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Meyhoefer I, Sprenger A, Derad D, Grotegerd D, Leenings R, Leehr EJ, Breuer F, Surmann M, Rolfes K, Arolt V, Romer G, Lappe M, Rehder J, Koutsouleris N, Borgwardt S, Schultze-Lutter F, Meisenzahl E, Kircher TTJ, Keedy SS, Bishop JR, Ivleva EI, McDowell JE, Reilly JL, Hill SK, Pearlson GD, Tamminga CA, Keshavan MS, Gershon ES, Clementz BA, Sweeney JA, Hahn T, Dannlowski U, Lencer R. Evidence from comprehensive independent validation studies for smooth pursuit dysfunction as a sensorimotor biomarker for psychosis. Sci Rep 2024; 14:13859. [PMID: 38879556 PMCID: PMC11180169 DOI: 10.1038/s41598-024-64487-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/10/2024] [Indexed: 06/19/2024] Open
Abstract
Smooth pursuit eye movements are considered a well-established and quantifiable biomarker of sensorimotor function in psychosis research. Identifying psychotic syndromes on an individual level based on neurobiological markers is limited by heterogeneity and requires comprehensive external validation to avoid overestimation of prediction models. Here, we studied quantifiable sensorimotor measures derived from smooth pursuit eye movements in a large sample of psychosis probands (N = 674) and healthy controls (N = 305) using multivariate pattern analysis. Balanced accuracies of 64% for the prediction of psychosis status are in line with recent results from other large heterogenous psychiatric samples. They are confirmed by external validation in independent large samples including probands with (1) psychosis (N = 727) versus healthy controls (N = 292), (2) psychotic (N = 49) and non-psychotic bipolar disorder (N = 36), and (3) non-psychotic affective disorders (N = 119) and psychosis (N = 51) yielding accuracies of 65%, 66% and 58%, respectively, albeit slightly different psychosis syndromes. Our findings make a significant contribution to the identification of biologically defined profiles of heterogeneous psychosis syndromes on an individual level underlining the impact of sensorimotor dysfunction in psychosis.
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Affiliation(s)
- Inga Meyhoefer
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
- Otto-Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Duesseldorf/LVR, Duesseldorf, Germany
| | - Andreas Sprenger
- Department of Neurology, University of Luebeck, Luebeck, Germany
| | - David Derad
- Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
| | - Ramona Leenings
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
| | - Fabian Breuer
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
| | - Marian Surmann
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
| | - Karen Rolfes
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
| | - Volker Arolt
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
- Otto-Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| | - Georg Romer
- Department of Child Adolescence Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Markus Lappe
- Otto-Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
- Institute of Psychology, University of Muenster, Muenster, Germany
| | - Johanna Rehder
- Institute of Psychology, University of Muenster, Muenster, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University Munich, Munich, Germany
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Max-Planck-Institute of Psychiatry Munich, Munich, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Duesseldorf/LVR, Duesseldorf, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Duesseldorf/LVR, Duesseldorf, Germany
| | - Tilo T J Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Sarah S Keedy
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, USA
| | - Jeffrey R Bishop
- Department of Experimental and Clinical Pharmacology and Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA
| | - Elena I Ivleva
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer E McDowell
- Departments of Psychology and Neuroscience, Bio-Imaging Research Center, University of Georgia, Athens, GA, USA
| | - James L Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Scot Kristian Hill
- Department of Psychology, Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | - Godfrey D Pearlson
- Departments of Psychiatry and Neuroscience, Yale School of Medicine, and Olin Research Center, Institute of Living/Hartford Hospital, Hartford, CT, USA
| | - Carol A Tamminga
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Elliot S Gershon
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, USA
| | - Brett A Clementz
- Departments of Psychology and Neuroscience, Bio-Imaging Research Center, University of Georgia, Athens, GA, USA
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Tim Hahn
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany
| | - Rebekka Lencer
- Institute for Translational Psychiatry, University of Muenster, Albert Schweitzer Campus 1, Build. A9a, 48149, Muenster, Germany.
- Otto-Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany.
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany.
