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Rice LJ, Agu J, Carter CS, Cho YH, Harris J, Heilman K, Nazarloo HP, Naanai H, Porges S, Einfeld SL. The relationship between cardiac activity, behaviour and endogenous oxytocin and vasopressin in Prader-Willi Syndrome: An exploratory study. Int J Psychophysiol 2024; 205:112429. [PMID: 39237036 DOI: 10.1016/j.ijpsycho.2024.112429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 08/26/2024] [Accepted: 09/02/2024] [Indexed: 09/07/2024]
Abstract
This study aimed to increase our understanding of cardiac activity abnormalities in Prader-Willi Syndrome (PWS) and the relationship between cardiac activity, PWS behaviours thought to be associated with cardiac vagal tone and endogenous oxytocin and vasopressin levels. We compared cardiac activity (respiratory sinus arrhythmia (RSA), low-frequency heart rate variability (LF-HRV), heart period) in 30 adolescents and adults with PWS to 30 typically developing age-matched controls. RSA, LF-HRV, and heart period were lower in individuals with PWS than in the control group. In the control group, RSA was higher for females than males. However, for those with PWS, there was no difference between the sexes. Individuals with the mUPD genetic subtype had lower RSA and LF-HRV than participants with the PWS deletion subtype and compared to typically developing controls, no difference was found between the latter two groups. Heart period was also lower for those with mUPD compared to controls. Higher RSA reduced the odds of having temper outbursts and skin-picking. RSA was lower in those with PWS and psychosis compared to those with PWS without psychosis. Finally, we found RSA correlated with vasopressin for those with mUPD but not deletion. There was no relationship between RSA and oxytocin plasma or saliva levels. Our findings suggest autonomic dysfunction in PWS that is more marked in mUPD than deletion and potentially due to greater loss of parasympathetic activity in mUPD.
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Affiliation(s)
- Lauren J Rice
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, New South Wales, Australia; Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.
| | - Josephine Agu
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - C Sue Carter
- Department of Psychology, University of Virginia; Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - Yoon Hi Cho
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - James Harris
- Department of Psychiatry and Behavioural Sciences and Paediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Keri Heilman
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | | | - Habiba Naanai
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Stephen Porges
- Kinsey Institute, Indiana University, Bloomington, IN, USA; Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Stewart L Einfeld
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, New South Wales, Australia
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Fattal J, Brascamp JW, Slate RE, Lehet M, Achtyes ED, Thakkar KN. Blunted pupil light reflex is associated with negative symptoms and working memory in individuals with schizophrenia. Schizophr Res 2022; 248:254-262. [PMID: 36115190 PMCID: PMC9613610 DOI: 10.1016/j.schres.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 08/21/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
Two largely separate lines of research have documented altered pupillary dynamics in individuals diagnosed with schizophrenia. An older set of studies has demonstrated reductions in the pupillary light reflex (PLR) in individuals with schizophrenia; however, clinical and cognitive correlates of this blunted PLR have been relatively unexplored. More recently, a large body of work has demonstrated reductions in pupillary dilation in response to cognitive demands in individuals with schizophrenia, and the degree of this blunted pupil dilation has been related to more severe cognitive deficits and motivational negative symptoms. These clinically relevant alterations in the cognitive modulation of pupil size have been interpreted as reflecting insufficient information processing resources or inappropriate effort allocation. To begin to bridge these two lines of work, we investigated the PLR in 34 individuals with schizophrenia and 30 healthy controls and related the amplitude of the PLR to motivational negative symptoms and cognitive performance. Consistent with prior work, we found that the PLR was reduced in individuals with schizophrenia, and furthermore, that these measurements were highly reliable across individuals. Blunted constriction was associated with more severe motivational negative symptoms and poorer working memory among individuals with schizophrenia. These observed correlates provide a bridge between older literature documenting an altered PLR and more recent work reporting associations between negative symptoms, cognition, and blunted pupillary dilation in response to cognitive demands in individuals with schizophrenia. We provide possible mechanistic interpretations of our data and consider a parsimonious explanation for reduced cognitive- and light-related modulation of pupil size.
