Olfactory impairment in monozygotic twins discordant for schizophrenia

Olfactory Dysfunction in Schizophrenia: Evaluating Olfactory Abilities Across Species

Though understudied relative to perturbations in the auditory and visual domains, olfactory dysfunction is a common symptom of schizophrenia. Over the past two decades, the availability of standardized assessments to quantify human olfactory abilities, and enhance understanding of the neurophysiology supporting olfaction, has increased, enabling a more thorough characterization of these deficits. In contrast to other psychiatric conditions for which olfactory dysfunction has been observed (e.g., major depressive disorder, bipolar disorder, Alzheimer's disease), the impairments observed in schizophrenia are particularly global and profound. At this level, such deficits in olfactory abilities likely impact the enjoyment of food, detection of environmental hazards, and influence social relationships. More broadly, the study of olfactory phenotypes in schizophrenia presents new avenues for detection of those at-risk for the condition, identification of therapeutic targets for treatment development, and for the characterization of novel animal models relevant to schizophrenia and psychosis. This review will consider the olfactory performance of individuals with schizophrenia in domains for which standardized assessments are available (odor sensitivity, discrimination, identification, and memory). Paradigms available for assessing these abilities in rodents will also be discussed with the aim of facilitating translation. Thus, future studies will be able to include cross-species translation of mechanisms relevant to olfactory function and cognition, what has gone awry in the disease state, and test potential therapeutics.

Deficits in odor discrimination versus odor identification in patients with schizophrenia and negative correlations with GABAergic and DNA methyltransferase mRNAs in lymphocytes

Introduction

People with schizophrenia have been reported to show deficits in tests of olfactory function. DNA methylation and GABAergic input have been implicated in biochemical processes controlling odor in animal studies, but this has not been investigated in human studies.

Methods

In a study of measures of DNA methylation and GABAergic mRNAs in lymphocytes, we also measured odor identification and discrimination with the Sniffin' Sticks battery in 58 patients with chronic schizophrenia (CSZ) and 48 controls. mRNAs in lymphocytes were assessed by qPCR using TaqManTM probes. Cognition was assessed by the MATRICS battery (Measurement and Treatment Research to Improve Cognition in Schizophrenia) in CSZ and controls, and symptoms in CSZ were assessed by PANSS scale (Positive and Negative Symptom Scale). The relationships of odor deficits with mRNA, cognition, and symptoms were explored by correlation analysis. Variables which significantly differentiated CSZ from controls were explored by logistic regression.

Results

Overall, CSZ showed significantly (P≤.001) lower scores on odor discrimination compared to controls, with a moderate effect size, but no difference in odor identification. Deficits in odor discrimination, which has not been standardly assessed in many prior studies, strongly differentiated CSZ from controls. In logistic regression analysis, odor discrimination, but not odor identification, was a significant variable predicting schizophrenia versus control class membership. This is the first study to report relationship between odor deficits and DNA methylation and GABAergic mRNAs in blood cells of human subjects. There were negative correlations of odor identification with DNA methylation enzymes mRNAs and significant negative correlations with odor discrimination and GABAergic mRNAs. Lower odor scores were significantly associated with lower cognitive scores on the MATRICS battery in CSZ but not control subjects. In CSZ, lower odor scores were significantly associated with negative symptom scores, while higher odor identification scores were associated with PANNS Excitement factor.

Discussion

Odor discrimination was a more powerful variable than odor identification in discriminating CSZ from controls and should be used more regularly as an odor measure in studies of schizophrenia. The substantive meaning of the negative correlations of odor discrimination and GABAergic mRNA variables in peripheral lymphocytes of CSZ needs more investigation and comparison with results in neural tissue.

Neuropsychiatric Symptoms Mediated the Relationship Between Odor Identification and Cognition in Alzheimer's Disease Spectrum: A Structural Equation Model Analysis

Background: Odor identification dysfunction is an early predictor of the development of Alzheimer's disease (AD), but neuropsychiatric symptoms (NPS), which are common in AD and mild cognitive impairment (MCI), are also associated with odor identification dysfunction. Whether NPS affect the specificity of using odor identification dysfunction to predict cognitive decline in AD and MCI remains unclear.

Methods: Patients (233 with MCI and 45 with AD) and 45 healthy controls (HCs) underwent assessments of odor identification (Sniffin' Sticks), NPS (Neuropsychiatric Inventory-12), and cognitive function (global cognition, memory, language, executive function, visual-spatial skill, and attention). Structural equation modeling (SEM) with bootstrapping estimation was conducted to explore the relationships between odor identification, NPS, and cognition.

Results: Patients with NPS showed significantly worse performance in odor identification and cognition than patients without NPS and HCs. The SEM showed odor identification to be positively associated with cognition, and cognition had special indirect effects on odor identification through affective and psychosis symptoms (two factors extracted from Neuropsychiatric Inventory-12). Additionally, affective and psychosis symptoms partially mediated the effect of cognition on odor identification.

Conclusion: Neuropsychiatric symptoms are associated with odor identification dysfunction in patients with AD and MCI. Studies exploring the relationship between odor identification dysfunction and cognitive decline in patients with AD and MCI should include an assessment of affective and psychosis symptoms, and adjust their confounding effects.

