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Perrottelli A, Giordano GM, Koenig T, Caporusso E, Giuliani L, Pezzella P, Bucci P, Mucci A, Galderisi S. Electrophysiological Correlates of Reward Anticipation in Subjects with Schizophrenia: An ERP Microstate Study. Brain Topogr 2024; 37:1-19. [PMID: 37402859 PMCID: PMC11199294 DOI: 10.1007/s10548-023-00984-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
Abstract
The current study aimed to investigate alterations of event-related potentials (ERPs) microstate during reward anticipation in subjects with schizophrenia (SCZ), and their association with hedonic experience and negative symptoms. EEG data were recorded in thirty SCZ and twenty-three healthy controls (HC) during the monetary incentive delay task in which reward, loss and neutral cues were presented. Microstate analysis and standardized low-resolution electromagnetic tomography (sLORETA) were applied to EEG data. Furthermore, analyses correlating a topographic index (the ERPs score), calculated to quantify brain activation in relationship to the microstate maps, and scales assessing hedonic experience and negative symptoms were performed. Alterations in the first (125.0-187.5 ms) and second (261.7-414.1 ms) anticipatory cue-related microstate classes were observed. In SCZ, reward cues were associated to shorter duration and earlier offset of the first microstate class as compared to the neutral condition. In the second microstate class, the area under the curve was smaller for both reward and loss anticipation cues in SCZ as compared to HC. Furthermore, significant correlations between ERPs scores and the anticipation of pleasure scores were detected, while no significant association was found with negative symptoms. sLORETA analysis showed that hypo-activation of the cingulate cortex, insula, orbitofrontal and parietal cortex was detected in SCZ as compared to HC. Abnormalities in ERPs could be traced already during the early stages of reward processing and were associated with the anticipation of pleasure, suggesting that these dysfunctions might impair effective evaluation of incoming pleasant experiences. Negative symptoms and anhedonia are partially independent results.
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Affiliation(s)
- A Perrottelli
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - G M Giordano
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - T Koenig
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - E Caporusso
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - L Giuliani
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - P Pezzella
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - P Bucci
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Mucci
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - S Galderisi
- University of Campania "Luigi Vanvitelli", Naples, Italy
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2
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Giordano GM, Sanmarchi F, Mucci A, Rucci P, Brando F, Caporusso E, Giuliani L, Melillo A, Pezzella P, Bucci P, Rocca P, Rossi A, Bertolino A, Rossi R, Pergola G, Galderisi S, Maj M. External validation of the five domains of negative symptoms: Focus on cognition, functional capacity, and real-world functioning. Eur Psychiatry 2023; 67:e3. [PMID: 38097401 DOI: 10.1192/j.eurpsy.2023.2478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The conceptualization of negative symptoms (NS) in schizophrenia is still controversial. Recent confirmatory factor-analytic studies suggested that the bi-dimensional model (motivational deficit [MAP] and expressive deficit [EXP]) may not capture the complexity of NS structure, which could be better defined by a five-factor (five NS domains) or a hierarchical model (five NS domains as first-order factors, and MAP and EXP, as second-order factors). A validation of these models is needed to define the structure of NS. To evaluate the validity and temporal stability of the five-factor or the hierarchical structure of the brief negative symptom scale (BNSS) in individuals with schizophrenia (SCZ), exploring associations between these models with cognition, social cognition, functional capacity, and functioning at baseline and at 4 years follow-up. METHODS Clinical variables were assessed using state-of-the-art tools in 612 SCZ at two-time points. The validity of the five-factor and the hierarchical models was analyzed through structural equation models. RESULTS The two models had both a good fit and showed a similar pattern of associations with external validators at the two-time points, with minor variations. The five-factor solution had a slightly better fit. The associations with external validators favored the five-factor structure. CONCLUSIONS Our findings suggest that both five-factor and hierarchical models provide a valid conceptualization of NS in relation to external variables and that five-factor solution provides the best balance between parsimony and granularity to summarize the BNSS structure. This finding has important implications for the study of pathophysiological mechanisms and the development of new treatments.
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Affiliation(s)
- Giulia M Giordano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesco Brando
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Edoardo Caporusso
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Melillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giulio Pergola
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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3
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Lu C, Zhu X, Feng Y, Ao W, Li J, Gao Z, Luo H, Chen M, Cai F, Zhan S, Li H, Sun W, Hu J. Atypical antipsychotics antagonize GABA A receptors in the ventral tegmental area GABA neurons to relieve psychotic behaviors. Mol Psychiatry 2023; 28:2107-2121. [PMID: 36754983 DOI: 10.1038/s41380-023-01982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
Psychosis is an abnormal mental condition that can cause patients to lose contact with reality. It is a common symptom of schizophrenia, bipolar disorder, sleep deprivation, and other mental disorders. Clinically, antipsychotic medications, such as olanzapine and clozapine, are very effective in treatment for psychosis. To investigate the neural circuit mechanism that is affected by antipsychotics and identify more selective therapeutic targets, we employed a strategy by using these effective antipsychotics to identify antipsychotic neural substrates. We observed that local injection of antipsychotics into the ventral tegmental area (VTA) could reverse the sensorimotor gating defects induced by MK-801 injection in mice. Using in vivo fiber photometry, electrophysiological techniques, and chemogenetics, we found that antipsychotics could activate VTA gamma-aminobutyric acid (GABA) neurons by blocking GABAA receptors. Moreover, we found that the VTAGABA nucleus accumbens (NAc) projection was crucially involved in such antipsychotic effects. In summary, our study identifies a novel therapeutic target for the treatment of psychosis and underscores the utility of a 'bedside-to-bench' approach for identifying neural circuits that influence psychotic disorders.
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Affiliation(s)
- Chen Lu
- School of Life Science and Technology, ShanghaiTech University, 201210, Shanghai, China
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 200031, Shanghai, China
- University of Chinese Academy of Sciences, 100049, Beijing, China
| | - Xiaona Zhu
- School of Life Science and Technology, ShanghaiTech University, 201210, Shanghai, China.
| | - Yifan Feng
- School of Life Science and Technology, ShanghaiTech University, 201210, Shanghai, China
| | - Weizhen Ao
- School of Life Science and Technology, ShanghaiTech University, 201210, Shanghai, China
- iHuman Institute, ShanghaiTech University, 201210, Shanghai, China
| | - Jie Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030, Shanghai, China
| | - Zilong Gao
- School of Life Sciences, Westlake University, 310024, Hangzhou, China
| | - Huoqing Luo
- School of Life Science and Technology, ShanghaiTech University, 201210, Shanghai, China
| | - Ming Chen
- Institutes of Brain Science, Fudan University, 200032, Shanghai, China
| | - Fang Cai
- School of Life Science and Technology, ShanghaiTech University, 201210, Shanghai, China
| | - Shulu Zhan
- School of Life Science and Technology, ShanghaiTech University, 201210, Shanghai, China
| | - Hongxia Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | - Wenzhi Sun
- Chinese Institute for Brain Research, 102206, Beijing, China.
- School of Basic Medical Sciences, Capital Medical University, 100069, Beijing, China.
| | - Ji Hu
- School of Life Science and Technology, ShanghaiTech University, 201210, Shanghai, China.