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Affiliation(s)
- Jessica Fattal
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America
| | - Jan W Brascamp
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America
| | - Rachael E Slate
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America
| | - Matthew Lehet
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America
| | - Eric D Achtyes
- Division of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, MI, United States of America; Cherry Health, Grand Rapids, MI, United States of America
| | - Katharine N Thakkar
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America; Division of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, MI, United States of America.
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Interoception abnormalities in schizophrenia: A review of preliminary evidence and an integration with Bayesian accounts of psychosis. Neurosci Biobehav Rev 2021; 132:757-773. [PMID: 34823914 DOI: 10.1016/j.neubiorev.2021.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/31/2021] [Accepted: 11/13/2021] [Indexed: 01/07/2023]
Abstract
Schizophrenia research has traditionally focused almost exclusively on how the brain interprets the outside world. However, our internal bodily milieu is also central to how we interpret the world and construct our reality: signals from within the body are critical for not only basic survival, but also a wide range of brain functions from basic perception, emotion, and motivation, to sense of self. In this article, we propose that interoception-the processing of bodily signals-may have implications for a wide range of clinical symptoms in schizophrenia and may thus provide key insights into illness mechanisms. We start with an overview of interoception pathways. Then we provide a review of direct and indirect findings in various interoceptive systems in schizophrenia and interpret these findings in the context of computational frameworks that model interoception as hierarchical Bayesian inference. Finally, we propose a conceptual model of how altered interoceptive inference may contribute to specific schizophrenia symptoms-negative symptoms in particular-and suggest directions for future research, including potential new avenues of treatment.
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Laborde S, Allen MS, Borges U, Hosang TJ, Furley P, Mosley E, Dosseville F. The Influence of Slow-Paced Breathing on Executive Function. J PSYCHOPHYSIOL 2021. [DOI: 10.1027/0269-8803/a000279] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Abstract. The aim of this experiment was to test the immediate effects of slow-paced breathing on executive function. Slow-paced breathing is suggested to increase cardiac vagal activity, and the neurovisceral integration model predicts that higher cardiac vagal activity leads to better executive functioning. In total, 78 participants (41 men, 37 women; Mage = 23.22 years) took part in two counterbalanced experimental conditions: a 3 × 5 min slow-paced breathing condition and a television viewing control condition. After each condition, heart rate variability was measured and participants performed three executive function tasks: the color-word match Stroop (inhibition), the automated operation span task (working memory), and the modified card sorting task (cognitive flexibility). Results showed that performance on executive function tasks was better after slow-paced breathing compared to control, with higher scores observed for Stroop interference accuracy, automated operation span score, and perseverative errors, but not Stroop interference reaction times. This difference in executive function between experimental conditions was not mediated by cardiac vagal activity. Therefore, findings only partially align with predictions of the neurovisceral integration model. Slow-paced breathing appears a promising technique to improve immediate executive function performance. Further studies are recommended that address possible alternative underlying mechanisms and long-term effects.