Self-Processing and Self-Face Reaction Time Latencies: A Review

In this article, we detail the advantages of self-face identification latencies over more traditional tests of mirror self-recognition. Using reaction time latencies (measured in milliseconds) to identify different dimensions of the self, instead of relying on a simple dichotomous pass/fail mirror mark-test outcome, enables investigators to examine individual differences in self-processing time. This is a significant methodological step forward with important implications. The point of departure for our article is to detail research we and others have conducted on latencies for self-face identification, to show how self-processing occurs in the right side of the brain, how schizophrenia is a self-processing disorder, how self-face reaction time latencies implicate the existence of an underlying multiple modal self-processing system, and to explore ideas for future research.

Assessing olfactory, memory, social and circadian phenotypes associated with schizophrenia in a genetic model based on Rim

Schizophrenia shows high heritability and several of the genes associated with this disorder are involved in calcium (Ca2+) signalling and synaptic function. One of these is the Rab-3 interacting molecule-1 (RIM1), which has recently been associated with schizophrenia by Genome Wide Association Studies (GWAS). However, its contribution to the pathophysiology of this disorder remains unexplored. In this work, we use Drosophila mutants of the orthologue of RIM1, Rim, to model some aspects of the classical and non-classical symptoms of schizophrenia. Rim mutants showed several behavioural features relevant to schizophrenia including social distancing and altered olfactory processing. These defects were accompanied by reduced evoked Ca2+ influx and structural changes in the presynaptic terminals sent by the primary olfactory neurons to higher processing centres. In contrast, expression of Rim-RNAi in the mushroom bodies (MBs), the main memory centre in flies, spared learning and memory suggesting a differential role of Rim in different synapses. Circadian deficits have been reported in schizophrenia. We observed circadian locomotor activity deficits in Rim mutants, revealing a role of Rim in the pacemaker ventral lateral clock neurons (LNvs). These changes were accompanied by impaired day/night remodelling of dorsal terminal synapses from a subpopulation of LNvs and impaired day/night release of the circadian neuropeptide pigment dispersing factor (PDF) from these terminals. Lastly, treatment with the commonly used antipsychotic haloperidol rescued Rim locomotor deficits to wildtype. This work characterises the role of Rim in synaptic functions underlying behaviours disrupted in schizophrenia.

Olfactory dysfunction in frontotemporal dementia and psychiatric disorders: A systematic review

Frontotemporal dementia (FTD) is a progressive neurodegenerative disease. Diagnosis of FTD, especially the behavioural variant, is challenging because of symptomatic overlap with psychiatric disorders (depression, schizophrenia, bipolar disorder). Olfactory dysfunction is common in both FTD and psychiatric disorders, and often appears years before symptom onset. This systematic review analysed 74 studies on olfactory function in FTD, depression, schizophrenia and bipolar disorder to identify differences in olfactory dysfunction profiles, focusing on the most common smell measures: odour identification and discrimination. Results revealed that FTD patients were severely impaired in odour identification but not discrimination; in contrast, patients diagnosed with schizophrenia showed impairments in both measures, while those diagnosed with depression showed no olfactory impairments. Findings in bipolar disorder were mixed. Therefore, testing odour identification and discrimination differentiates FTD from depression and schizophrenia, but not from bipolar disorder. Given the high prevalence of odour identification impairments in FTD, and that smell dysfunction predicts neurodegeneration in other diseases, olfactory testing seems a promising avenue towards improving diagnosis between FTD and psychiatric disorders.

The behavioral and neurochemical characterization of a Drosophila dysbindin mutant supports the contribution of serotonin to schizophrenia negative symptoms

Mutations in the dystrobrevin binding protein 1 (DTNBP1) gene that encodes for the dysbindin-1 protein, are associated with a higher risk for schizophrenia. Interestingly, individuals carrying high-risk alleles in this gene have been associated with an increased incidence of negative symptoms for the disease, which include anhedonia, avolition and social withdrawal. Here we evaluated behavioral and neurochemical changes in a hypomorphic Drosophila mutant for the orthologue of human Dysbindin-1, dysb¹. Mutant dysb¹ flies exhibit altered social space parameters, suggesting asocial behavior, accompanied by reduced olfactory performance. Moreover, dysb¹ mutant flies show poor performance in basal and startle-induced locomotor activity. We also report a reduction in serotonin brain levels and changes in the expression of the Drosophila serotonin transporter (dSERT) in dysb¹ flies. Our data show that the serotonin-releasing amphetamine derivative 4-methylthioamphetamine (4-MTA) modulates social spacing and locomotion in control flies, suggesting that serotonergic circuits modulate these behaviors. 4-MTA was unable to modify the behavioral deficiencies in mutant flies, which is consistent with the idea that the efficiency of pharmacological agents acting at dSERT depends on functional serotonergic circuits. Thus, our data show that the dysb¹ mutant exhibits behavioral deficits that mirror some aspects of the endophenotypes associated with the negative symptoms of schizophrenia. We argue that at least part of the behavioral aspects associated with these symptoms could be explained by a serotonergic deficit. The dysb¹ mutant presents an opportunity to study the molecular underpinnings of schizophrenia negative symptoms and reveals new potential targets for treatment of the disease.

Associations between olfactory identification and (social) cognitive functioning: A cross-sectional study in schizophrenia patients and healthy controls

Schizophrenia patients have difficulties identifying odors, possibly a marker of cognitive and social impairment. This study investigated olfactory identification (OI) differences between patients and controls, related to cognitive and social functioning in childhood and adolescence, to present state cognition and to present state social cognition. 132 schizophrenia patients and 128 healthy controls were assessed on OI performance with the Sniffin' Sticks task. Multiple regression analyses were conducted investigating OI in association with cognitive and social functioning measures in childhood/adolescence and in association with IQ, memory, processing speed, attention, executive functioning, face recognition, emotion recognition and theory of mind. Patients had reduced OI performance compared to controls. Also, patients scored worse on childhood/adolescence cognitive and social functioning, on present state cognitive functioning and present state social cognition compared to controls. OI in patients and controls was significantly related to cognitive and social functioning in childhood/adolescence, to present state cognition and to present state social cognition, with worse functioning being associated with worse OI. In this study, findings of worse OI in patients relative to controls were replicated. We also showed associations between OI and cognitive and social functioning which are not specific to schizophrenia.

