, Shihabuddin L, Buchsbaum MS. [Not Available]. Open Neuroimag J 2009; 3:31-47. [PMID: 19547667 PMCID: PMC2700015 DOI: 10.2174/1874440000903010031] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Revised: 02/17/2009] [Accepted: 02/18/2009] [Indexed: 11/22/2022] Open
Abstract
Previous studies have reported continued focal gray matter loss after the clinical onset of schizophrenia. Longitudinal assessments in chronic illness, of white matter in particular, have been less conclusive. We used diffusion-tensor and structural magnetic resonance imaging in 16 healthy subjects and 49 chronic schizophrenia patients, subdivided into good-outcome (n=23) and poor-outcome (n=26) groups, scanned twice 4 years apart. Fractional anisotropy, gray matter and white matter volumes were parcellated into the Brodmann’s areas and entered into multiway ANCOVAs. At baseline, schizophrenia patients had 1) lower anisotropy in frontoparietal white matter, 2) larger posterior frontal white matter volumes, and 3) smaller frontal, temporal, and parietal gray matter volumes. On follow-up, healthy subjects showed a more pronounced 1) decline in anisotropy, 2) expansion of regional white matter volumes, and 3) reduction in regional gray matter volumes than schizophrenia patients. Good-outcome patients showed a more pronounced decline in white matter anisotropy and a less pronounced increase in white matter volumes than poor-outcome patients. Poor-outcome patients displayed a greater gray matter loss throughout the brain than good-outcome patients. In the chronic phase of the illness, longitudinal changes in both gray and white matter are in the direction of an effacement of between-group differences among schizophrenia patients and healthy subjects. Similarly, preexisting white matter differences between good-outcome and poor-outcome patients diminish over time. In contrast, gray matter volumes in poor-outcome patients continue to decline more rapidly than in patients with good outcome. These patterns are consistent with earlier onset of aging-associated changes in schizophrenia.
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Affiliation(s)
- Serge A Mitelman
- Department of Psychiatry, Mount Sinai School of Medicine, New York, USA.
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246
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Chan WY, Chia MY, Yang GL, Woon PS, Sitoh YY, Collinson SL, Nowinski WL, Sim K. Duration of Illness, Regional Brain Morphology and Neurocognitive Correlates in Schizophrenia. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n5p388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction: Previous studies examining brain effects of duration of illness in schizophrenia have focused on either cortical or subcortical structures. Hence this study sought to elucidate the regional grey matter changes (both cortical and subcortical) and neurocognitive correlates with increased duration of illness in a large sample of patients with schizophrenia using voxel-based morphometry.
Materials and Methods: Ninety patients (72 males and 18 females) with DSM-IV diagnosis of schizophrenia were recruited and assessed using magnetic resonance imaging and a battery of neuropsychological tests.
Results: A longer duration of illness was associated with smaller grey matter volumes in the left superior frontal gyrus, bilateral putamen, right superior temporal gyrus, right superior occipital gyrus as well as the right thalamus. No region showed increased grey matter volume above threshold with longer duration of illness. Longer duration of illness was correlated with poorer attention.
Conclusions: The grey matter reductions in different brain regions highlighted that a distributed network of cortical and subcortical regions was associated with duration of illness. This is consistent with neural models that implicate involvement of thalamo-cortical circuitry as the disruption in these neural pathways can result in specific deficits such as poorer attention. The results have implications for the understanding of brain changes in schizophrenia, and with further studies, may guide better tailored and targeted clinical management in terms of reducing the impact of duration of illness on neural substrates in schizophrenia in the future.
Key words: Duration of Illness, Grey Matter, Magnetic resonance imaging, Voxel-based Morphometry
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Affiliation(s)
| | | | | | | | | | | | | | - Kang Sim
- Woodbridge Hospital/ Institute of Mental Health, Singapore
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Sargin D, Hassouna I, Sperling S, Sirén AL, Ehrenreich H. Uncoupling of neurodegeneration and gliosis in a murine model of juvenile cortical lesion. Glia 2009; 57:693-702. [DOI: 10.1002/glia.20797] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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248
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Current world literature. Addictive disorder. Curr Opin Psychiatry 2009; 22:331-6. [PMID: 19365188 DOI: 10.1097/yco.0b013e32832ae253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW Although structural magnetic resonance imaging (sMRI) and neuropathological investigations offer complementary information that can be used to formulate and test hypotheses about pathophysiological mechanisms in psychiatric disorders, the findings from these two fields are seldom integrated in a systematic manner. In this study, we overview recent sMRI findings in schizophrenia and bipolar disorder and consider how they relate to neuropathological data. RECENT FINDINGS sMRI research indicates that schizophrenia is associated with volumetric reductions in a network of frontal, temporal, limbic, striatal, and thalamic regions. Some of these abnormalities are apparent prior to psychosis onset and may progress with ongoing illness. sMRI findings in bipolar disorder have been more variable, with both volumetric increases and decreases being reported across several brain regions at different illness stages. Neuropathological studies of both patient groups suggest the cellular changes associated with these volumetric differences affect diverse tissue compartments in a regionally heterogeneous way. SUMMARY These findings suggest that any putative pathophysiological mechanism in schizophrenia or bipolar disorder should account for the dynamic, complex, and regionally heterogeneous brain abnormalities seen in these patients. We contend that greater integration of the findings from these two fields will facilitate more targeted and hypothesis-driven research in the future.
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250
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Schall U. Consciousness and hallucinations in schizophrenia: secondary aspects of generalized neuropil pathology? Aust N Z J Psychiatry 2009; 43:393-4. [PMID: 19296296 DOI: 10.1080/00048670902721160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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