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Affiliation(s)
- S. Laborde
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Germany
- UFR STAPS, EA 4260 CESAMS, University of Caen Normandy, Caen, France
| | - M. S. Allen
- School of Psychology, University of Wollongong, Australia
| | - U. Borges
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Germany
- Department of Health & Social Psychology, Institute of Psychology, German Sport University Cologne, Germany
| | - T. J. Hosang
- Experimental Psychology Unit, Helmut Schmidt University/University of the Federal Armed Forces, Hamburg, Germany
| | - P. Furley
- Institute for Training and Computer Science in Sport, German Sport University Cologne, Germany
| | - E. Mosley
- Department of Sport Science and Performance, Solent University, Southampton, UK
| | - F. Dosseville
- UMR-S 1075 COMETE, Caen, France
- INSERM, UMR-S 1075 COMETE, University of Caen Normandy, Caen, France
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Associations between physiological responses to social-evaluative stress and daily functioning in first-episode schizophrenia. Schizophr Res 2020; 218:233-239. [PMID: 31948901 PMCID: PMC7299766 DOI: 10.1016/j.schres.2019.12.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 12/28/2019] [Accepted: 12/31/2019] [Indexed: 01/25/2023]
Abstract
Schizophrenia (SZ) is associated with impaired adaptive functioning, including difficulties managing the demands of independent living, work, school, and interpersonal relationships. Prior studies have linked the physiological stress response with less effective coping in daily life. Differences in stress-response tendencies may also support heterogeneity in daily functioning in SZ. The present study examined two established measures of the stress response in patients with first-episode SZ. Salivary cortisol was included as an index of hypothalamic-pituitary-adrenal response. Vagal suppression (VS), a measure of stress-related reduction in heart rate variability, was used to assess parasympathetic flexibility. Greater cortisol response and VS to social-evaluative stress were predicted to be associated with better functioning in SZ over and above relationships with social cognition and neurocognition, two well-established predictors of functional outcome. Thirty-eight first-episode SZ outpatients and 29 healthy comparison subjects (HC) provided social cognitive, neurocognitive, and physiological measurements before and after the Trier Social Stress Test (TSST). Although SZ and HC did not differ on VS to the TSST, patients exhibited significant associations between VS and functioning across all four domains of the Role Functioning Scale. Furthermore, greater VS predicted more effective functioning with friends, beyond the contributions associated with social cognition and neurocognition, and strengthened the positive effects of higher levels of social cognition on independent living/self-care. VS elicited by social-evaluative stress in the laboratory may reflect stress-response tendencies in daily life that are relevant for daily functioning in first-episode SZ.
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Guccione C, di Scalea GL, Ambrosecchia M, Terrone G, Di Cesare G, Ducci G, Schimmenti A, Caretti V. Early Signs of Schizophrenia and Autonomic Nervous System Dysregulation: A Literature Review. CLINICAL NEUROPSYCHIATRY 2019; 16:86-97. [PMID: 34908942 PMCID: PMC8662712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Recent research suggests that early signs of schizophrenia can be detected several years before its onset. Evidence suggests that the identification of at-risk individuals before the psychotic onset can significantly improve the course of the disorder. However, instruments employed for the detection of prodromal symptoms are far from being accurate in the prediction of a future transition to psychosis. The aim of the present review is to summarize literature on the early signs of schizophrenia and to identify physiological markers that may aid the identification of the disorder before psychotic transition. METHOD This critical review includes studies published between 1979 and 2018 that were indexed in major databases with the following keywords: schizophrenia, prodromal phase, basic symptoms, autonomic nervous system, heart rate variability. RESULTS The examination of the relevant literature showed that, despite recent progress in the identification of at-risk states, the currently employed instruments do not allow an effective prediction of a future psychotic onset. Also, evidence suggests a significant association between alterations in the autonomic nervous system (ANS) functioning and psychotic disorders. However, literature on the association between ANS functioning and at-risk states for psychosis is still scarce. The addition of physiological risk indicators may represent a step forward in the detection of at-risk individuals. CONCLUSIONS Overall, the present literature review highlights that a future schizophrenic onset cannot be strongly predicted with current available measures. Given the established correlation between schizophrenia and autonomic dysregulation, an investigation of the ANS functioning in individuals who are at increased risk of developing schizophrenia may be particularly useful to improve the quality of the assessment, to identify at an early stage the dysregulated physiological patterns that have been linked with schizophrenia, and therefore to develop tailored interventions. Accordingly, it is crucial that future research investigates the presence of autonomic deficits in individuals at risk for psychosis.