Olfactory impairment in first-episode schizophrenia: a case-control study, and sex dimorphism in the relationship between olfactory impairment and psychotic symptoms

BACKGROUND

A body of studies has focused on the olfactory impairment among people with schizophrenia. The effect of sex on this relationship has attracted the attention of researchers. These issues have not been studied much in Chinese schizophrenia patients.

METHODS

We conducted a case-control study of 110 first-episode antipsychotic medicine naïve schizophrenia patients aged 18-35 years and 110 controls, matched by age and sex. Odour threshold, discrimination and identification were assessed by the "Sniffin' Sticks" test. Psychotic symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS).

RESULTS

The odour threshold, discrimination and identification scores of patients with schizophrenia were significantly lower than those of the healthy control group. The difference in identification score had statistical significance between male and female patients with schizophrenia (t = - 2.45, P < 0.05). Controlling for confounding factor, in male schizophrenia participants, the negative subscale score was significantly and inversely correlated with the discrimination (γ = - 0.37, p < 0.008), identification (γ = - 0.45, p < 0.008) and TDI (γ = - 0.50, p < 0.008) scores; the general psychopathology subscale score was inversely and significantly correlated with the identification (γ = - 0.47, p < 0.008) and TDI (γ = - 0.41, p < 0.008) scores. For female schizophrenia patients, positive and general psychopathology subscale scores had a significant inverse correlation with the identification score (positive: γ = - 0.47, p < 0.008; general psychopathology: γ = - 0.42, p < 0.008).

CONCLUSIONS

Controlling for confounder, negative symptoms were related to impaired odour discrimination and identification in male schizophrenia patients, while positive symptoms were correlated with impaired odour identification in female schizophrenia patients. This sex dimorphism could provide useful information for future studies aiming to finding biomarkers of schizophrenia.

Olfactory identification deficit and its relationship with hedonic traits in patients with first-episode schizophrenia and individuals with schizotypy

OBJECTIVE

Olfactory identification impairments have been consistently found in schizophrenia patients. However, few previous studies have investigated this in first-episode patients. There are also inconsistent findings regarding olfactory identification ability in psychometrically-defined schizotypy individuals. In this study, we directly compared the olfactory identification ability of first-episode schizophrenia patients with schizotypy individuals. The relationship between olfactory identification impairments and hedonic traits was also examined.

METHODS

Thirty-five first-episode schizophrenia patients, 40 schizotypy individuals as defined by the Chapman's Anhedonia Scales and 40 demographically matched controls were recruited. The University of Pennsylvania Smell Identification Test was administered. Hedonic capacity was assessed using the Temporal Experience of Pleasure Scale (TEPS).

RESULTS

The results showed that both the schizophrenia and schizotypy groups showed poorer olfactory identification ability than controls, and the impairment was significantly correlated with reduced pleasure experiences.

CONCLUSION

Our findings support olfactory identification impairment as a trait marker for schizophrenia.

Overrated hedonic judgment of odors in patients with schizophrenia

AIMS

The odor identification ability and its hedonic judgment in patients with schizophrenia were evaluated in the study. The association between olfactory performance and negative symptoms and β-endorphin concentration was also analyzed.

METHODS

Study groups consisted of 23 patients with negative symptoms (PN) and 25 without predominant negative symptoms (PP) and 21 healthy individuals. The University of Pennsylvania Smell Identification Test, odor hedonic evaluation, and plasma concentrations of β-endorphin assay in all participants were performed.

RESULTS

PN perceived the poorer olfactory identification; nevertheless, they evaluated unpleasant odors as more pleasant than PP and controls. Beta-endorphin concentration was significantly higher among PN than in other study groups. No association was observed between β-endorphin and odors identification and odor hedonic judgment among all study groups.

CONCLUSIONS

There is potential relationship between increased β-endorphin concentration and severity of negative symptoms. Patients with predominant negative symptoms tend to evaluate odors as significantly more pleasant. Individuals with this subtype of schizophrenia might present specific, altered pattern of smell identification and hedonic judgment. Presumably, β-endorphin has no direct influence on olfactory identification performance and hedonic judgment in schizophrenia.

Initiation of the age-related decline of odor identification in humans: A meta-analysis

BACKGROUND

Aging is an important contributor to olfactory system deterioration in humans, leading to increased health and safety risks as well as affecting the quality of life. However, it is currently unknown when age-related olfactory deterioration begins in humans and thus when to initiate interventions to prevent or slow it.

OBJECTIVE

To determine the decade in which olfactory function begins to deteriorate in healthy humans by determining when odor identification is first impaired.

DATA SOURCE AND STUDY SELECTION

Studies cited in the PubMed database were searched from its inception to March 2017 using the terms "olfac*" or "smell" and "ag*". The effect size of each comparison was calculated.

RESULTS

In this meta-analysis, the effect sizes as determined using Cohen's d for the comparisons between 30 and 39.9- and 40-49.9-year-olds was 0.06 (95% CI: -0.17 to 0.29), between 40-49.9-year-olds was 0.62 (95% CI: 0.20-1.04), considered a medium effect size, and between 35-55-year-olds and those >55years old was 1.12 (95% CI: 1.06-1.45), considered a very large effect.