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Jüres F, Kaufmann C, Riesel A, Grützmann R, Heinzel S, Elsner B, Bey K, Wagner M, Kathmann N, Klawohn J. Heart rate and heart rate variability in obsessive-compulsive disorder: Evidence from patients and unaffected first-degree relatives. Biol Psychol 2024; 189:108786. [PMID: 38531496 DOI: 10.1016/j.biopsycho.2024.108786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/16/2024] [Accepted: 03/22/2024] [Indexed: 03/28/2024]
Abstract
Altered heart rate (HR) and heart rate variability (HRV) are common observations in psychiatric disorders. Yet, few studies have examined these cardiac measures in obsessive-compulsive disorder (OCD). The current study aimed to investigate HR and HRV, indexed by the root mean square of successive differences (RMSSD) and further time domain indices, as putative biological characteristics of OCD. Electrocardiogram was recorded during a five-minute resting state. Group differences between patients with OCD (n = 96), healthy participants (n = 112), and unaffected first-degree relatives of patients with OCD (n = 47) were analyzed. As potential moderators of group differences, we examined the influence of age and medication, respectively. As results indicated, patients with OCD showed higher HR and lower HRV compared to healthy participants. These group differences were not moderated by age. Importantly, subgroup analyses showed that only medicated patients displayed lower HRV compared to healthy individuals, while HR alterations were evident in unmedicated patients. Regarding unaffected first-degree relatives, group differences in HRV remained at trend level. Further, an age-moderated group differentiation showed that higher HRV distinguished relatives from healthy individuals in young adulthood, whereas at higher age lower HRV was indicative of relatives. Both the role of familial risk and medication in HRV alterations need further elucidation. Pending future studies, alterations in HR and potentially HRV might serve as useful indices to characterize the pathophysiology of OCD.
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Affiliation(s)
- Franziska Jüres
- Humboldt-Universität zu Berlin, Department of Psychology, Berlin, Germany.
| | - Christian Kaufmann
- Humboldt-Universität zu Berlin, Department of Psychology, Berlin, Germany
| | - Anja Riesel
- Humboldt-Universität zu Berlin, Department of Psychology, Berlin, Germany; Universität Hamburg, Department of Psychology, Hamburg, Germany
| | - Rosa Grützmann
- Humboldt-Universität zu Berlin, Department of Psychology, Berlin, Germany; MSB Medical School Berlin, Department of Psychology, Berlin, Germany
| | - Stephan Heinzel
- Humboldt-Universität zu Berlin, Department of Psychology, Berlin, Germany; Freie Universität Berlin, Department of Education and Psychology, Berlin, Germany; TU Dortmund University, Department of Educational Sciences and Psychology, Dortmund, Germany
| | - Björn Elsner
- Humboldt-Universität zu Berlin, Department of Psychology, Berlin, Germany
| | - Katharina Bey
- University Hospital Bonn, Department of Psychiatry and Psychotherapy, Bonn, Germany
| | - Michael Wagner
- University Hospital Bonn, Department of Psychiatry and Psychotherapy, Bonn, Germany
| | - Norbert Kathmann
- Humboldt-Universität zu Berlin, Department of Psychology, Berlin, Germany
| | - Julia Klawohn
- Humboldt-Universität zu Berlin, Department of Psychology, Berlin, Germany; MSB Medical School Berlin, Department of Medicine, Berlin, Germany
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Abstract
The experiential core of the obsessive mind rests on subtle, primary mental phenomena (such as obsessions and so called "sensory phenomena") which precede and trigger behavioral compulsions. Converging evidence supports a possible pathophysiological role for altered corollary discharge (phenotypically expressed in sensorimotor symptoms and contributing to a reduced Sense of Agency [SoA]), in the neurodevelopment of obsessions and "sensory phenomena." In phenomenological terms, "sensory phenomena" may represent the subjective experiential resonance of an individual history of persistent inaccurate sensory predictions, whereas accompanying manifestations, such as the obsessive need for order and symmetry, may represent a compensatory attempt to mitigate "sensory phenomena" (eg, by increasing the sensory predictability of the surrounding world). Since disturbances of both SoA and Sense of Ownership have been thematized as potential pathogenetic factors in the neurodevelopment of the psychotic mind, a dimensional account of altered sensorimotor prediction may partly explain the affinities (and high comorbidity) between obsessive-compulsive disorder and schizophrenia spectrum disorders.
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Abstract
Obsessive-compulsive disorder (OCD) is a chronic and disabling mental disorder characterized by the presence of obsessions and/or compulsions that cause major distress and impair important areas of functioning. About 9 out of 10 patients with OCD have comorbid psychiatric diagnoses. A high proportion of clinically diagnosed OCD patients fulfill diagnostic criteria of a schizophrenia spectrum disorder, to the point that significant evidence in the literature supports the existence and the clinical relevance of a schizo-obsessive spectrum of disorders, including schizotypal personality disorder (SPD) with OCD (schizotypal OCD). In this paper, we provide a brief but comprehensive analysis of the literature on the clinical coexistence between OCD and SPD. The clinical validity of the so-called schizotypal OCD is analyzed through a comprehensive investigation of the relationship between SPD features and obsessive-compulsive phenomena in clinical OCD samples. This review describes the potential connections between OCD and SPD on the epidemiological, sociodemographic, psychopathological, and clinical levels. SPD is commonly observed in OCD patients: about 10% of OCD patients have a full categorical diagnosis of SPD. Early clinical identification of SPD features-and, more generally, of psychotic features and personality disorders-in OCD patients is strongly recommended. In fact, a proper and early diagnosis with early treatment may have benefits for prognosis. However, although schizotypal OCD seems to have clinical and predictive validity, further neurobiological and genetic studies on etiological specificity are warranted.