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Affiliation(s)
| | | | | | - Grazia Terrone
- Department of Humanities, Literature, and Cultural Heritage, University of Foggia
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Schulz S, Haueisen J, Bär KJ, Voss A. Multivariate assessment of the central-cardiorespiratory network structure in neuropathological disease. Physiol Meas 2018; 39:074004. [PMID: 29933248 DOI: 10.1088/1361-6579/aace9b] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The new interdisciplinary field of network physiology is increasingly becoming a focus of interest in medicine. Autonomic nervous system (ANS) dysfunction is well described in schizophrenia (SZO). However, the linear and nonlinear coupling between the ANS and central nervous system (CNS) has only been partly addressed until now. This coupling can be assumed to be a feedback-feedforward network, reacting with flexible and adaptive responses to internal and external factors. APPROACH For the first time, in this study we investigated linear and nonlinear short-term central-cardiorespiratory coupling of 17 patients suffering from paranoid SZO in comparison to 17 age-gender matched healthy subjects analyzing heart rate (HR), respiration (RESP), and the power of frontal electroencephalogram (EEG) activity (P EEG). The objective is to determine how the different regulatory aspects of the CNS-ANS affect the central-cardiorespiratory network (CCRN). To quantify these couplings within the CCRN normalized short time partial directed coherence and the new multivariate high-resolution joint symbolic dynamics were applied. MAIN RESULTS We found that the CCRN in SZO can be characterized as a bidirectional one, with stronger central driving mechanisms (P EEG → HR) towards HR regulation than vice versa, and with stronger respiratory influence (RESP → P EEG) on central activity than vice versa. This suggests that the central-cardiorespiratory process (closed-loop) is mainly focused on adapting the HR via the sinoatrial node than focusing on respiratory regulation. On the other hand, the feedback-loop from ANS to CNS is strongly dominated via respiratory activity. SIGNIFICANCE We demonstrated a considerably significantly different CCRN structure in SZO with a strong central influence on the cardiac system and a strong respiratory influence on the CNS. Moreover, this study provides a more in-depth understanding of the interplay of the central and autonomic regulatory network in healthy subjects and SZO patients.
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Affiliation(s)
- Steffen Schulz
- Institute of Innovative Health Technologies, Ernst-Abbe-Hochschule Jena, Jena, Germany. Department of Pediatrics, Division of Oncology and Hematology, Charité Universitätsmedizin, Berlin, Germany
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Yuen JWY, Kim DD, Procyshyn RM, White RF, Honer WG, Barr AM. Clozapine-Induced Cardiovascular Side Effects and Autonomic Dysfunction: A Systematic Review. Front Neurosci 2018; 12:203. [PMID: 29670504 PMCID: PMC5893810 DOI: 10.3389/fnins.2018.00203] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/14/2018] [Indexed: 12/24/2022] Open
Abstract
Background: Clozapine is the antipsychotic of choice for treatment-resistant schizophrenia and has minimal risk for extrapyramidal symptoms. Therapeutic benefits, however, are accompanied by a myriad of cardiometabolic side-effects. The specific reasons for clozapine's high propensity to cause adverse cardiometabolic events remain unknown, but it is believed that autonomic dysfunction may play a role in many of these. Objective: This systematic review summarizes the literature on autonomic dysfunction and related cardiovascular side effects associated with clozapine treatment. Method: A search of the EMBASE, MEDLINE, and EBM Cochrane databases was conducted using the search terms antipsychotic agents, antipsychotic drug*, antipsychotic*, schizophrenia, schizophren*, psychos*, psychotic*, mental ill*, mental disorder*, neuroleptic*, cardiovascular*, cardiovascular diseases, clozapine*, clozaril*, autonomic*, sympathetic*, catecholamine*, norepinephrine, noradrenaline, epinephrine, adrenaline. Results: The search yielded 37 studies that were reviewed, of which only 16 studies have used interventions to manage cardiovascular side effects. Side effects reported in the studies include myocarditis, orthostatic hypotension and tachycardia. These were attributed to sympathetic hyperactivity, decreased vagal contribution, blockade of cholinergic and adrenergic receptors, reduced heart rate variability and elevated catecholamines with clozapine use. Autonomic neuropathy was identified by monitoring blood pressure and heart rate changes in response to stimuli and by spectral analysis of heart rate variability. Metoprolol, lorazepam, atenolol, propranolol, amlodipine, vasopressin and norepinephrine infusion were used to treat tachycardia and fluctuations in blood pressure, yet results were limited to case reports. Conclusion: The results indicate there is a lack of clinical studies investigating autonomic dysfunction and a limited use of interventions to manage cardiovascular side effects associated with clozapine. As there is often no alternative treatment for refractory schizophrenia, the current review highlights the need for better designed studies, use of autonomic tests for prevention of cardiovascular disease and development of novel interventions for clozapine-induced side effects.