CONCLUSION

Olfactory function deterioration, as determined by an impaired ability to identify odors, starts in the fifth decade of life in healthy humans.

Rodents and humans are able to detect the odour of L-Lactate

L-Lactate (LL) is an essential cellular metabolite which can be used to generate energy. In addition, accumulating evidence suggests that LL is used for inter-cellular signalling. Some LL-sensitive receptors have been identified but we recently proposed that there may be yet another unknown G-protein coupled receptor (GPCR) sensitive to LL in the brain. Olfactory receptors (ORs) represent the largest family of GPCRs and some of them are expressed outside the olfactory system, including brain, making them interesting candidates for non-olfactory LL signalling. One of the “ectopically” expressed ORs, Olfr78 in mice (Olr59 in rats and OR51E2 in humans), reportedly can be activated by LL. This implies that both rodents and humans should be able to detect the LL odour. Surprisingly, this has never been demonstrated. Here we show that mice can detect the odour of LL in odour detection and habituation-dishabituation tasks, and discriminate it from peppermint and vanilla odours. Behaviour of the Olfr78 null mice and wildtype mice in odour detection task was not different, indicating that rodents are equipped with more than one LL-sensitive OR. Rats were also able to use the smell of LL as a cue in an odour-reward associative learning task. When presented to humans, more than 90% of participants detected a smell of LL in solution. Interestingly, LL was perceived differently than acetate or propionate—LL was preferentially reported as a pleasant sweet scent while acetate and propionate were perceived as repulsive sour/acid smells. Subjective perception of LL smell was different in men and women. Taken together, our data demonstrate that both rodents and humans are able to detect the odour of LL. Moreover, in mice, LL perception is not purely mediated by Olfr78. Discovery of further LL-sensitive OR might shed the light on their contribution to LL signalling in the body.

Abnormal N400 Semantic Priming Effect May Reflect Psychopathological Processes in Schizophrenia: A Twin Study

OBJECTIVE

Activation of semantic networks is indexed by the N400 effect. We used a twin study design to investigate whether N400 effect abnormalities reflect genetic/trait liability or are related to psychopathological processes in schizophrenia.

METHODS

We employed robust linear regression to compare N400 and behavioral priming effects across 36 monozygotic twin pairs (6 pairs concordant for schizophrenia/schizoaffective disorder, 11 discordant pairs, and 19 healthy control pairs) performing a lexical decision task. Moreover, we examined the correlation between Brief Psychiatric Rating Scale (BPRS) score and the N400 effect and the influence of medication status on this effect.

RESULTS

Regression yielded a significant main effect of group on the N400 effect only in the direct priming condition (p = 0.003). Indirect condition and behavioral priming effect showed no significant effect of group. Planned contrasts with the control group as a reference group revealed that affected concordant twins had significantly reduced N400 effect compared to controls, and discordant affected twins had a statistical trend for reduced N400 effect compared to controls. The unaffected twins did not differ significantly from the controls. There was a trend for correlation between reduced N400 effect and higher BPRS scores, and the N400 effect did not differ significantly between medicated and unmedicated patients.

CONCLUSIONS

Reduced N400 effect may reflect disease-specific processes in schizophrenia implicating frontotemporal brain network in schizophrenia pathology.

Association between olfactory identification and parkinsonism in patients with non-affective psychosis

AIM

Olfactory identification deficits (OIDs) are seen in schizophrenia patients and individuals at increased risk for psychosis but its pathophysiology remains unclear. Although dopaminergic imbalance is known to lie at the core of schizophrenia symptomatology, its role in the development of OIDs has not been elucidated yet. This study investigated the association between OIDs and symptoms of parkinsonism as a derivative of dopaminergic functioning.

METHODS

In 320 patients diagnosed with non-affective psychosis, olfactory identification performance was assessed by means of the Sniffin' Sticks task. Level of parkinsonian symptoms was assessed by means of the Unified Parkinson's Disease Rating Scale (UPDRS-III). By means of multiple linear regression with bootstrapping, the association between UPDRS and Sniffin' Sticks score was investigated while correcting for potential confounders. A Bonferroni corrected P-value of 0.007 was used.

RESULTS

Higher UPDRS scores significantly predicted worse olfactory identification in patients with non-affective psychosis with an unadjusted b = -0.07 (95% CI -0.10 to -0.04) and an adjusted b = -0.04 (95% CI -0.07 to -0.01).

CONCLUSION

Results provide preliminary evidence that the same vulnerability may underlie the development of parkinsonism and OIDs in patients with non-affective psychosis. Further investigation should evaluate the clinical value of OIDs as a marker of dopaminergic vulnerability that may predict psychosis.

The Evaluation of Olfactory Function in Patients With Schizophrenia

The aim of this study was to compare olfactory threshold, smell identification, intensity and pleasantness ratings between patients with schizophrenia and healthy controls, and (2) to evaluate correlations between ratings of olfactory probes and illness characteristics. Thirty one patients with schizophrenia and 31 control subjects were assessed with the olfactory n-butanol threshold test, the Iran smell identification test (Ir-SIT), and the suprathreshold amyl acetate odor intensity and odor pleasantness rating test. All olfactory tasks were performed unirhinally.