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Fitzgerald KD, Schroder HS, Marsh R. Cognitive Control in Pediatric Obsessive-Compulsive and Anxiety Disorders: Brain-Behavioral Targets for Early Intervention. Biol Psychiatry 2021; 89:697-706. [PMID: 33454049 PMCID: PMC8353584 DOI: 10.1016/j.biopsych.2020.11.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/19/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022]
Abstract
The DSM provides distinct criteria for obsessive-compulsive disorder (OCD) and various types of anxiety disorders, but phenomenological overlap, high rates of comorbidity, and early onset suggest common underlying mechanisms. This notion is further supported by use of the same treatments-cognitive behavioral therapy and serotonin reuptake inhibitor medication-for managing both OCD and non-OCD anxiety disorders in clinical settings. While early intervention with these gold standard treatments is recommended for pediatric OCD and anxiety disorders, young patients often remain symptomatic even after treatment. To guide the development of novel, mechanistically targeted treatments to better resolve OCD and anxiety symptoms, the identification of neural circuits underlying psychological constructs with relevance across disorders has been recommended. One construct that may be relevant for understanding pediatric OCD and anxiety disorders is cognitive control, given the difficulty that young patients experience in dismissing obsessions, compulsions, and worry despite recognition that these symptoms are excessive and unreasonable. In this review, we examine findings from a growing body of literature implicating brain-behavioral markers of cognitive control in pediatric OCD and anxiety disorders, including before and after treatment. We conclude by suggesting that interventions designed to enhance the functioning of the task control circuits underlying cognitive control may facilitate brain maturation to help affected youth overcome symptoms.
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Affiliation(s)
- Kate D Fitzgerald
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rachel Marsh
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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Wolf A, Ueda K, Hirano Y. Recent updates of eye movement abnormalities in patients with schizophrenia: A scoping review. Psychiatry Clin Neurosci 2021; 75:82-100. [PMID: 33314465 PMCID: PMC7986125 DOI: 10.1111/pcn.13188] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/27/2020] [Accepted: 12/09/2020] [Indexed: 12/15/2022]
Abstract
AIM Although eye-tracking technology expands beyond capturing eye data just for the sole purpose of ensuring participants maintain their gaze at the presented fixation cross, gaze technology remains of less importance in clinical research. Recently, impairments in visual information encoding processes indexed by novel gaze metrics have been frequently reported in patients with schizophrenia. This work undertakes a scoping review of research on saccadic dysfunctions and exploratory eye movement deficits among patients with schizophrenia. It gathers promising pieces of evidence of eye movement abnormalities in attention-demanding tasks on the schizophrenia spectrum that have mounted in recent years and their outcomes as potential biological markers. METHODS The protocol was drafted based on PRISMA for scoping review guidelines. Electronic databases were systematically searched to identify articles published between 2010 and 2020 that examined visual processing in patients with schizophrenia and reported eye movement characteristics as potential biomarkers for this mental illness. RESULTS The use of modern eye-tracking instrumentation has been reported by numerous neuroscientific studies to successfully and non-invasively improve the detection of visual information processing impairments among the screened population at risk of and identified with schizophrenia. CONCLUSIONS Eye-tracking technology has the potential to contribute to the process of early intervention and more apparent separation of the diagnostic entities, being put together by the syndrome-based approach to the diagnosis of schizophrenia. However, context-processing paradigms should be conducted and reported in equally accessible publications to build comprehensive models.