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Affiliation(s)
- Jessica W Y Yuen
- Faculty of Medicine and Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - David D Kim
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, Faculty of Medicine Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Randall F White
- Department of Psychiatry, Faculty of Medicine Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychiatry, Faculty of Medicine Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
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Holzman JB, Bridgett DJ. Heart rate variability indices as bio-markers of top-down self-regulatory mechanisms: A meta-analytic review. Neurosci Biobehav Rev 2017; 74:233-255. [PMID: 28057463 DOI: 10.1016/j.neubiorev.2016.12.032] [Citation(s) in RCA: 252] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/13/2016] [Accepted: 12/28/2016] [Indexed: 12/29/2022]
Abstract
Theoretical perspectives posit that heart-rate variability (HRV) reflects self-regulatory capacity and therefore can be employed as a bio-marker of top-down self-regulation (the ability to regulate behavioral, cognitive, and emotional processes). However, existing findings of relations between self-regulation and HRV indices are mixed. To clarify the nature of such relations, we conducted a meta-analysis of 123 studies (N=14,347) reporting relations between HRV indices and aspects of top-down self-regulation (e.g., executive functioning, emotion regulation, effortful control). A significant, albeit small, effect was observed (r=0.09) such that greater HRV was related to better top-down self-regulation. Differences in relations were negligible across aspects of self-regulation, self-regulation measurement methods, HRV computational techniques, at-risk compared with healthy samples, and the context of HRV measurement. Stronger relations were observed in older relative to younger samples and in published compared to unpublished studies. These findings generally support the notion that HRV indices can tentatively be employed as bio-markers of top-down self-regulation. Conceptual and theoretical implications, and critical gaps in current knowledge to be addressed by future work, are discussed.
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10
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Schulz S, Bolz M, Bär KJ, Voss A. Central- and autonomic nervous system coupling in schizophrenia. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2016; 374:rsta.2015.0178. [PMID: 27044986 PMCID: PMC4822441 DOI: 10.1098/rsta.2015.0178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 05/03/2023]
Abstract
The autonomic nervous system (ANS) dysfunction has been well described in schizophrenia (SZ), a severe mental disorder. Nevertheless, the coupling between the ANS and central brain activity has been not addressed until now in SZ. The interactions between the central nervous system (CNS) and ANS need to be considered as a feedback-feed-forward system that supports flexible and adaptive responses to specific demands. For the first time, to the best of our knowledge, this study investigates central-autonomic couplings (CAC) studying heart rate, blood pressure and electroencephalogram in paranoid schizophrenic patients, comparing them with age-gender-matched healthy subjects (CO). The emphasis is to determine how these couplings are composed by the different regulatory aspects of the CNS-ANS. We found that CAC were bidirectional, and that the causal influence of central activity towards systolic blood pressure was more strongly pronounced than such causal influence towards heart rate in paranoid schizophrenic patients when compared with CO. In paranoid schizophrenic patients, the central activity was a much stronger variable, being more random and having fewer rhythmic oscillatory components. This study provides a more in-depth understanding of the interplay of neuronal and autonomic regulatory processes in SZ and most likely greater insights into the complex relationship between psychotic stages and autonomic activity.