Patients with schizophrenia showed disrupted olfaction in all four measures. Longer duration of schizophrenia was associated with a larger impairment of olfactory threshold or microsmic range on the Ir-SIT (P = 0.04, P = 0.05, respectively). In patients with schizophrenia, female subjects’ ratings of pleasantness followed the same trend as control subjects, whereas male patients’ ratings showed an opposite trend. Patients exhibiting high positive score on the positive and negative syndrome scale (PANSS) performed better on the olfactory threshold test (r = 0.37, P = 0.04). The higher odor pleasantness ratings of patients were associated with presence of positive symptoms.

The results suggest that both male and female patients with schizophrenia had difficulties on the olfactory threshold and smell identification tests, but appraisal of odor pleasantness was more disrupted in male patients.

Olfactory processing in schizophrenia, non-ill first-degree family members, and young people at-risk for psychosis

OBJECTIVES

While deficits in odor identification and discrimination have been reported in schizophrenia, few studies have examined the relative specificity of these deficits in patients and at-risk youth.

METHOD

Sniffin' Sticks odor identification and discrimination were assessed in schizophrenia outpatients and non-ill first-degree relatives (Study One), as well as youth at clinical (CR) or genetic (GR) risk for schizophrenia (Study Two). Scores were z-transformed, using the performance of a demographically-matched adult or adolescent comparison group.

RESULTS

Patients and relatives were impaired on odor identification, but odor discrimination impairment was limited to the patient group. A similar pattern of impairment emerged in at-risk youth. GR youth were impaired on odor identification but not discrimination, while CR youth were impaired on both tasks. In patients, olfactory impairment was correlated with negative symptomatology.

CONCLUSIONS

To our knowledge, this is the first study to show that CR youth are impaired on both olfactory tasks, as observed in adult schizophrenia patients. GR youth were impaired only on odor identification like their adult counterparts. These data suggest that odor identification impairment, in isolation, may represent a genetic marker of vulnerability for schizophrenia, while odor discrimination deficits may be a biomarker associated with the development of psychosis.

Brain structural imaging correlates of olfactory dysfunction in obsessive-compulsive disorder

Olfactory dysfunction has been described in obsessive-compulsive disorder (OCD). Brain regions involved in smell processing partially overlap with structures included in the neurobiological models of OCD, although no previous studies have analyzed the neuroanatomical correlates of olfactory dysfunction in this disorder. The aim of our study was to examine the association between regional gray matter volume, as assessed by a voxel-based morphometry analysis of magnetic resonance images (MRI), and olfactory function, as assessed by the Sniffin' Sticks test (SST). Olfactory function was assessed in 19 OCD patients and 19 healthy volunteers. All participants were also scanned in a 1.5-T magnet to obtain T1-weighted anatomical MRIs, which were pre-processed and analyzed with SPM8. Three different correlation models were used to study the association between regional gray matter volumes and olfactory function in the domains assessed by the SST: detection threshold, discrimination, and identification. OCD patients showed a significant impairment in all the domains assessed by the SST. Voxel-based mapping revealed a positive association in healthy controls between detection threshold and the gray matter content of a left anterior cingulate cortex cluster. In OCD patients, a positive correlation was observed between identification errors and the gray matter volume of the left medial orbital gyrus. In a post hoc analysis, these two gray matter regions were shown to be enlarged in OCD patients. Our findings support the idea that olfactory dysfunction in OCD is associated with volumetric changes in brain areas typically implicated in the neurobiology of the disorder.

Meta-analysis of olfactory function in schizophrenia, first-degree family members, and youths at-risk for psychosis

BACKGROUND

Previous research has provided compelling support for olfactory dysfunction in schizophrenia patients, their first-degree relatives, and youth at-risk for psychosis. A previous meta-analysis revealed large effect sizes across olfactory tasks but was limited to 2 olfactory tasks and did not examine moderator variables. Thus, the current meta-analysis was undertaken to incorporate additional studies, risk cohorts, olfactory test domains, and moderator variable analyses.

METHOD

A meta-analysis was conducted on 67 publications examining olfactory function in schizophrenia patients and 15 publications examining olfactory functioning in youth at-risk for psychosis, first-degree relatives of schizophrenia patients, and individuals with schizotypy.

RESULTS

Results revealed medium-to-large olfactory deficits in schizophrenia patients though significant heterogeneity was evident. Several variables moderated overall study effects. At-risk youths similarly demonstrated medium-to-large effect sizes, whereas first-degree relatives and individuals with schizotypy showed small effects.

CONCLUSIONS

Findings suggest robust olfactory deficits in schizophrenia and at-risk youths. In schizophrenia, several variables had significant impact on these deficits and warrant consideration in prospective studies. Our findings also indicate that olfactory measures may be a useful marker of schizophrenia risk status.

Effects of adjunctive intranasal oxytocin on olfactory identification and clinical symptoms in schizophrenia: results from a randomized double blind placebo controlled pilot study

BACKGROUND

Deficits in olfactory identification have been widely reported in patients with schizophrenia (SZ) and are associated with negative symptomatology. Adjunctive oxytocin delivered intranasally has been shown to improve some aspects of social cognition as well as positive and negative symptoms in patients with schizophrenia. Given the intranasal delivery route of oxytocin to olfactory pathways and that olfactory abnormalities are a potential endophenotype in SZ, we investigated the effect of intranasal oxytocin on olfactory identification as well as positive and negative symptoms in people with schizophrenia.

METHODS

Individuals with schizophrenia or schizoaffective disorder (n=28; 16 outpatients, 12 inpatients) were randomized to receive adjunctive intranasal oxytocin 20 IU BID or placebo for 3 weeks.