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Affiliation(s)
- Alexandra Wolf
- International Research Fellow of Japan Society for the Promotion of Science, Fukuoka, Japan.,Department of Human Science, Research Center for Applied Perceptual Science, Kyushu University, Fukuoka, Japan
| | - Kazuo Ueda
- Department of Human Science, Research Center for Applied Perceptual Science, Kyushu University, Fukuoka, Japan
| | - Yoji Hirano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Poletti M, Tortorella A, Raballo A. Impaired Corollary Discharge in Psychosis and At-Risk States: Integrating Neurodevelopmental, Phenomenological, and Clinical Perspectives. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 4:832-841. [PMID: 31262709 DOI: 10.1016/j.bpsc.2019.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 12/28/2022]
Abstract
The brain is increasingly viewed in contemporary neuroscience as a predictive machine; its products, such as movements and decisions, are indeed accompanied by predictions of outcomes at distinct levels of awareness. In this conceptual review, we focus on corollary discharge, a basic neurophysiological mechanism that is allegedly involved in sensory prediction and contributes to the distinction between self-generated and externally generated actions. Failures in corollary discharge have been hypothesized as potentially relevant for the progressive development of positive psychotic symptoms such as passivity delusions and auditory verbal hallucinations. We articulate this framework adopting three confocal lenses, namely, the neurodevelopmental, phenomenological, and clinical perspectives. Converging evidence from these research domains indicates a possible developmental cascade leading to increased lifetime risk of psychosis. That is, early childhood alterations of corollary discharge mechanisms, endophenotypically expressed in motor impairment, may concur with a progressive fading of the feeling of self-agency on one's own experiences. Combined with other age-dependent situational challenges occurring along development, this may progressively hamper the ontogenesis of the embodied self, thereby facilitating the emergence of anomalous subjective experiences such as self-disorders (a longitudinal index of schizophrenia spectrum vulnerability) and broadly conceived clinical high-risk states. Overall, this condition increases the risk of developing passivity symptoms, phenotypically expressed in a severity gradient ranging from intrusive thoughts to passivity delusions and auditory verbal hallucinations. Empirical and clinical implications of this framework, as well as future scenarios, are discussed.
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Affiliation(s)
- Michele Poletti
- Department of Mental Health, Azienda Unità Sanitaria Locale-IRCSS di Reggio Emilia, Reggio Emilia, Italy
| | - Alfonso Tortorella
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy; Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy.
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Bey K, Lennertz L, Grützmann R, Heinzel S, Kaufmann C, Klawohn J, Riesel A, Meyhöfer I, Ettinger U, Kathmann N, Wagner M. Impaired Antisaccades in Obsessive-Compulsive Disorder: Evidence From Meta-Analysis and a Large Empirical Study. Front Psychiatry 2018; 9:284. [PMID: 30008679 PMCID: PMC6033994 DOI: 10.3389/fpsyt.2018.00284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/11/2018] [Indexed: 01/23/2023] Open
Abstract
Increasing evidence indicates that patients with obsessive-compulsive disorder (OCD) exhibit alterations in fronto-striatal circuitry. Performance deficits in the antisaccade task would support this model, but results from previous small-scale studies have been inconclusive as either increased error rates, prolonged antisaccade latencies, both or neither have been reported in OCD patients. In order to address this issue, we investigated antisaccade performance in a large sample of OCD patients (n = 169) and matched control subjects (n = 183). As impaired antisaccade performance constitutes a potential endophenotype of OCD, unaffected first-degree relatives of OCD patients (n = 100) were assessed, as well. Furthermore, we conducted a quantitative meta-analysis to integrate our data with previous findings. In the empirical study, OCD patients exhibited significantly increased antisaccade latencies, intra-subject variability (ISV) of antisaccade latencies, and antisaccade error rates. The latter effect was driven by errors with express latency (80-130 ms), as patients did not differ significantly from controls with regards to regular errors (>130 ms). Notably, unaffected relatives of OCD patients showed elevated antisaccade express error rates and increased ISV of antisaccade latencies, as well. Antisaccade performance was not associated with state anxiety within groups. Among relatives, however, we observed a significant correlation between antisaccade error rate and harm avoidance. Medication status of OCD patients, symptom severity, depressive comorbidity, comorbid anxiety disorders and OCD symptom dimensions did not significantly affect antisaccade performance. Meta-analysis of 10 previous and the present empirical study yielded a medium-sized effect (SMD = 0.48, p < 0.001) for higher error rates in OCD patients, while the effect for latencies did not reach significance owing to strong heterogeneity (SMD = 0.51, p = 0.069). Our results support the assumption of impaired antisaccade performance in OCD, although effects sizes were only moderately large. Furthermore, we provide the first evidence that increased antisaccade express error rates and ISV of antisaccade latencies may constitute endophenotypes of OCD. Findings regarding these more detailed antisaccade parameters point to potentially underlying mechanisms, such as early pre-stimulus inhibition of the superior colliculus.
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Affiliation(s)
- Katharina Bey
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Leonhard Lennertz
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Rosa Grützmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephan Heinzel
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Christian Kaufmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia Klawohn
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Biomedical Sciences and Psychology, Florida State University, Tallahassee, FL, United States
| | - Anja Riesel
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Inga Meyhöfer
- Department of Psychology, University of Bonn, Bonn, Germany
| | | | - Norbert Kathmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
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