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Affiliation(s)
- Steffen Schulz
- Institute of Innovative Health Technologies, University of Applied Sciences, Jena, Germany
| | - Mathias Bolz
- Department of Child and Adolescent Psychiatry, Pain and Autonomics-Integrative Research, University Hospital, Jena, Germany
| | - Karl-Jürgen Bär
- Department of Psychiatry and Psychotherapy, Pain and Autonomics-Integrative Research, University Hospital, Jena, Germany
| | - Andreas Voss
- Institute of Innovative Health Technologies, University of Applied Sciences, Jena, Germany
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11
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Clamor A, Lincoln TM, Thayer JF, Koenig J. Resting vagal activity in schizophrenia: meta-analysis of heart rate variability as a potential endophenotype. Br J Psychiatry 2016; 208:9-16. [PMID: 26729841 DOI: 10.1192/bjp.bp.114.160762] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cardiac vagal tone, indexed by heart rate variability (HRV), is a proxy for the functional integrity of feedback mechanisms integrating central and peripheral physiology. AIMS To quantify differences in HRV in individuals with schizophrenia compared with healthy controls. METHOD Databases were systematically searched for studies eligible for inclusion. Random effect meta-analyses of standardised mean differences were calculated for vagal activity indicated by high-frequency HRV and the root mean square of successive R-R interval differences (RMSSD). RESULTS Thirty-four studies were included. Significant main effects were found for high-frequency HRV (P = 0.0008; Hedges' g = -0.98, 95% CI -1.56 to -0.41, k = 29) and RMSSD (P<0.0001; g = -0.91, 95% CI -1.19 to -0.62, k = 24), indicating lower vagal activity in individuals with schizophrenia than in healthy controls. Considerable heterogeneity was evident but effects were robust in subsequent sensitivity analyses. CONCLUSIONS Given the association between low HRV, threat processing, emotion regulation and executive functioning, reduced vagal tone may be an endophenotype for the development of psychotic symptoms.
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Affiliation(s)
- Annika Clamor
- Annika Clamor, MSc, Tania M. Lincoln, Dr. rer. nat., University of Hamburg, Department of Clinical Psychology and Psychotherapy, Hamburg, Germany; Julian F. Thayer, PhD, The Ohio State University, Department of Psychology, Columbus, Ohio, USA; Julian Koenig, Dr. sc. hum., University of Heidelberg, Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Tania M Lincoln
- Annika Clamor, MSc, Tania M. Lincoln, Dr. rer. nat., University of Hamburg, Department of Clinical Psychology and Psychotherapy, Hamburg, Germany; Julian F. Thayer, PhD, The Ohio State University, Department of Psychology, Columbus, Ohio, USA; Julian Koenig, Dr. sc. hum., University of Heidelberg, Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Julian F Thayer
- Annika Clamor, MSc, Tania M. Lincoln, Dr. rer. nat., University of Hamburg, Department of Clinical Psychology and Psychotherapy, Hamburg, Germany; Julian F. Thayer, PhD, The Ohio State University, Department of Psychology, Columbus, Ohio, USA; Julian Koenig, Dr. sc. hum., University of Heidelberg, Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Julian Koenig
- Annika Clamor, MSc, Tania M. Lincoln, Dr. rer. nat., University of Hamburg, Department of Clinical Psychology and Psychotherapy, Hamburg, Germany; Julian F. Thayer, PhD, The Ohio State University, Department of Psychology, Columbus, Ohio, USA; Julian Koenig, Dr. sc. hum., University of Heidelberg, Department of Child and Adolescent Psychiatry, Section for Translational Psychobiology in Child and Adolescent Psychiatry, Heidelberg, Germany
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12
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Montaquila JM, Trachik BJ, Bedwell JS. Heart rate variability and vagal tone in schizophrenia: A review. J Psychiatr Res 2015; 69:57-66. [PMID: 26343595 DOI: 10.1016/j.jpsychires.2015.07.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 07/14/2015] [Accepted: 07/23/2015] [Indexed: 01/08/2023]
Abstract