RESULTS

All 28 participants completed the clinical trial. Odor identification performance significantly improved on the University of Pennsylvania Smell Identification Test (UPSIT) total score and subscore for pleasant smells. UPSIT score (F=5.20, df=1,23, p=0.032) and subscore for pleasant smells (F=4.56, df=1,23, p=0.044), in patients treated with oxytocin were compared to placebo from baseline to endpoint. Global symptomatology as well as positive and negative symptoms were not improved by intranasal oxytocin. In fact, global symptoms, not positive or negative symptoms, improved in the placebo group. Secondary analysis shows that intranasal oxytocin improved negative symptoms in the small group of inpatients. Intranasal oxytocin was well tolerated during the three week trial.

CONCLUSION

Adjunctive intranasal oxytocin may improve olfactory identification, particularly in items of positive valence. Larger studies are needed to determine the effects of oxytocin on negative symptoms in SZ. (NCT00884897; http://www.clinicaltrials.gov).

The influence of semantic processing on odor identification ability in schizophrenia

Despite the well-documented observation of odor identification deficits in schizophrenia, less is known about where the disruption in the process of correctly identifying an odor occurs. This study aimed to determine the potential moderating effects of semantic processing on the observed olfactory dysfunction in schizophrenia. Schizophrenia patients and healthy comparison subjects completed two versions of the University of Pennsylvania Smell Identification Test (UPSIT): an uncued free-response version and the standard multiple-choice paradigm, as well as three semantic measures: The Boston Naming Test, Animal Naming, and Pyramids and Palm Tree Test. Schizophrenia patients yielded significantly lower scores than the comparison group on the standard UPSIT and on semantic measures. No relationship was observed between olfactory and semantic task performance in patients. These data suggest that odor identification deficits may not be primarily due to semantic processing deficits in schizophrenia.

Olfaction, "olfiction," and the schizophrenia-spectrum: an updated meta-analysis on identification and acuity

Olfaction deficits in individuals with schizophrenia are well documented. A meta-analysis conducted nearly a dozen years ago on the topic revealed a deficit of a full standard deviation in magnitude compared to nonpatient controls. Recent efforts have been attempted to determine whether deficits in olfactory identification and acuity reflect a vulnerability marker of schizophrenia-spectrum pathology. To address this issue, the present study conducted a meta-analysis of 16 studies of individuals with schizotypy, defined in terms of a) "ultra-high risk" status, b) having an affected biological family member, or c) having extreme scores on a schizotypy questionnaire. We also conducted an updated meta-analysis of 40 studies of olfactory functioning in schizophrenia. Consistent with the prior meta-analysis, patients with schizophrenia showed impairments in olfaction identification on a full standard deviation in magnitude (d = -.99). Individuals with schizotypy showed much more subtle (d = -.24) differences in olfaction, though the effect sizes were higher for studies examining individuals at "ultra-high risk" (d = -.67) versus studies examining individuals with psychometrically-defined (d = -.14) schizotypy. Differences in olfactory acuity, relative to their respective control groups, were small for both the schizophrenia (d = -.45) and schizotypy (d = -.38) studies but were similar in magnitude. The present findings argue against the notion that deficits in olfaction identification are a vulnerability marker of schizophrenia. Suggestions for future research are recommended.

Is the odour identification deficit in schizophrenia influenced by odour hedonics?

INTRODUCTION. While smell identification deficits have been well documented in schizophrenia, less work has examined identification accuracy for pleasant and unpleasant odours. The current investigation examined odour identification performance for pleasant and unpleasant odours in a sample of inpatients with schizophrenia and nonpsychiatric community controls. METHOD. The Brief Smell Identification Test was used to investigate accuracy in the identification of pleasant and unpleasant odours in 23 schizophrenia inpatients and 21 nonpsychiatric controls. RESULTS. Results revealed that schizophrenia patients showed reduced accuracy on pleasant odours, but intact performance for unpleasant odours. CONCLUSIONS. Results provide preliminary support for a specific deficit in identifying pleasant odours in patients with schizophrenia. Future studies separating odours by valence categories are warranted.

Olfactory identification and preference in bipolar disorder and schizophrenia

Olfactory identification deficit appears to be an enduring feature of schizophrenia, but it is unclear whether it is specific to schizophrenia or present in psychotic disorders in general. The aim of the present study was to compare olfactory identification and olfactory preference in schizophrenia and bipolar disorder. Individuals with schizophrenia or bipolar disorder and demographically matched healthy participants were given the University of Pennsylvania Smell Identification Test (UPSIT) to assess olfactory identification ability. To examine olfactory hedonic judgment, participants were also asked to indicate their preference for each UPSIT item on a 5-point rating scale, immediately after odor identification. Clinical symptoms and social competence were also assessed. Both schizophrenic and bipolar groups showed olfactory identification deficits compared with the healthy controls, but schizophrenic patients were more impaired than bipolar patients on the UPSIT accuracy. Interestingly, both bipolar and schizophrenic patients rated odors to be more pleasant than did healthy controls, but all groups preferred odors that they could correctly identify to unidentified smells. Restricted range of preference ratings was associated with the severity of negative symptoms in schizophrenia, and with mania in bipolar disorder. Social competence was associated with better olfactory identification performance. These findings suggest that olfactory identification and preference are compromised in bipolar disorder as well as in schizophrenia, but the precise nature of these abnormalities needs to be further elucidated.

