Abnormal auditory sensory gating-out in first-episode and never-medicated paranoid schizophrenia patients: an fMRI study

Association of P50 with social function, but not with cognition in patients with first-episode schizophrenia

Functional deficits including cognitive impairment and social dysfunction are the core symptoms of schizophrenia (SCZ), and sensory gating (SG) deficits may be involved in the pathological mechanism of functional deficits in SCZ. This study was to investigate the relationship between defective P50 inhibition and functional deficits in first-episode drug naïve (FEDN) SCZ patients. A total of 95 FEDN SCZ patients and 53 healthy controls (HC) were recruited. The Chinese version of UCSD Performance-Based Skills (UPSA), MATRICS Consensus Cognitive Battery (MCCB), and EEG system were used to assess the social function, cognitive performance, and P50 inhibition, respectively. The MCCB total score and eight domain scores were significantly lower in patients with FEDN SCZ than those in HC (all p < 0.05). The UPSA total score and financial skills scores were also significantly lower in SCZ patients than that in the HC (all p < 0.05). Compared with HC, patients with FEDF SCZ had a higher P50 ratio (all p < 0.05). There was no correlation between P50 components and MCCB scores in patients with FEDF SCZ. However, there was only a correlation between the P50 ratio and UPSA financial skills, communication skills, or total score in patients (all p < 0.05). Defective P50 inhibition in FEDN SCZ patients may be associated with social dysfunction but not cognitive impairment, suggesting that the social dysfunction and cognitive impairment of patients with FEDN SCZ may have different pathogenic mechanisms.

P50 inhibition defects, psychopathology and gray matter volume in patients with first-episode drug-naive schizophrenia

BACKGROUND

Sensory gating deficits and gray matter volume (GMV) abnormalities have been found to be associated with the pathogenesis and psychopathology of patients with schizophrenia (SCZ). However, no studies have investigated their interrelationship in first-episode treatment-naive (FETN) SCZ patients.

METHODS

We recruited 52 FETN SCZ patients and 57 healthy controls. The Positive and Negative Syndrome Scale (PANSS) was used to measure the psychopathology of the patients. We collected magnetic resonance imaging and P50 inhibition data from all participants.

RESULTS

Compared to healthy controls, patients had shorter S1 and S2 latencies but larger S2 amplitudes and P50 ratio (Bonferroni adjusted all p < 0.01). In patients, S2 latency was independently associated with PANSS total score, negative symptoms and general psychopathology (t = 2.26-2.58, both P < 0.05), whereas S1 (t = 2.44, P < 0.05) and S2 latencies (t = 2.13, P < 0.05) were associated with PANSS cognitive factor. Moreover, GMV in the left inferior temporal gyrus, left lingual gyrus and right superior occipital gyrus, and bilateral dorsolateral superior frontal gyrus were each associated with the P50 components (all p < 0.05). In addition, GMV associated with S2 latency was negatively correlated with PANSS general psychopathology (t = -2.46, p < 0.05) and total score (t = -2.34, p < 0.05).

CONCLUSIONS

Our findings indicate that FETN SCZ patients exhibit deficits in P50 inhibition and GMV of brain regions associated with these deficits may be associated with their psychopathological symptoms, suggesting that brain structures associated with P50 components may be important biomarkers of SCZ psychopathology. Future studies could use a prospective longitudinal design to investigate the potential causal relationship of brain structures associated with P50 components in the psychopathological symptoms of SCZ patients.

P50 inhibition defects with psychopathology and cognitive impairment in patients with first-episode drug naïve schizophrenia

BACKGROUND

Many studies have announced that P50 inhibition defects represent sensory gating deficits in schizophrenia, but studies seldom have searched the correlation between P50 inhibition defects and the psychopathology or cognitive impairment of patients with first-episode, drug naïve (FEDN) of schizophrenia. In this study, we investigated the auditory sensory gating deficits in a large number of Han patients with FEDN schizophrenia and their correlation with clinical symptoms and cognitive impairment.

METHODS

A total of 130 patients with FEDN schizophrenia and 189 healthy controls were recruited in this study. Positive and Negative Syndrome Scale (PANSS) and its five-factor model were used to score the psychopathology of the patients, and P50 inhibition was recorded using the 64-channel electroencephalography (EEG) system.

RESULTS

Patients exhibited significantly longer S1 and S2 latency, lower S1 and S2 amplitudes and lower P50 difference than healthy controls (all p < 0.05). Significant correlations existed between S1 latency and PANSS negative symptoms or cognitive factor, P50 ratio and general psychopathology, P50 ratio and PANSS total score, P50 difference and general psychopathology, and P50 difference and PANSS total score (all p < 0.05). Multiple regression analysis revealed that S1 latency, sex, age, and education were contributors to negative symptom score (all p < 0.05). S1 latency, S2 latency, sex, age, and smoking status were contributors to cognitive factor (all p < 0.05).

CONCLUSIONS

Our results show that patients with FEDN schizophrenia have P50 inhibition defects, which may be related to their psychopathological symptoms and cognitive impairment.