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Connectivity alterations of mesostriatal pathways in first episode psychosis. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:15. [PMID: 36918579 PMCID: PMC10014938 DOI: 10.1038/s41537-023-00339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 02/24/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND AND HYPOTHESIS Pathogenic understanding of the psychotic disorders converges on regulation of dopaminergic signaling in mesostriatocortical pathways. Functional connectivity of the mesostriatal pathways may inform us of the neuronal networks involved. STUDY DESIGN This longitudinal study of first episode psychosis (FEP) (49 patients, 43 controls) employed seed-based functional connectivity analyses of fMRI data collected during a naturalistic movie stimulus. STUDY RESULTS We identified hypoconnectivity of the dorsal striatum with the midbrain, associated with antipsychotic medication dose in FEP, in comparison with the healthy control group. The midbrain regions that showed hypoconnectivity with the dorsal striatum also showed hypoconnectivity with cerebellar regions suggested to be involved in regulation of the mesostriatocortical dopaminergic pathways. None of the baseline hypoconnectivity detected was seen at follow-up. CONCLUSIONS These findings extend earlier resting state findings on mesostriatal connectivity in psychotic disorders and highlight the potential for cerebellar regulation of the mesostriatocortical pathways as a target of treatment trials.
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Brasso C, Stanziano M, Bosco FM, Morese R, Valentini MC, Vercelli A, Rocca P. Alteration of the Functional Connectivity of the Cortical Areas Characterized by the Presence of Von Economo Neurons in Schizophrenia, a Pilot Study. J Clin Med 2023; 12:jcm12041377. [PMID: 36835913 PMCID: PMC9962963 DOI: 10.3390/jcm12041377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Von Economo neurons (VENs) are rod, stick, or corkscrew cells mostly located in layer V of the frontoinsular and anterior cingulate cortices. VENs are projection neurons related to human-like social cognitive abilities. Post-mortem histological studies found VEN alterations in several neuropsychiatric disorders, including schizophrenia (SZ). This pilot study aimed to evaluate the role of VEN-containing areas in shaping patterns of resting-state brain activation in patients with SZ (n = 20) compared to healthy controls (HCs; n = 20). We performed a functional connectivity analysis seeded in the cortical areas with the highest density of VENs followed by fuzzy clustering. The alterations found in the SZ group were correlated with psychopathological, cognitive, and functioning variables. We found a frontotemporal network that was shared by four clusters overlapping with the salience, superior-frontal, orbitofrontal, and central executive networks. Differences between the HC and SZ groups emerged only in the salience network. The functional connectivity of the right anterior insula and ventral tegmental area within this network were negatively correlated with experiential negative symptoms and positively correlated with functioning. This study provides some evidence to show that in vivo, VEN-enriched cortical areas are associated with an altered resting-state brain activity in people with SZ.
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Affiliation(s)
- Claudio Brasso
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
- Struttura Complessa di Psichiatria Universitaria, Dipartimento di Neuroscienze e Salute Mentale, Azienda Ospedaliero-Universitaria “Città della Salute e della Scienza di Torino”, 10126 Turin, Italy
- Correspondence: ; Tel.: +39-011-670-7720
| | - Mario Stanziano
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, 20133 Milan, Italy
| | - Francesca Marina Bosco
- Research Group on Inferential Processes in Social Interaction (GIPSI), Department of Psychology, University of Turin, 10124 Turin, Italy
| | - Rosalba Morese
- Faculty of Communication Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Maria Consuelo Valentini
- Struttura Complessa di Neuroradiologia, Dipartimento Diagnostica per Immagini e Radiologia Interventistica, Azienda Ospedaliero-Universitaria “Città della Salute e della Scienza di Torino”, 10126 Turin, Italy
| | - Alessandro Vercelli
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
- Neuroscience Institute Cavalieri Ottolenghi (NICO), 10043 Orbassano, Italy
| | - Paola Rocca
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
- Struttura Complessa di Psichiatria Universitaria, Dipartimento di Neuroscienze e Salute Mentale, Azienda Ospedaliero-Universitaria “Città della Salute e della Scienza di Torino”, 10126 Turin, Italy
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Sabaroedin K, Tiego J, Fornito A. Circuit-Based Approaches to Understanding Corticostriatothalamic Dysfunction Across the Psychosis Continuum. Biol Psychiatry 2023; 93:113-124. [PMID: 36253195 DOI: 10.1016/j.biopsych.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 06/14/2022] [Accepted: 07/17/2022] [Indexed: 11/28/2022]
Abstract
Dopamine is known to play a role in the pathogenesis of psychotic symptoms, but the mechanisms driving dopaminergic dysfunction in psychosis remain unclear. Considerable attention has focused on the role of corticostriatothalamic (CST) circuits, given that they regulate and are modulated by the activity of dopaminergic cells in the midbrain. Preclinical studies have proposed multiple models of CST dysfunction in psychosis, each prioritizing different brain regions and pathophysiological mechanisms. A particular challenge is that CST circuits have undergone considerable evolutionary modification across mammals, complicating comparisons across species. Here, we consider preclinical models of CST dysfunction in psychosis and evaluate the degree to which they are supported by evidence from human resting-state functional magnetic resonance imaging studies conducted across the psychosis continuum, ranging from subclinical schizotypy to established schizophrenia. In partial support of some preclinical models, human studies indicate that dorsal CST and hippocampal-striatal functional dysconnectivity are apparent across the psychosis spectrum and may represent a vulnerability marker for psychosis. In contrast, midbrain dysfunction may emerge when symptoms warrant clinical assistance and may thus be a trigger for illness onset. The major difference between clinical and preclinical findings is the strong involvement of the dorsal CST in the former, consistent with an increasing prominence of this circuitry in the primate brain. We close by underscoring the need for high-resolution characterization of phenotypic heterogeneity in psychosis to develop a refined understanding of how the dysfunction of specific circuit elements gives rise to distinct symptom profiles.
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Affiliation(s)
- Kristina Sabaroedin
- Departments of Radiology and Paediatrics, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Jeggan Tiego
- Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Alex Fornito
- Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
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7
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Giordano GM, Pezzella P, Giuliani L, Fazio L, Mucci A, Perrottelli A, Blasi G, Amore M, Rocca P, Rossi A, Bertolino A, Galderisi S. Resting-State Brain Activity Dysfunctions in Schizophrenia and Their Associations with Negative Symptom Domains: An fMRI Study. Brain Sci 2023; 13:brainsci13010083. [PMID: 36672064 PMCID: PMC9856573 DOI: 10.3390/brainsci13010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/07/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023] Open
Abstract
The aim of the present study was to examine the neurobiological correlates of the two negative symptom domains of schizophrenia, the Motivational Deficit domain (including avolition, anhedonia, and asociality) and the Expressive Deficit domain (including blunted affect and alogia), focusing on brain areas that are most commonly found to be associated with negative symptoms in previous literature. Resting-state (rs) fMRI data were analyzed in 62 subjects affected by schizophrenia (SZs) and 46 healthy controls (HCs). The SZs, compared to the HCs, showed higher rs brain activity in the right inferior parietal lobule and the right temporoparietal junction, and lower rs brain activity in the right dorsolateral prefrontal cortex, the bilateral anterior dorsal cingulate cortex, and the ventral and dorsal caudate. Furthermore, in the SZs, the rs brain activity in the left orbitofrontal cortex correlated with negative symptoms (r = -0.436, p = 0.006), in particular with the Motivational Deficit domain (r = -0.424, p = 0.002), even after controlling for confounding factors. The left ventral caudate correlated with negative symptoms (r = -0.407, p = 0.003), especially with the Expressive Deficit domain (r = -0.401, p = 0.003); however, these results seemed to be affected by confounding factors. In line with the literature, our results demonstrated that the two negative symptom domains might be underpinned by different neurobiological mechanisms.