Identification of pleasant, neutral, and unpleasant odors in schizophrenia

Recent work on odor hedonics in schizophrenia has indicated that patients display abnormalities in hedonic judgments of odors in comparison to healthy comparison participants. In the current study, identification accuracy for pleasant, neutral, and unpleasant odors in individuals with schizophrenia and healthy controls was examined. Thirty-three schizophrenia patients (63% male) and thirty-one healthy volunteers (65% male) were recruited. The groups were well matched on age, sex, and smoking status. Participants were administered the University of Pennsylvania Smell Identification Test, which was subsequently divided into 16 pleasant, 15 neutral, and 9 unpleasant items. Analysis of identification z-scores for pleasant, neutral, and unpleasant odors revealed a significant diagnosis by valence interaction. Post-hoc analysis revealed that schizophrenia participants made more identification errors on pleasant and neutral odors compared to healthy controls, with no differences observed for unpleasant odors. No effect was seen for sex. The findings from the current investigation suggest that odor identification accuracy in patients is influenced by odor valence. This pattern of results parallels a growing body of literature indicating that patients display aberrant pleasantness ratings for pleasant odors and highlights the need for additional research on the influence of odor valence on olfactory identification performance in individuals with schizophrenia.

Olfactory dysfunction in schizophrenia: a review of neuroanatomy and psychophysiological measurements

Olfactory processing is thought to be mediated via the frontal and temporolimbic brain regions, both of which, as well as olfactory dysfunction, are implicated in schizophrenia. Likewise, several empirical studies of olfactory dysfunction--in particular, olfactory deficits in identification, odor detection threshold sensitivity, and odor memory, along with associated brain structural changes--have been conducted to illuminate the pathophysiology of schizophrenia. These anomalies have been investigated, more recently, as possible biological markers of that disabling illness. This article summarizes recent research on neuroimaging changes associated with olfactory impairments in schizophrenia patients and on related functional changes in psychophysiological measurements (e.g., odor identification, odor discrimination, odor detection threshold, and odor memory). The possible role of these changes as biological markers of the disorder will be discussed, as will potentially productive directions for future research.

Olfactory function and schizophrenia: an update

PURPOSE OF REVIEW

Olfaction is a field of growing interest in schizophrenia research. This article reviews recent studies on olfactory functions in schizophrenia.

RECENT FINDINGS

The current literature provides additional insights into olfactory deficits, abnormalities, and olfactory hedonic dysfunction in schizophrenia. Recent findings reinforce particular associations with negative symptoms and deficit syndrome schizophrenia. Studies indicate that abnormalities in patients with schizophrenia extend to more peripheral olfactory structures and functions, including olfactory receptor neuron dysfunction. Olfactory identification ability was found to relate to prodromal disorganization symptoms in young high-risk patients. Further support for the notion of a genetic contribution to olfactory dysfunction in schizophrenia derives from studies reporting physiological olfactory dysfunction (olfactory event-related potentials) in unaffected relatives, and an odor-specific hyposmia, present in both patients with schizophrenia and family members.

SUMMARY

Further research is needed to improve our understanding of olfactory dysfunction in schizophrenia. Recent encouraging findings underscore that the olfactory system is a field of research that holds promise for advancing our understanding of the pathophysiology of schizophrenia and possibly as a useful endophenotypic marker of neurodevelopmental vulnerability.

Prevalence and longitudinal stability of negative symptoms in healthy participants

OBJECTIVE

Although negative symptoms are prominent in older patients with schizophrenia, it is unknown whether this pattern is prevalent in healthy participants. The objective of this study was to evaluate whether negative symptoms are present in healthy populations and to determine whether they are linked to illness-related processes or normal aging.

METHODS

A systemic review of 26 studies that have administered negative symptom assessments to healthy participants was conducted. In addition, 213 (age > 40 years old) healthy participants completed PANSS and SANS ratings at both baseline and 1-year follow-up. One-hundred participants also completed ratings after 3 years.

RESULTS

Across all reviewed studies, negative symptoms were absent in the majority of participants. Comparable results were found in the current study's large longitudinal evaluation with middle-aged to older adults.

CONCLUSIONS

Taken together, the data suggest that healthy volunteers do not suffer from prominent negative symptoms. This finding is consistent with the hypothesis that the greater prevalence and severity of negative symptoms in older patients is not related to normal aging but to illness-related processes.

Negative symptoms of schizophrenia correlate with impairment on the University of Pennsylvania smell identification test

Deficits in odor identification have been most frequently described in schizophrenia (SZ). A relationship between dysfunction in odor identification and negative symptoms of SZ has also been reported. Furthermore, deficit SZ (a subtype of the illness with primary, enduring negative symptoms) has been found to be associated with a particularly poor performance on odor identification tests indicating that deficits in smell identification could be differentially expressed in some subtypes of SZ. We describe correlations of performance on smell identification with positive and negative symptoms of SZ. Patients with SZ (n=15) and normal controls (n=19) were tested by the University of Pennsylvania Smell Identification Test (UPSIT). Psychopathology was assessed with the Scales for the Assessment of Positive and Negative Symptoms (SAPS and SANS). SZ patients performed more poorly on the UPSIT test than did normal controls. Consistent with previous findings, we observed a correlation of SANS with UPSIT performance. In particular, specific subdomains of SANS, such as blunted affect, apathy and anhedonia, were associated with odor identification deficits. Furthermore, UPSIT score predicts these subdomains of negative symptoms. No correlation was observed between positive symptom and odor identification deficits. Our study further reinforces a relation between olfactory identification deficit and negative symptoms in SZ and suggests that smell identification could be a candidate endophenotype relevant to negative symptoms of SZ.

Olfactory identification in young relatives at risk for schizophrenia

OBJECTIVE

Olfactory identification deficits (OIDs) are seen in schizophrenia, but it is unclear whether they are state- or trait-related.