Objective electrophysiological fatigability markers and their modulation through tDCS

OBJECTIVE

Cognitive fatigability is a frequent symptom after sustained performance. Fatigability is evident in healthy subjects but is also often comorbid in several neuropsychiatric diseases. However, to date, clinical diagnostic almost solely relies on the self-reported subjective experience of fatigue. The goals of this present study were i) to complement the purely subjective fatigue diagnostic with objective electrophysiological fatigability parameters and ii) to prove the potential therapeutic application of transcranial direct current stimulation (tDCS) as a fatigability intervention.

METHODS

We performed a pseudo-randomized, sham-controlled, parallel-group trial. Forty healthy participants received either anodal or sham tDCS over the left dorsolateral prefrontal cortex (DLPFC) while they performed an exhaustive cognitive task to induce cognitive fatigability. To assess fatigability changes, we analyzed variations of prepulse inhibition (PPI) and P50 suppression as well as frontomedial theta and occipital alpha power with time-on-task.

RESULTS

The task reliably induced subjective exhaustion in all participants. Furthermore, we confirmed fatigability-related increases in frontomedial theta and occipital alpha power throughout the task. Additionally, fatigability significantly reduced PPI as well as P50 sensory gating. Anodal tDCS over the left DLPFC successfully counteracted fatigability and reduced the fatigability-related increase in alpha power as well as the decline in both gating parameters.

CONCLUSION

Occipital alpha and sensorimotor/sensory gating are suitable parameters to assess the severity of fatigability objectively. Anodal tDCS can counteract fatigability and has therapeutic potential for the treatment of fatigability in neuropsychiatric diseases.

SIGNIFICANCE

Fatigability can be objectively assessed by electrophysiological measures and attenuated by tDCS.

Structural and functional brain abnormalities in schizophrenia: A cross-sectional study at different stages of the disease

Structural and functional deficits associated with schizophrenia are observed prior to the onset of psychosis and differ according to the stage of illness. However, most previous studies concentrated on a limited period during the illness, and it remains uncertain how these abnormalities develop throughout the entire disease course. In the current study, we investigated the gray matter (GM) and regional neural activity alterations in subjects at 4 different stages of schizophrenia. The subjects comprised 53 genetic high risk (HR) individuals, 26 ultra-high risk (UHR) individuals, 58 patients with first-episode schizophrenia (FES), 41 patients with chronic schizophrenia (ChSz) and 39 healthy controls (HC), all of whom underwent structural and resting-state functional MRI scanning. Gray matter volume (GMV), amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) values were compared voxelwise among the five groups using voxel-based morphometry (VBM) and the software REST. Correlations among structural, functional abnormalities and PANSS scores in the FES group were evaluated by partial correlation analysis and multiple stepwise regression. Pronounced GMV decline was observed in the bilateral occipital lobe, left orbital frontal cortex, bilateral superior parietal lobule (SPL), right middle temporal gyrus (MTG), gyrus rectus and medial superior frontal gyrus (SFG) in the FES group and in the bilateral occipital lobe in the HR group. The FES patients also showed increased ALFF in the caudate and decreased ReHo in the bilateral inferior parietal lobule (IPL) and precuneus. The ChSz patients displayed increased ALFF in the right hippocampus. The GMV of the right MTG and SPL and the ReHo of the precuneus were negatively correlated with the general psychopathology scale, while the GMV of the right MTG was negatively correlated with the total score on the Positive and Negative Syndrome Scale (PANSS). The GMV of the right occipital cortex and SPL were associated with the ALFF of the caudate, the GMV of the right SPL was associated with the ReHo of the bilateral IPL and precuneus. GM deficits and regional dysfunction are evident prior to the onset of psychotic symptoms and are more prominent during the onset of illness than during any other phase. The right MTG and SPL, the striatum and the DMN may play important roles in the pathological changes underlying schizophrenia.

Association between structural and functional brain alterations in drug-free patients with schizophrenia: a multimodal meta-analysis

BACKGROUND

Neuroimaging studies have shown both structural and functional abnormalities in patients with schizophrenia. Recently, studies have begun to explore the association between structural and functional grey matter abnormalities. By conducting a meta-analysis on morphometric and functional imaging studies of grey matter alterations in drug-free patients, the present study aims to examine the degree of overlap between brain regions with anatomic and functional changes in patients with schizophrenia.

METHODS

We performed a systematic search of PubMed, Embase, Web of Science and the Cochrane Library to identify relevant publications. A multimodal analysis was then conducted using Seed-based d Mapping software. Exploratory analyses included jackknife, subgroup and meta-regression analyses.

RESULTS

We included 15 structural MRI studies comprising 486 drug-free patients and 485 healthy controls, and 16 functional MRI studies comprising 403 drug-free patients and 428 controls in our meta-analysis. Drug-free patients were examined to reduce pharmacological effects on the imaging data. Multimodal analysis showed considerable overlap between anatomic and functional changes, mainly in frontotemporal regions, bilateral medial posterior cingulate/paracingulate gyrus, bilateral insula, basal ganglia and left cerebellum. There were also brain regions showing only anatomic changes in the right superior frontal gyrus, left supramarginal gyrus, right lingual gyrus and functional alternations involving the right angular gyrus.