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Affiliation(s)
- Giulia Maria Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Correspondence: ; Tel.: +39-0815666512
| | - Leonardo Fazio
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, 70124 Bari, Italy
- Department of Medicine and Surgery, LUM University, 70010 Casamassima, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Andrea Perrottelli
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Giuseppe Blasi
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, 70124 Bari, Italy
| | - Mario Amore
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, 10126 Turin, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L’Aquila, 67100 L’Aquila, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, 70124 Bari, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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8
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Bucci P, Giordano GM, Mucci A, Rocca P, Rossi A, Bertolino A, Aguglia E, Altamura C, Amore M, Bellomo A, Biondi M, Carpiniello B, Cascino G, Dell'Osso L, Fagiolini A, Giuliani L, Marchesi C, Montemagni C, Pettorruso M, Pompili M, Rampino A, Roncone R, Rossi R, Siracusano A, Tenconi E, Vita A, Zeppegno P, Galderisi S, Maj M. Sex and gender differences in clinical and functional indices in subjects with schizophrenia and healthy controls: Data from the baseline and 4-year follow-up studies of the Italian Network for Research on Psychoses. Schizophr Res 2023; 251:94-107. [PMID: 36610377 DOI: 10.1016/j.schres.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023]
Abstract
Gender differences in clinical and psychosocial aspects of schizophrenia have been widely reported. Findings have not always been consistent, and some of them need further research. In a large sample of community dwelling persons with schizophrenia, we investigated gender differences in clinical, cognitive and functional indices, as well as their changes over a 4-year follow-up and their impact on real-life functioning. Gender differences in personal resources, cognitive and functional indices were explored also in a sample of healthy controls. Men with respect to women had an earlier age of illness onset, a worse premorbid adjustment in the academic domain, more severe avolition, expressive deficit and positive symptoms, lower prevalence of comorbidity for affective disorders, less frequent use of two coping strategies ('religion' and 'use of emotional support') and more frequent positive history of substance and alcohol abuse. In addition, men were more impaired in verbal learning, while women in reasoning/problem solving. Some patterns of gender differences observed in healthy controls were not confirmed in patients. Men's disadvantages in the clinical picture did not translate into a worse outcome. This finding may be related to the complex interplay of several factors acting as predictors or mediators of outcome.
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Affiliation(s)
- Paola Bucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli" Naples, Italy.
| | | | - Armida Mucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Bertolino
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Carlo Altamura
- Department of Psychiatry, University of Milan, Milan, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Antonello Bellomo
- Psychiatry Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Massimo Biondi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Liliana Dell'Osso
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Carlo Marchesi
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy
| | - Cristiana Montemagni
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Mauro Pettorruso
- Department of Neuroscience and Imaging, G. D'Annunzio University, Chieti, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio Rampino
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Rita Roncone
- Unit of Psychiatry, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rodolfo Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, Psychiatry and Clinical Psychology Unit, Tor Vergata University of Rome, Rome, Italy
| | - Elena Tenconi
- Psychiatric Clinic, Department of Neurosciences, University of Padua, Padua, Italy
| | - Antonio Vita
- Psychiatric Unit, School of Medicine, University of Brescia, Brescia, Italy; Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Psychiatric Unit, University of Eastern Piedmont, Novara, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli" Naples, Italy
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- The members of the Italian Network for Research on Psychoses involved in this study are listed in the Acknowledgments
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9
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The Impact of Antipsychotic Treatment on Neurological Soft Signs in Patients with Predominantly Negative Symptoms of Schizophrenia. Biomedicines 2022; 10:biomedicines10112939. [PMID: 36428507 PMCID: PMC9687986 DOI: 10.3390/biomedicines10112939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022] Open
Abstract
Schizophrenia is a complex and incompletely elucidated pathology that affects sensorimotor function and also produces numerous therapeutic challenges. The aims of this cross-sectional study were to identify the profile of neurological soft signs (NSS) in patients with predominantly negative symptoms of schizophrenia (PNS) compared with patients with schizophrenia who do not present a predominance of negative symptoms (NPNS) and also to objectify the impact of treatment on the neurological function of these patients. Ninety-nine (n = 99; 56 females and 43 males) patients diagnosed with schizophrenia according to DSM-V were included; these patients were undergoing antipsychotic (4 typical antipsychotics, 86 atypical antipsychotics, and 9 combinations of two atypical antipsychotics) or anticholinergic treatment (24 out of 99) at the time of evaluation, and the PANSS was used to identify the patients with predominantly negative symptoms (n = 39), the Neurological Evaluation Scale (NES) was used for the evaluation of neurological soft signs (NSS), and the SAS was used for the objectification of the extrapyramidal side effects induced by the neuroleptic treatment, which was converted to chlorpromazine equivalents (CPZE). The study's main finding was that, although the daily dose of CPZE did not represent a statistically significant variable, in terms of neurological soft signs, patients with PNS had higher rates of NSS.
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Lu C, Feng Y, Li H, Gao Z, Zhu X, Hu J. A preclinical study of deep brain stimulation in the ventral tegmental area for alleviating positive psychotic-like behaviors in mice. Front Hum Neurosci 2022; 16:945912. [PMID: 36034113 PMCID: PMC9399924 DOI: 10.3389/fnhum.2022.945912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation (DBS) is a clinical intervention for the treatment of movement disorders. It has also been applied to the treatment of psychiatric disorders such as depression, anorexia nervosa, obsessive-compulsive disorder, and schizophrenia. Psychiatric disorders including schizophrenia, bipolar disorder, and major depression can lead to psychosis, which can cause patients to lose touch with reality. The ventral tegmental area (VTA), located near the midline of the midbrain, is an important region involved in psychosis. However, the clinical application of electrical stimulation of the VTA to treat psychotic diseases has been limited, and related mechanisms have not been thoroughly studied. In the present study, hyperlocomotion and stereotyped behaviors of the mice were employed to mimic and evaluate the positive-psychotic-like behaviors. We attempted to treat positive psychotic-like behaviors by electrically stimulating the VTA in mice and exploring the neural mechanisms behind behavioral effects. Local field potential recording and in vivo fiber photometry to observe the behavioral effects and changes in neural activities caused by DBS in the VTA of mice. Optogenetic techniques were used to verify the neural mechanisms underlying the behavioral effects induced by DBS. Our results showed that electrical stimulation of the VTA activates local gamma-aminobutyric acid (GABA) neurons, and dopamine (DA) neurons, reduces hyperlocomotion, and relieves stereotyped behaviors induced by MK-801 (dizocilpine) injection. The results of optogenetic manipulation showed that the activation of the VTA GABA neurons, but not DA neurons, is involved in the alleviation of hyperlocomotion and stereotyped behaviors. We visualized changes in the activity of specific types in specific brain areas induced by DBS, and explored the neural mechanism of DBS in alleviating positive psychotic-like behaviors. This preclinical study not only proposes new technical means of exploring the mechanism of DBS, but also provides experimental justification for the clinical treatment of psychotic diseases by electrical stimulation of the VTA.
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Affiliation(s)
- Chen Lu
- School of Life Science and Technology, Shanghai Tech University, Shanghai, China
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yifan Feng
- School of Life Science and Technology, Shanghai Tech University, Shanghai, China
| | - Hongxia Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zilong Gao
- School of Life Sciences, Westlake University, Hangzhou, China
| | - Xiaona Zhu
- School of Life Science and Technology, Shanghai Tech University, Shanghai, China
| | - Ji Hu
- School of Life Science and Technology, Shanghai Tech University, Shanghai, China
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Subbanna M, Shivakumar V, Bhalerao G, Varambally S, Venkatasubramanian G, Debnath M. Variants of Th17 pathway-related genes influence brain morphometric changes and the risk of schizophrenia through epistatic interactions. Psychiatr Genet 2022; 32:146-155. [PMID: 35353801 DOI: 10.1097/ypg.0000000000000315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE T helper 17 (Th17) pathway has been reported to be abnormal in schizophrenia; however, it is not known whether variation within genes of this pathway has any impact on schizophrenia. Herein, the impact of genetic variations and gene-gene interactions of Th17 pathway-related genes on the risk, psychopathology, and brain volume was examined in schizophrenia patients. METHODS Functional polymorphisms within interleukin 6 ( IL6 )(rs1800795 and rs1800797), IL10 (rs1800872 and rs1800896), IL17A (rs2275913 and rs8193036), IL22 (rs2227484 and rs2227485), IL23R (rs1884444), and IL27 (rs153109 and rs181206) genes were studied in 224 schizophrenia patients and 226 healthy controls. These variants were correlated with the brain morphometry, analyzed using MRI in a subset of patients ( n = 117) and controls ( n = 137). RESULTS Patients carrying CC genotype of rs2227484 of IL22 gene had significantly higher apathy total score [ F (1,183) = 5.60; P = 0.019; partial ɳ 2 = 0.030]. Significant epistatic interactions between IL6 (rs1800797) and IL17A (rs2275913) genes were observed in schizophrenia patients. GG genotype of rs2275913 of IL17A gene was associated with reduced right middle occipital gyrus volume in schizophrenia patients ( T = 4.56; P < 0.001). CONCLUSION Interactions between genes of Th17 pathway impact the risk for schizophrenia. The variants of Th17 pathway-related genes seem to have a determining effect on psychopathology and brain morphometric changes in schizophrenia.
