The study of acoustic startle reflex in male patients with chronic schizophrenia

Research Progress in the Study of Startle Reflex to Disease States

The startle reflex is considered a primitive physiological reflex, a defense response that occurs in the organism when the body feels sudden danger and uneasiness, characterized by habituation and sensitization effects, and studies on the startle reflex often deal with pre-pulse inhibition (PPI) and sensorimotor gating. Under physiological conditions, the startle reflex is stable at a certain level, and when the organism is in a pathological state, such as stroke, spinal cord injury, schizophrenia, and other diseases, the reflex undergoes a series of changes, making it closely related to the progress of disease. This paper summarizes the startle reflex in physiological and pathological states by reviewing the databases of PubMed, Web of Science, Cochrane Library, EMBASE, China Biology Medicine, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodical, Wanfang Data, and identifies and analyzes the startle reflex and excessive startle reaction disorder.

Meta-Analysis of Sensorimotor Gating Deficits in Patients With Schizophrenia Evaluated by Prepulse Inhibition Test

Prepulse inhibition (PPI) of startle is an operational measure of sensorimotor gating that is often impaired in patients with schizophrenia. Despite the large number of studies, there is considerable variation in PPI outcomes reported. We conducted a systematic review and meta-analysis investigating PPI impairment in patients with schizophrenia compared with healthy control subjects, and examined possible explanations for the variation in results between studies. Major databases were screened for observational studies comparing healthy subjects and patients with schizophrenia for the prepulse and pulse intervals of 60 and 120 ms as primary outcomes, ie, PPI-60 and PPI-120. Standardized mean difference (SMD) and 95% confidence intervals (CI) were extracted and pooled using random effects models. We then estimated the mean effect size of these measures with random effects meta-analyses and evaluated potential PPI heterogeneity moderators, using sensitivity analysis and meta-regressions. Sixty-seven primary studies were identified, with 3685 healthy and 4290 patients with schizophrenia. The schizophrenia group showed reduction in sensorimotor gating for both PPI-60 (SMD = -0.50, 95% CI = [-0.61, -0.39]) and PPI-120 (SMD = -0.44, 95% CI = [-0.54, -0.33]). The sensitivity and meta-regression analysis showed that sample size, gender proportion, imbalance for gender, source of control group, and study continent were sources of heterogeneity (P < .05) for both PPI-60 and PPI-120 outcomes. Our findings confirm a global sensorimotor gating deficit in schizophrenia patients, with overall moderate effect size for PPI-60 and PPI-120. Methodological consistency should decrease the high level of heterogeneity of PPI results between studies.

Acoustic startle response and its modulation in schizophrenia and autism spectrum disorder in Asian subjects

The acoustic startle response (ASR) and its modulation, including prepulse inhibition (PPI), are considered to be promising neurophysiological indices for translational research in psychiatry. Impairment of the PPI has been reported in several psychiatric disorders, but particularly in schizophrenia, where PPI is considered to be a candidate endophenotype of the disorder. Although the profiles of the ASR differ between races, recent studies of single ethnicity samples in Asia were in accord with a number of studies from Western countries, in reporting that patients with schizophrenia exhibit impaired PPI. The PPI of the ASR is known to develop before 8years of age, and PPI impairment has only been reported in adults (not children) with autism spectrum disorder (ASD), which involves atypical features that are present from early development. Recent Asian studies of children with ASD suggest that comprehensive investigation of the ASR and its modulation, including the startle response to weak startle stimuli, peak startle latency, and PPI, may contribute to an understanding of the impairment of the neural circuitry in children with ASD and its comorbid behavioral problems. In this review, we review recent findings on the ASR and its modulation from Asian countries, and discuss its potential use for studying sensorimotor gating and its relationship to schizophrenia and ASD. In conclusion, the ASR and its modulation can provide a well-established global neurophysiological index for translational research in psychiatric disorders. Future studies investigating the development of sensorimotor gating in early development may contribute to prevention of psychiatric disorders.