LIMITATIONS

The methodological aspects, patient characteristics and clinical variables of the included studies were heterogeneous, and we cannot exclude medication effects.

CONCLUSION

The present study showed overlapping anatomic and functional brain abnormalities mainly in the default mode (DMN) and auditory networks (AN) in drug-free patients with schizophrenia. However, the pattern of changes differed in these networks. Decreased grey matter was associated with decreased activation within the DMN, whereas it was associated with increased activation within the AN. These discrete patterns suggest different pathophysiological changes impacting structural and functional associations within different neural networks in patients with schizophrenia.

Differential sensory fMRI signatures in autism and schizophrenia: Analysis of amplitude and trial-to-trial variability

Autism and schizophrenia share multiple phenotypic and genotypic markers, and there is ongoing debate regarding the relationship of these two disorders. To examine whether cortical dynamics are similar across these disorders, we directly compared fMRI responses to visual, somatosensory and auditory stimuli in adults with autism (N=15), with schizophrenia (N=15), and matched controls (N=15). All participants completed a one-back letter detection task presented at fixation (to control attention) while task-irrelevant sensory stimulation was delivered to the different modalities. We focused specifically on the response amplitudes and the variability in sensory fMRI responses of the two groups, given the evidence of greater trial-to-trial variability in adults with autism. Both autism and schizophrenia individuals showed weaker signal-to-noise ratios (SNR) in sensory-evoked responses compared to controls (d>0.42), but for different reasons. For the autism group, the fMRI response amplitudes were indistinguishable from controls but were more variable trial-to-trial (d=0.47). For the schizophrenia group, response amplitudes were smaller compared to autism (d=0.44) and control groups (d=0.74), but were not significantly more variable (d<0.29). These differential group profiles suggest (1) that greater trial-to-trial variability in cortical responses may be specific to autism and is not a defining characteristic of schizophrenia, and (2) that blunted response amplitudes may be characteristic of schizophrenia. The relationship between the amplitude and the variability of cortical activity might serve as a specific signature differentiating these neurodevelopmental disorders. Identifying the neural basis of these responses and their relationship to the underlying genetic bases may substantially enlighten the understanding of both disorders.

Impulsivity is Associated with Early Sensory Inhibition in Neurophysiological Processing of Affective Sounds

Impulsivity is widely related to socially problematic behaviors and psychiatric illness. Previous studies have investigated the relationship between response inhibition and impulsivity. However, no study has intensively examined how impulsivity correlates with automatic sensory processing before the drive for response inhibition to sensory inputs. Sensory gating (SG) is an automatic inhibitory function that attenuates the neural response to redundant sensory information and protects higher cognitive functions from the burst of information processing. Although SG functions abnormally in several clinical populations, there is very little evidence supporting SG changes in conjunction with impulsivity traits in non-clinical populations. The present study recruited healthy adults (n = 23) to conduct a neurophysiological experiment using a paired-click paradigm and self-report scales assessing impulsive behavioral traits. Auditory stimuli included not only a pure tone but also white noise to explore the differences in auditory-evoked potential (AEP) responses between the two stimuli. White noise is more affective than pure tones; therefore, we predicted that the SG of AEPs (P50, N100, and P200) for white noise would correlate more with self-reported impulsivity than with those for pure tones. Our main findings showed that SG of the P50 and P200 amplitudes significantly correlated with self-reported reward responsiveness and fun-seeking, respectively, only for white noise stimuli, demonstrating that higher-scoring impulsivity subcomponents were related to greater SG. Frequency-domain analyses also revealed that greater desynchronization of the beta band for the second white noise stimulus was associated with higher motor impulsivity scores, suggesting that an impulsivity-related change of SG was associated with attentional modulation. These findings indicate that the measurement of SG of white noise may be an efficient tool to evaluate impulsivity in non-clinical populations, and should also be applied to clinical populations.

Sensory disturbances, inhibitory deficits, and the P50 wave in schizophrenia

Sensory gating disturbances in schizophrenia are often described as an inability to filter redundant sensory stimuli that typically manifest as inability to gate neuronal responses related to the P50 wave, characterizing a decreased ability of the brain to inhibit various responses to insignificant stimuli. It implicates various deficits of perceptual and attentional functions, and this inability to inhibit, or "gate", irrelevant sensory inputs leads to sensory and information overload that also may result in neuronal hyperexcitability related to disturbances of habituation mechanisms. These findings seem to be particularly important in the context of modern electrophysiological and neuroimaging data suggesting that the filtering deficits in schizophrenia are likely related to deficits in the integrity of connections between various brain areas. As a consequence, this brain disintegration produces disconnection of information, disrupted binding, and disintegration of consciousness that in terms of modern neuroscience could connect original Bleuler's concept of "split mind" with research of neural information integration.