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Affiliation(s)
- Manjula Subbanna
- Department of Human Genetics, National Institute of Mental Health and Neurosciences
| | - Venkataram Shivakumar
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, and Departments of
- Integrative Medicine
| | - Gaurav Bhalerao
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, and Departments of
| | - Shivarama Varambally
- Integrative Medicine
- Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ganesan Venkatasubramanian
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, and Departments of
- Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health and Neurosciences
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Tseng PT, Zeng BS, Hung CM, Liang CS, Stubbs B, Carvalho AF, Brunoni AR, Su KP, Tu YK, Wu YC, Chen TY, Li DJ, Lin PY, Hsu CW, Chen YW, Suen MW, Satogami K, Takahashi S, Wu CK, Yang WC, Shiue YL, Huang TL, Li CT. Assessment of Noninvasive Brain Stimulation Interventions for Negative Symptoms of Schizophrenia: A Systematic Review and Network Meta-analysis. JAMA Psychiatry 2022; 79:770-779. [PMID: 35731533 PMCID: PMC9218931 DOI: 10.1001/jamapsychiatry.2022.1513] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Negative symptoms have a detrimental impact on functional outcomes and quality of life in people with schizophrenia, and few therapeutic options are considered effective for this symptomatic dimension. Studies have suggested that noninvasive brain stimulation (NIBS) interventions may be effective in treating negative symptoms. However, the comparative efficacy of different NIBS protocols for relieving negative symptoms remains unclear. OBJECTIVE To compare the efficacy and acceptability of different NIBS interventions for treating negative symptoms. DATA SOURCES The ClinicalKey, Cochrane CENTRAL, Embase, ProQuest, PubMed, ScienceDirect, ClinicalTrials.gov, and Web of Science electronic databases were systematically searched from inception through December 7, 2021. STUDY SELECTION A frequentist model network meta-analysis was conducted to assess the pooled findings of trials that evaluated the efficacy of repetitive transcranial magnetic stimulation (rTMS), theta-burst stimulation, transcranial random noise stimulation, transcutaneous vagus nerve stimulation, and transcranial direct current stimulation on negative symptoms in schizophrenia. Randomized clinical trials (RCTs) examining NIBS interventions for participants with schizophrenia were included. DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. Data were independently extracted by multiple observers. The pair-wise meta-analytic procedures were conducted using a random-effects model. MAIN OUTCOMES AND MEASURES The coprimary outcomes were changes in the severity of negative symptoms and acceptability (ie, dropout rates owing to any reason). Secondary outcomes were changes in positive and depressive symptoms. RESULTS Forty-eight RCTs involving 2211 participants (mean [range] age, 38.7 [24.0-57.0] years; mean [range] proportion of female patients, 30.6% [0%-70.0%]) were included. Compared with sham control interventions, excitatory NIBS strategies (standardized mean difference [SMD]: high-definition transcranial random noise stimulation, -2.19 [95% CI, -3.36 to -1.02]; intermittent theta-burst stimulation, -1.32 [95% CI, -1.88 to -0.76]; anodal transcranial direct current stimulation, -1.28 [95% CI, -2.55 to -0.02]; high-frequency rTMS, -0.43 [95% CI, -0.68 to -0.18]; extreme high-frequency rTMS, -0.45 [95% CI, -0.79 to -0.12]) over the left dorsolateral prefrontal cortex with or without other inhibitory stimulation protocols in the contralateral regions of the brain were associated with significantly larger reductions in negative symptoms. Acceptability did not significantly differ between the groups. CONCLUSIONS AND RELEVANCE In this network meta-analysis, excitatory NIBS protocols over the left dorsolateral prefrontal cortex were associated with significantly large improvements in the severity of negative symptoms. Because relatively few studies were available for inclusion, additional well-designed, large-scale RCTs are warranted.
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Affiliation(s)
- Ping-Tao Tseng
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan,Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan,Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan,Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bing-Syuan Zeng
- Department of Internal Medicine, E-DA Cancer Hospital, Kaohsiung, Taiwan
| | - Chao-Ming Hung
- Division of General Surgery, Department of Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Andre F. Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Andre R. Brunoni
- Service of Interdisciplinary Neuromodulation, National Institute of Biomarkers in Psychiatry, Laboratory of Neurosciences (LIM-27), Departamento e Instituto de Psiquiatria, Faculdade de Medicina da University of Sao Paulo, Sao Paulo, Brazil,Departamento de Ciências Médicas, Faculdade de Medicina da University of Sao Paulo, Sao Paulo, Brazil
| | - Kuan-Pin Su
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan,College of Medicine, China Medical University, Taichung, Taiwan,An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Dian-Jeng Li
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan,Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan
| | - Mein-Woei Suen
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan,Gender Equality Education and Research Center, Asia University, Taichung, Taiwan,Department of Medical Research, Asia University Hospital, Asia University, Taichung, Taiwan,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Kazumi Satogami
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Shun Takahashi
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan,Clinical Research and Education Center, Asakayama General Hospital, Sakai, Japan,Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Japan,Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan,Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Japan
| | - Ching-Kuan Wu
- Department of Psychiatry, Kaohsiung Kingswood Psychiatric Clinic, Kaohsiung, Taiwan
| | - Wei-Cheng Yang
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan,Department of Adult Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Tiao-Lai Huang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan,Department of Psychiatry, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan,Genomic and Proteomic Core Laboratory, Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Institute of Brain Science and Brain Research Center, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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King VL, Lahti AC, Maximo JO, ver Hoef LW, John S, Kraguljac NV. Contrasting Frontoparietal Network Connectivity in Antipsychotic Medication-Naive First-Episode Psychosis Patients Who Do and Do Not Display Features of the Deficit Syndrome. Schizophr Bull 2022; 48:1344-1353. [PMID: 35869578 PMCID: PMC9673254 DOI: 10.1093/schbul/sbac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The deficit syndrome is a clinical subtype of schizophrenia that is characterized by enduring negative symptoms. Several lines of evidence point to frontoparietal involvement, but the frontoparietal control network (FPCN) and its subsystems (FPCNA and FPCNB) proposed by Yeo et al. have not been systematically characterized at rest in patients with the deficit syndrome. METHODS We used resting-state fMRI to investigate the FPCN and its subnetworks in 72 healthy controls and 65 antipsychotic medication-naive, first-episode psychosis patients (22 displayed deficit syndrome features, 43 did not). To assess whole-brain FPCN connectivity, we used the right posterior parietal cortex as the seed region. We then performed region of interest analyses in FPCN subsystems. RESULTS We found that patterns of FPCN dysconnectivity to the whole brain differed in patients who displayed deficit syndrome features compared with those who did not. Examining the FPCN on a more granular level revealed reduced within-FPCN(A) connectivity only in patients displaying deficit features. FPCNB connectivity did not differ between patient groups. DISCUSSION Here, we describe a neurobiological signature of aberrant FPCN connectivity in antipsychotic-naive, first-episode patients who display clinical features of the deficit syndrome. Importantly, frontoparietal subnetwork connectivity differentiated subgroups, where the FPCNA is selectively involved in patients with deficit features. Our findings add to the growing body of literature supporting a neurobiological distinction between two clinical subtypes of schizophrenia, which has the potential to be leveraged for patient stratification in clinical trials and the development of novel treatments.