METHODS

We examined the prevalence of OIDs, as assessed by the University of Pennsylvania Smell Identification Test (UPSIT), and their correlations with prodromal symptoms in young relatives at risk for schizophrenia or schizoaffective disorder (HR-S).

RESULTS

UPSIT scores were lower in HR- S than in healthy controls, but were non-significant after covarying the effects of age, gender and IQ. OID deficits in HR-S were correlated, after covarying out the effects of age and IQ, with prodromal disorganisation.

CONCLUSION

The potential value of OID deficits as markers of psychopathological vulnerability in young relatives at risk for schizophrenia deserves further investigation.

Deletion of the STOP gene, a microtubule stabilizing factor, leads only to discrete cerebral metabolic changes in mice

In mice, deletion of the STOP protein leads to subtle anatomic changes and induces depleted synaptic vesicle pools, impaired synaptic plasticity, hyperdopaminergy, and major behavioral disorders alleviated by neuroleptics, hence leading to a schizophrenic-like phenotype. In this study, we applied the quantitative autoradiographic [(14)C]2-deoxyglucose technique to study to what extent the basal rate of cerebral glucose utilization in STOP-knockout (STOP-KO) mice occurs in regions where metabolic changes have been reported in schizophrenic patients. Studies were performed on wild-type, heterozygous, and homozygous STOP-KO mice (7-8 per group). Mice were implanted with femoral artery and vein catheters, and cerebral glucose utilization was quantified over 45 min. Compared with that in wild-type mice, glucose utilization in STOP-KO mice was significantly increased in the olfactory cortex, ventromedial and anterolateral hypothalamus, ventral tegmental area, and substantia nigra pars compacta. Nonsignificant increases, ranging between 9% and 19%, were recorded in the whole auditory system, CA1 pyramidal cell layer, and dorsal raphe. Glucose utilization was also significantly increased in heterozygous mice compared with that in wild-type mice in olfactory cortex. These data might reflect hyperdopaminergic activity, olfactory deficits, and sleep disturbances in STOP-KO mice that have also been reported in schizophrenic patients.

Olfactory physiological impairment in first-degree relatives of schizophrenia patients

BACKGROUND

Efforts to characterize genetic vulnerability to schizophrenia are increasingly focused on the identification of endophenotypes--neurobiological abnormalities that are evident in individuals at risk. Behavioral studies have demonstrated olfactory impairments in odor detection and identification in unaffected 1st-degree relatives of schizophrenia patients, suggesting that abnormalities in this simple sensory system may serve as candidate endophenotypes. It is unclear, however, whether these behavioral abnormalities reflect basic olfactory sensory processing deficits or nonspecific disruptions of attention and cognition.

METHOD

Unirhinal chemosensory olfactory evoked potentials were acquired from 14 unaffected 1st-degree relatives of schizophrenia patients and 20 healthy individuals with equivalent age and gender distributions, using 3 different concentrations of hydrogen sulfide. Subjects were also assessed behaviorally for ability to detect and identify odors.

RESULTS

Family members exhibited left nostril olfactory detection impairments and bilateral olfactory identification abnormalities. They had reduced evoked potential response amplitudes for the initial N1 component in the left nostril. The subsequent P2 evoked potential response was reduced bilaterally. The pattern and magnitude of family member deficits were comparable to those previously observed for schizophrenia patients.

CONCLUSION

1st-degree relatives of schizophrenia patients exhibit specific neurophysiological impairments in early olfactory sensory processing. The presence of these neurophysiological abnormalities in both schizophrenia patients and their unaffected 1st-degree relatives suggests that these represent genetically mediated vulnerability markers or endophenotypes of the illness.

Olfactory identification performance in individuals with psychometrically-defined schizotypy

While deficits in olfaction have been well documented in individuals with schizophrenia, less research has focused on olfactory identification performance in psychometrically-defined schizotypy. The Abbreviated Schizotypal Personality Questionnaire was used to define two groups of 26 individuals (62% female) reporting high and average levels of schizotypy. Overall group differences on the Brief Smell Identification Test did not approach statistical significance, and this finding did not differ within either sex. The findings may reflect either the abbreviated nature of the measures used, or a lack of reliable olfactory performance differences in schizotypy.

Neural substrates of olfactory processing in schizophrenia patients and their healthy relatives

Odorants represent powerful stimuli capable of eliciting various emotional responses. In schizophrenia patients and their non-affected relatives, olfactory and emotional functions are impaired, revealing a familial influence on these deficits. We aimed at determining the neural basis of emotional olfactory dysfunctions using odors of different emotional valence for mood induction and functional magnetic resonance imaging (fMRI) by comparing 13 schizophrenia patients, their non-affected brothers and 26 matched healthy controls. Blood-oxygen-level-dependent (BOLD) effects and subjective mood changes were assessed during negative (rotten yeast), positive (vanilla) and neutral (ambient air) olfactory stimulation. Group comparisons of brain activation were performed in regions of interest. Subjective ratings were comparable between groups and indicated successful mood induction. However, during stimulation with the negative odor, hypofunctional activity emerged in regions of the right frontal and temporal cortex in the patients. A familial influence in the neural substrates of negative olfactory dysfunction was indicated by a similar reduced frontal brain activity in relatives. Dysfunctions therefore appeared to be located in regions involved in higher cognitive processes associated with olfaction. No familial influences were indicated for cerebral dysfunctions during positive olfactory stimulation. Results point to a differentiation between trait and state components in cerebral dysfunctions during emotional olfactory processing in schizophrenia.