Recent heart rate variability (HRV) research has identified diminished levels of parasympathetic activity among schizophrenia patients. Over two dozen empirically-based studies have been published on this topic; primarily over the last decade. However, no theoretical review appears to have been published on this work. Further, only one empirical study has evaluated HRV research findings in the context of documented hypothalamic-pituitary-adrenal axis hyperactivity in schizophrenia. HRV research indicates that no abnormalities exist in the initial sympathetic stress response of schizophrenia patients. However, evidence has consistently demonstrated that patients exhibit a diminished capacity to recover from a stress response as a result of deficits in parasympathetic activity. Moreover, this diminished parasympathetic nervous system (PNS) response, also known as decreased vagal tone, has been found to relate to increased symptom severity. Although these findings may cause speculation that the observed vagal tone disruption merely results from anxiety produced by the presence of positive symptomology, additional studies have identified similar parasympathetic dysfunction among nonpsychotic relatives of individuals with schizophrenia. We posit that the resulting sympathovagal imbalance leads to an overall sympathetic dominance despite the fact that sympathetic nervous system activity is not abnormally elevated among patients. Implications are discussed within the context of the diathesis-stress/vulnerability-stress model, including the potential for identifying a mechanism of action by which environmental stressors may contribute to triggering first-episode psychosis.
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Affiliation(s)
- Julian M Montaquila
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, United States
| | - Benjamin J Trachik
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, United States
| | - Jeffrey S Bedwell
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, United States.
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13
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Nilsson BM, Holm G, Hultman CM, Ekselius L. Cognition and autonomic function in schizophrenia: inferior cognitive test performance in electrodermal and niacin skin flush non-responders. Eur Psychiatry 2014; 30:8-13. [PMID: 25169443 DOI: 10.1016/j.eurpsy.2014.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 06/13/2014] [Accepted: 06/29/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Patients with schizophrenia suffer from a broad range of cognitive disturbances. The impact in terms of functional outcome is significant. There are also several reports of disturbed autonomic regulation in the disease. The present study examined cognitive function as well as psychophysiological parameters in patients with schizophrenia and healthy controls. METHODS Twenty-five patients and 14 controls were investigated with electrodermal activity (EDA), an oral niacin skin flush test and a comprehensive neurocognitive test program including the Wechsler battery (WAIS-R), Fingertapping Test, Trail Making Test, Verbal Fluency, Benton Visual Retention Test, Wisconsin Card Sorting Test and Rey Auditory Verbal Learning Test. RESULTS The patients generally had inferior test results compared to controls. Further analysis revealed that the EDA non-responding patient group explained this variation with significant lower test results than controls. On executive tests, EDA non-responders also performed significantly worse than EDA responding patients. The small group of niacin non-responding patients exhibited an even lower overall test performance. Delayed niacin flush also correlated inversely with psychomotor function and IQ in the patients. CONCLUSION The findings support the hypothesis of a neurodevelopment disturbance affecting both autonomic function and higher cortical function in schizophrenia.
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Affiliation(s)
- B M Nilsson
- Department of Neuroscience, Psychiatry, Uppsala University, SE-751 85 Uppsala, Sweden.
| | - G Holm
- Department of Neuroscience, Psychiatry, Uppsala University, SE-751 85 Uppsala, Sweden
| | - C M Hultman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, SE-17177 Stockholm, Sweden
| | - L Ekselius
- Department of Neuroscience, Psychiatry, Uppsala University, SE-751 85 Uppsala, Sweden
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