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Affiliation(s)
- Victoria L King
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adrienne C Lahti
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jose O Maximo
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lawrence W ver Hoef
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sooraj John
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nina V Kraguljac
- To whom correspondence should be addressed; Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, SC 501, 1720 7th Ave S, Birmingham, AL 35294-0017, USA; tel: 205-996-7171, e-mail:
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Sadeghi D, Shoeibi A, Ghassemi N, Moridian P, Khadem A, Alizadehsani R, Teshnehlab M, Gorriz JM, Khozeimeh F, Zhang YD, Nahavandi S, Acharya UR. An overview of artificial intelligence techniques for diagnosis of Schizophrenia based on magnetic resonance imaging modalities: Methods, challenges, and future works. Comput Biol Med 2022; 146:105554. [DOI: 10.1016/j.compbiomed.2022.105554] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 12/21/2022]
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Giordano GM, Caporusso E, Pezzella P, Galderisi S. Updated perspectives on the clinical significance of negative symptoms in patients with schizophrenia. Expert Rev Neurother 2022; 22:541-555. [PMID: 35758871 DOI: 10.1080/14737175.2022.2092402] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Negative symptoms in schizophrenia are associated with poor response to available treatments, poor quality of life, and functional outcome. Therefore, they represent a substantial burden for people with schizophrenia, their families, and health-care systems. AREAS COVERED In this manuscript, we will provide an update on the conceptualization, assessment, and treatment of this complex psychopathological dimension of schizophrenia. EXPERT OPINION Despite the progress in the conceptualization of negative symptoms and in the development of state-of-the-art assessment instruments made in the last decades, these symptoms are still poorly recognized, and not always assessed in line with current conceptualization. Every effort should be made to disseminate the current knowledge on negative symptoms, on their assessment instruments and available treatments whose efficacy is supported by research evidence. Longitudinal studies should be promoted to evaluate the natural course of negative symptoms, improve our ability to identify the different sources of secondary negative symptoms, provide effective interventions, and target primary and persistent negative symptoms with innovative treatment strategies. Further research is needed to identify pathophysiological mechanisms of primary negative symptoms and foster the development of new treatments.
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Caravaggio F, Barnett AJ, Nakajima S, Iwata Y, Kim J, Borlido C, Mar W, Gerretsen P, Remington G, Graff-Guerrero A. The effects of acute dopamine depletion on resting-state functional connectivity in healthy humans. Eur Neuropsychopharmacol 2022; 57:39-49. [PMID: 35091322 DOI: 10.1016/j.euroneuro.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 11/24/2022]
Abstract
Alpha-methyl-para-tyrosine (AMPT), a competitive inhibitor of tyrosine hydroxylase, can be used to deplete endogenous dopamine in humans. We examined how AMPT-induced dopamine depletion alters resting-state functional connectivity of the basal ganglia, and canonical resting-state networks, in healthy humans. Fourteen healthy participants (8 females; age [mean ± SD] = 27.93 ± 9.86) completed the study. Following dopamine depletion, the caudate showed reduced connectivity with the medial prefrontal cortex (mPFC) (Cohen's d = 1.89, p<.0001). Moreover, the caudate, putamen, globus pallidus, and midbrain all showed reduced connectivity with the occipital cortex (Cohen's d = 1.48-1.90; p<.0001-0.001). Notably, the dorsal caudate showed increased connectivity with the sensorimotor network (Cohen's d = 2.03, p=.002). AMPT significantly decreased self-reported motivation (t(13)=4.19, p=.001) and increased fatigue (t(13)=4.79, p=.0004). A greater increase in fatigue was associated with a greater reduction in connectivity between the substantia nigra and the mPFC (Cohen's d = 3.02, p<.00001), while decreased motivation was correlated with decreased connectivity between the VTA and left sensorimotor cortex (Cohen's d = 2.03, p=.00004). These findings help us to better understand the role of dopamine in basal ganglia function and may help us better understand neuropsychiatric diseases where abnormal dopamine levels are observed.
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Affiliation(s)
- Fernando Caravaggio
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada.
| | - Alexander J Barnett
- Center for Neuroscience, University of California, Davis, 1515 Newton Ct, Davis, California 95618, United States of America
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University, 2 Chome-15-45 Mita, Tokyo 108-8345, Japan
| | - Yusuke Iwata
- Department of Neuropsychiatry, University of Yamanashi, 4 Chome-4-37 Takeda, Kofu 400-8510, Japan
| | - Julia Kim
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada
| | - Carol Borlido
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada
| | - Wanna Mar
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada
| | - Philip Gerretsen
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada
| | - Gary Remington
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada
| | - Ariel Graff-Guerrero
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada
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Galderisi S, Giordano GM. We are not ready to abandon the current schizophrenia construct, but should be prepared to do so. Schizophr Res 2022; 242:30-34. [PMID: 34924240 DOI: 10.1016/j.schres.2021.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022]
Abstract
The current schizophrenia construct as delineated in the latest editions of the DSM and the ICD has some strengths, but also many weaknesses. It improved the reliability of the diagnosis, made communication among clinicians, users and families less ambiguous, is useful for education and training, and for reimbursement and insurance purposes. However, many serious weaknesses should be considered. The term "Schizophrenia" does not recognize the heterogeneity of the disorder and might nourish the belief that schizophrenia represents a unitary disease. In addition, there is no agreement on the existence and nature of a "core aspect" of the disorder. Stable dimensions, in particular negative symptoms and cognitive impairment, which are key determinants of functioning, are not de facto regarded as core aspects. Finally, the construct is associated to the notion of a poor outcome, to a high level of stigma and has acquired a derogatory connotation. We are not ready but should be prepared to abandon the current schizophrenia construct. Clinicians and researchers should be encouraged to complement the ICD/DSM diagnosis with an in-depth characterization of the individual clinical picture, along with other variables, such as family history, comorbidities, vulnerability factors and personal trajectory. The "Primary Psychoses" construct, together with improved cross-sectional and longitudinal phenotypes from representative population and patient cohorts, and the availability of artificial intelligence methods, could lead to a new and more precise taxonomy of psychotic disorders, and increase the probability of identifying meaningful biomarkers to improve prevention, diagnosis, prognosis, and treatment for people suffering from psychotic disorders.
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Brakowski J, Manoliu A, Homan P, Bosch OG, Herdener M, Seifritz E, Kaiser S, Kirschner M. Aberrant striatal coupling with default mode and central executive network relates to self-reported avolition and anhedonia in schizophrenia. J Psychiatr Res 2022; 145:263-275. [PMID: 33187692 DOI: 10.1016/j.jpsychires.2020.10.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 10/13/2020] [Accepted: 10/30/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Avolition and anhedonia are common symptoms in schizophrenia and are related to poor long-term prognosis. There is evidence for aberrant cortico-striatal function and connectivity as neural substrate of avolition and anhedonia. However, it remains unclear how both relate to shared or distinct striatal coupling with large-scale intrinsic networks. Using resting state functional magnetic resonance imaging (rs-fMRI) this study investigated the association of large-scale cortico-striatal functional connectivity with self-reported and clinician-rated avolition and anhedonia in subjects with schizophrenia. METHODS Seventeen subjects with schizophrenia (SZ) and 28 healthy controls (HC) underwent rs-fMRI. Using Independent Component Analysis (ICA), we assessed Independent Components (ICs) reflecting intrinsic connectivity networks (ICNs), intra intrinsic functional connectivity within the ICs (intra-iFC), and intrinsic functional connectivity between different ICs (inter-iFC). Avolition and anhedonia were assessed using the Self Evaluation Scale for Negative Symptoms and the Brief Negative Symptom Scale. RESULTS ICA revealed three striatal components and six cortical ICNs. Both self-rated avolition and anhedonia correlated with increased inter-iFC between the caudate and posterior Default Mode Network (pDMN) and between the caudate and Central Executive Network (CEN). In contrast, clinician-rated avolition and anhedonia were not correlated with cortico-striatal connectivity. Group comparison revealed trend-wise decreased inter-iFC between the caudate and Salience Network (SN) in schizophrenia patients compared to HC. DISCUSSION Self-rated, but not clinician-rated, avolition and anhedonia was associated with aberrant striatal coupling with the default mode and the central executive network. These findings suggest that self-reported and clinician-rated scores might capture different aspects of motivational and hedonic deficits in schizophrenia and therefore relate to different cortico-striatal functional abnormalities.
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Affiliation(s)
- Janis Brakowski
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland.
| | - Andrei Manoliu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland; Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Russell Square House, 10-12, Russell Square London, WC1B 5EH, United Kingdom
| | - Philipp Homan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Oliver G Bosch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Marcus Herdener
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Chemin Du Petit-Bel-Air, 1226, Thônex, Switzerland
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland; Montreal Neurological Institute, McGill University, 3801 University St, Montréal, QC, H3A 2B4, Canada.
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19
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Schulz J, Zimmermann J, Sorg C, Menegaux A, Brandl F. Magnetic resonance imaging of the dopamine system in schizophrenia - A scoping review. Front Psychiatry 2022; 13:925476. [PMID: 36203848 PMCID: PMC9530597 DOI: 10.3389/fpsyt.2022.925476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
For decades, aberrant dopamine transmission has been proposed to play a central role in schizophrenia pathophysiology. These theories are supported by human in vivo molecular imaging studies of dopamine transmission, particularly positron emission tomography. However, there are several downsides to such approaches, for example limited spatial resolution or restriction of the measurement to synaptic processes of dopaminergic neurons. To overcome these limitations and to measure complementary aspects of dopamine transmission, magnetic resonance imaging (MRI)-based approaches investigating the macrostructure, metabolism, and connectivity of dopaminergic nuclei, i.e., substantia nigra pars compacta and ventral tegmental area, can be employed. In this scoping review, we focus on four dopamine MRI methods that have been employed in patients with schizophrenia so far: neuromelanin MRI, which is thought to measure long-term dopamine function in dopaminergic nuclei; morphometric MRI, which is assumed to measure the volume of dopaminergic nuclei; diffusion MRI, which is assumed to measure fiber-based structural connectivity of dopaminergic nuclei; and resting-state blood-oxygenation-level-dependent functional MRI, which is thought to measure functional connectivity of dopaminergic nuclei based on correlated blood oxygenation fluctuations. For each method, we describe the underlying signal, outcome measures, and downsides. We present the current state of research in schizophrenia and compare it to other disorders with either similar (psychotic) symptoms, i.e., bipolar disorder and major depressive disorder, or dopaminergic abnormalities, i.e., substance use disorder and Parkinson's disease. Finally, we discuss overarching issues and outline future research questions.
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Affiliation(s)
- Julia Schulz
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Juliana Zimmermann
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Sorg
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Aurore Menegaux
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Felix Brandl
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
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20
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Giordano GM, Brando F, Pezzella P, De Angelis M, Mucci A, Galderisi S. Factors influencing the outcome of integrated therapy approach in schizophrenia: A narrative review of the literature. Front Psychiatry 2022; 13:970210. [PMID: 36117655 PMCID: PMC9476599 DOI: 10.3389/fpsyt.2022.970210] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022] Open
Abstract
The integration of pharmacotherapy with psychosocial interventions has an important role to play in the improvement of functional outcome of subjects with schizophrenia (SCZ), in all stages of the disorder. It is essential for the adequate management of unmet therapeutic needs, such as negative symptoms and cognitive dysfunctions which account for most of the functional impairment of subjects with SCZ and do not respond to available antipsychotics. Enhancing the knowledge on factors involved in the effectiveness of integrated treatment plans is an important step forward for SCZ care. This review aims to identify factors that might influence the impact of integrated treatments on functional outcome. Most studies on the impact of psychosocial treatments on functional outcome of subjects with SCZ did not control for the effect of prescribed antipsychotics or concomitant medications. However, several factors relevant to ongoing pharmacological treatment might influence the outcome of integrated therapy, with an impact on the adherence to treatment (e.g., therapeutic alliance and polypharmacotherapy) or on illness-related factors addressed by the psychosocial interventions (e.g., cognitive dysfunctions or motivational deficits). Indirect evidence suggests that treatment integration should consider the possible detrimental effects of different antipsychotics or concomitant medications on cognitive functions, as well as on secondary negative symptoms. Cognitive dysfunctions can interfere with participation to an integrated treatment plan and can be worsened by extrapyramidal or metabolic side effects of antipsychotics, or concomitant treatment with anticholinergics or benzodiazepines. Secondary negative symptoms, due to positive symptoms, sedation, extrapyramidal side effects or untreated depression, might cause early drop-out and poor adherence to treatment. Researchers and clinicians should examine all the above-mentioned factors and implement appropriate and personalized integrated treatments to improve the outcome of SCZ.
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Affiliation(s)
| | | | | | | | - Armida Mucci
- University of Campania Luigi Vanvitelli, Naples, Italy
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21
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Giordano GM, Pezzella P, Quarantelli M, Bucci P, Prinster A, Soricelli A, Perrottelli A, Giuliani L, Fabrazzo M, Galderisi S. Investigating the Relationship between White Matter Connectivity and Motivational Circuits in Subjects with Deficit Schizophrenia: A Diffusion Tensor Imaging (DTI) Study. J Clin Med 2021; 11:61. [PMID: 35011803 PMCID: PMC8745695 DOI: 10.3390/jcm11010061] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 12/28/2022] Open
Abstract
Deficit schizophrenia is a subtype of schizophrenia presenting primary and enduring negative symptoms (NS). Although one of the most updated hypotheses indicates a relationship between NS and impaired motivation, only a few studies have investigated abnormalities of motivational circuits in subjects with deficit schizophrenia (DS). Our aim was to investigate structural connectivity within motivational circuits in DS. We analyzed diffusion tensor imaging (DTI) data from 46 subjects with schizophrenia (SCZ) and 35 healthy controls (HCs). SCZ were classified as DS (n = 9) and non-deficit (NDS) (n = 37) using the Schedule for Deficit Syndrome. The connectivity index (CI) and the Fractional Anisotropy (FA) of the connections between selected brain areas involved in motivational circuits were examined. DS, as compared with NDS and HCs, showed increased CI between the right amygdala and dorsal anterior insular cortex and increased FA of the pathway connecting the left nucleus accumbens with the posterior insular cortex. Our results support previous evidence of distinct neurobiological alterations underlying different clinical subtypes of schizophrenia. DS, as compared with NDS and HCs, may present an altered pruning process (consistent with the hyperconnectivity) in cerebral regions involved in updating the stimulus value to guide goal-directed behavior.
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Affiliation(s)
- Giulia M. Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.P.); (P.B.); (A.P.); (L.G.); (M.F.); (S.G.)
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.P.); (P.B.); (A.P.); (L.G.); (M.F.); (S.G.)
| | - Mario Quarantelli
- Biostructure and Bioimaging Institute, National Research Council, 80134 Naples, Italy; (M.Q.); (A.P.)
| | - Paola Bucci
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.P.); (P.B.); (A.P.); (L.G.); (M.F.); (S.G.)
| | - Anna Prinster
- Biostructure and Bioimaging Institute, National Research Council, 80134 Naples, Italy; (M.Q.); (A.P.)
| | - Andrea Soricelli
- Department of Integrated Imaging, IRCCS SDN, 80143 Naples, Italy;
- Department of Motor Sciences and Healthiness, University of Naples Parthenope, 80133 Naples, Italy
| | - Andrea Perrottelli
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.P.); (P.B.); (A.P.); (L.G.); (M.F.); (S.G.)
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.P.); (P.B.); (A.P.); (L.G.); (M.F.); (S.G.)
| | - Michele Fabrazzo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.P.); (P.B.); (A.P.); (L.G.); (M.F.); (S.G.)
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.P.); (P.B.); (A.P.); (L.G.); (M.F.); (S.G.)
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22
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Giordano GM, Brando F, Perrottelli A, Di Lorenzo G, Siracusano A, Giuliani L, Pezzella P, Altamura M, Bellomo A, Cascino G, Del Casale A, Monteleone P, Pompili M, Galderisi S, Maj M. Tracing Links Between Early Auditory Information Processing and Negative Symptoms in Schizophrenia: An ERP Study. Front Psychiatry 2021; 12:790745. [PMID: 34987433 PMCID: PMC8721527 DOI: 10.3389/fpsyt.2021.790745] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/19/2021] [Indexed: 01/28/2023] Open
Abstract
Background: Negative symptoms represent a heterogeneous dimension with a strong impact on functioning of subjects with schizophrenia (SCZ). Five constructs are included in this dimension: anhedonia, asociality, avolition, blunted affect, and alogia. Factor analyses revealed that these symptoms cluster in two domains: experiential domain (avolition, asociality, and anhedonia) and the expressive deficit (alogia and blunted affect), that might be linked to different neurobiological alterations. Few studies investigated associations between N100, an electrophysiological index of early sensory processing, and negative symptoms, reporting controversial results. However, none of these studies investigated electrophysiological correlates of the two negative symptom domains. Objectives: The aim of our study was to evaluate, within the multicenter study of the Italian Network for Research on Psychoses, the relationships between N100 and negative symptom domains in SCZ. Methods: Auditory N100 was analyzed in 114 chronic stabilized SCZ and 63 healthy controls (HCs). Negative symptoms were assessed with the Brief Negative Symptom Scale (BNSS). Repeated measures ANOVA and correlation analyses were performed to evaluate differences between SCZ and HCs and association of N100 features with negative symptoms. Results: Our findings demonstrated a significant N100 amplitude reduction in SCZ compared with HCs. In SCZ, N100 amplitude for standard stimuli was associated with negative symptoms, in particular with the expressive deficit domain. Within the expressive deficit, blunted affect and alogia had the same pattern of correlation with N100. Conclusion: Our findings revealed an association between expressive deficit and N100, suggesting that these negative symptoms might be related to deficits in early auditory processing in SCZ.
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Affiliation(s)
- Giulia M. Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesco Brando
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Perrottelli
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Foggia, Foggia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Foggia, Foggia, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Antonio Del Casale
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, University of Rome “La Sapienza”, Rome, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, University of Rome “La Sapienza”, Rome, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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23
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Giordano GM, Perrottelli A, Mucci A, Di Lorenzo G, Altamura M, Bellomo A, Brugnoli R, Corrivetti G, Girardi P, Monteleone P, Niolu C, Galderisi S, Maj M. Investigating the Relationships of P3b with Negative Symptoms and Neurocognition in Subjects with Chronic Schizophrenia. Brain Sci 2021; 11:1632. [PMID: 34942934 PMCID: PMC8699055 DOI: 10.3390/brainsci11121632] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/26/2021] [Accepted: 12/08/2021] [Indexed: 01/06/2023] Open
Abstract
Neurocognitive deficits and negative symptoms (NS) have a pivotal role in subjects with schizophrenia (SCZ) due to their impact on patients' functioning in everyday life and their influence on goal-directed behavior and decision-making. P3b is considered an optimal electrophysiological candidate biomarker of neurocognitive impairment for its association with the allocation of attentional resources to task-relevant stimuli, an important factor for efficient decision-making, as well as for motivation-related processes. Furthermore, associations between P3b deficits and NS have been reported. The current research aims to fill the lack of studies investigating, in the same subjects, the associations of P3b with multiple cognitive domains and the expressive and motivation-related domains of NS, evaluated with state-of-the-art instruments. One hundred and fourteen SCZ and 63 healthy controls (HCs) were included in the study. P3b amplitude was significantly reduced and P3b latency prolonged in SCZ as compared to HCs. In SCZ, a positive correlation was found between P3b latency and age and between P3b amplitude and the Attention-vigilance domain, while no significant correlations were found between P3b and the two NS domains. Our results indicate that the effortful allocation of attention to task-relevant stimuli, an important component of decision-making, is compromised in SCZ, independently of motivation deficits or other NS.
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Affiliation(s)
- Giulia M. Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.G.); (A.P.); (S.G.); (M.M.)
| | - Andrea Perrottelli
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.G.); (A.P.); (S.G.); (M.M.)
| | - Armida Mucci
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.G.); (A.P.); (S.G.); (M.M.)
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (G.D.L.); (C.N.)
| | - Mario Altamura
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.A.); (A.B.)
| | - Antonello Bellomo
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.A.); (A.B.)
| | - Roberto Brugnoli
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, University of Rome “La Sapienza”, 00189 Rome, Italy; (R.B.); (P.G.)
| | - Giulio Corrivetti
- Department of Mental Health, University of Salerno, 84133 Salerno, Italy;
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, University of Rome “La Sapienza”, 00189 Rome, Italy; (R.B.); (P.G.)
| | - Palmiero Monteleone
- Section of Neurosciences, Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, 84081 Salerno, Italy;
| | - Cinzia Niolu
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (G.D.L.); (C.N.)
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.G.); (A.P.); (S.G.); (M.M.)
| | - Mario Maj
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.G.); (A.P.); (S.G.); (M.M.)
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24
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Nakamura Y, Okada N, Koshiyama D, Kamiya K, Abe O, Kunimatsu A, Okanoya K, Kasai K, Koike S. Differences in Functional Connectivity Networks Related to the Midbrain Dopaminergic System-Related Area in Various Psychiatric Disorders. Schizophr Bull 2020; 46:1239-1248. [PMID: 31901932 PMCID: PMC7505191 DOI: 10.1093/schbul/sbz121] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Disruptions in the dopamine system have been observed in psychiatric disorders. Since dopamine is mainly produced in the ventral tegmental area (VTA), elucidating the differences in the VTA neural network across psychiatric disorders would facilitate a greater understanding of the pathophysiological mechanisms underlying these disorders. However, no study has compared VTA-seed-based functional connectivity across psychiatric disorders. Therefore, we conducted a resting-state functional magnetic resonance imaging (rs-fMRI) study to perform a seed-based fMRI analysis, using the VTA as a seed. METHODS We included participants with major depressive disorder (MDD; n = 45), schizophrenia (n = 32), and bipolar disorder (BPD; n = 30), along with healthy control participants (n = 46) who were matched for age, gender, and handedness. RESULTS The results showed that patients with MDD and BPD had altered VTA-related connectivity in the superior frontal gyrus, frontal pole regions, hippocampus, cerebellum, and posterior cingulate cortex. Some of these differences in connectivity were also found between affective disorders and schizophrenia; however, there were no differences between the schizophrenia and control groups. Connectivity between the VTA and the hippocampus was correlated with positive symptoms in the schizophrenia group. The connectivity was not associated with medication dose, and the results remained significant after controlling for dose. CONCLUSIONS The results suggest that altered brain functional connectivity related to VTA networks could be associated with the distinctive pathophysiologies of psychiatric disorders, especially affective disorders.
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Affiliation(s)
- Yuko Nakamura
- Center for Integrative Science of Human Behavior, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
- Center for Evolutionary Cognitive Science at the University of Tokyo, Tokyo, Japan
| | - Naohiro Okada
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- International Research Center for Neurointelligence (WPI-IRCN), UTIAS, The University of Tokyo, Tokyo, Japan
| | - Daisuke Koshiyama
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kouhei Kamiya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Kunimatsu
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Radiology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Kazuo Okanoya
- Center for Integrative Science of Human Behavior, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
- Center for Evolutionary Cognitive Science at the University of Tokyo, Tokyo, Japan
- International Research Center for Neurointelligence (WPI-IRCN), UTIAS, The University of Tokyo, Tokyo, Japan
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan
| | - Kiyoto Kasai
- Center for Integrative Science of Human Behavior, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
- Center for Evolutionary Cognitive Science at the University of Tokyo, Tokyo, Japan
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- International Research Center for Neurointelligence (WPI-IRCN), UTIAS, The University of Tokyo, Tokyo, Japan
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan
| | - Shinsuke Koike
- Center for Integrative Science of Human Behavior, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
- Center for Evolutionary Cognitive Science at the University of Tokyo, Tokyo, Japan
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- International Research Center for Neurointelligence (WPI-IRCN), UTIAS, The University of Tokyo, Tokyo, Japan
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan
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25
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Bègue I, Kaiser S, Kirschner M. Pathophysiology of negative symptom dimensions of schizophrenia – Current developments and implications for treatment. Neurosci Biobehav Rev 2020; 116:74-88. [DOI: 10.1016/j.neubiorev.2020.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/13/2020] [Accepted: 06/02/2020] [Indexed: 02/06/2023]
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26
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Xie X, Zu M, Zhang L, Bai T, Wei L, Huang W, Ji GJ, Qiu B, Hu P, Tian Y, Wang K. A common variant of the NOTCH4 gene modulates functional connectivity of the occipital cortex and its relationship with schizotypal traits. BMC Psychiatry 2020; 20:363. [PMID: 32646407 PMCID: PMC7346398 DOI: 10.1186/s12888-020-02773-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/29/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Schizotypal traits are considered as inheritable traits and the endophenotype for schizophrenia. A common variant in the NOTCH4 gene, rs204993, has been linked with schizophrenia, but the neural underpinnings are largely unknown. METHODS In present study, we compared the differences of brain functions between different genotypes of rs204993 and its relationship with schizotypal traits among 402 Chinese Han healthy volunteers. The brain function was evaluated with functional connectivity strength (FCS) using the resting-state functional magnetic resonance image(rs-fMRI). The schizotypal traits were measured by the schizotypal personality questionnaire (SPQ). RESULTS Our results showed that carriers with the AA genotype showed reduced FCS in the left occipital cortex when compared with carriers with the AG and GG genotypes, and the carriers with the AG genotype showed reduced FCS in the left occipital cortex when compared with carriers with the GG genotype. The FCS values in the left occipital lobe were negatively associated with the SPQ scores and its subscale scores within the carriers with the GG genotype, but not within the carriers with AA or AG genotype. CONCLUSION Our results suggested that the common variant in the NOTCH4 gene, rs204993, modulates the function of the occipital cortex, which may contribute to schizotypal traits. These findings provide insight for genetic effects on schizotypal traits and its potential neural substrate.
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Affiliation(s)
- Xiaohui Xie
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Meidan Zu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Long Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Tongjian Bai
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Ling Wei
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Anhui Medical University, Hefei, 230022, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230022, China
| | - Wanling Huang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Gong-Jun Ji
- Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Anhui Medical University, Hefei, 230022, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230022, China
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China
| | - Bensheng Qiu
- Center for Biomedical Engineering, University of Science and Technology of China, Hefei, Anhui, China
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Anhui Medical University, Hefei, 230022, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230022, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
- Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Anhui Medical University, Hefei, 230022, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230022, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
- Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Anhui Medical University, Hefei, 230022, China.
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230022, China.
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China.
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27
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Collo G, Mucci A, Giordano GM, Merlo Pich E, Galderisi S. Negative Symptoms of Schizophrenia and Dopaminergic Transmission: Translational Models and Perspectives Opened by iPSC Techniques. Front Neurosci 2020; 14:632. [PMID: 32625059 PMCID: PMC7315891 DOI: 10.3389/fnins.2020.00632] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 05/22/2020] [Indexed: 12/18/2022] Open
Abstract
Negative symptoms (NS) represent a heterogeneous dimension of schizophrenia (SCZ), associated with a poor functional outcome. A dysregulated dopamine (DA) system, including a reduced D1 receptor activation in the prefrontal cortex, DA hypoactivity in the caudate and alterations in D3 receptor activity, seems to contribute to the pathogenesis of NS. However, failure to take into account the NS heterogeneity has slowed down progress in research on their neurobiological correlates and discoveries of new effective treatments. A better neurobiological characterization of NS is needed, and this requires objective quantification of their features that can be applied in translational models, such as animal models and human inducible pluripotent stem cells (iPSC). In this review we summarize the evidence for dopaminergic alterations relevant to NS in translational animal models focusing on dysfunctional motivation, a core aspect of NS. Among others, experiments on mutant rodents with an overexpression of DA D2 or D3 receptors and the dopamine deficient mice are discussed. In the second part we summarize the findings from recent studies using iPSC to model the pathogenesis of SCZ. By retaining the genetic background of risk genetic variants, iPSC offer the possibility to study the effect of de novo mutations or inherited polymorphisms from subgroups of patients and their response to drugs, adding an important tool for personalized psychiatry. Given the key role of DA in NS, we focus on findings of iPSC-derived DA neurons. Since implementation of iPSC-derived neurons to study the neurobiology of SCZ is a relatively recent acquisition, the available data are limited. We highlight some methodological aspects of relevance in the interpretation of in vitro testing results, including limitations and strengths, offering a critical viewpoint for the implementation of future pharmacological studies aimed to the discovery and characterization of novel treatments for NS.
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Affiliation(s)
- Ginetta Collo
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giulia M. Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Emilio Merlo Pich
- Research & Development, Alfasigma Schweiz, Zofingen, Switzerland
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Openshaw RL, Thomson DM, Thompson R, Penninger JM, Pratt JA, Morris BJ, Dawson N. Map2k7 Haploinsufficiency Induces Brain Imaging Endophenotypes and Behavioral Phenotypes Relevant to Schizophrenia. Schizophr Bull 2020; 46:211-223. [PMID: 31219577 PMCID: PMC6942167 DOI: 10.1093/schbul/sbz044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
c-Jun N-terminal kinase (JNK) signaling contributes to functional plasticity in the brain and cognition. Accumulating evidence implicates a role for MAP kinase kinase 7 (MAP2K7), a JNK activator encoded by the Map2k7 gene, and other JNK pathway components in schizophrenia (ScZ). Mice haploinsufficient for Map2k7 (Map2k7+/- mice) display ScZ-relevant cognitive deficits, although the mechanisms are unclear. Here we show that Map2k7+/- mice display translationally relevant alterations in brain function, including hippocampal and mesolimbic system hypermetabolism with a contrasting prefrontal cortex (PFC) hypometabolism, reminiscent of patients with ScZ. In addition Map2k7+/- mice show alterations in functional brain network connectivity paralleling those reported in early ScZ, including PFC and hippocampal hyperconnectivity and compromised mesolimbic system functional connectivity. We also show that although the cerebral metabolic response to ketamine is preserved, the response to dextroamphetamine (d-amphetamine) is significantly attenuated in Map2k7+/- mice, supporting monoamine neurotransmitter system dysfunction but not glutamate/NMDA receptor (NMDA-R) dysfunction as a consequence of Map2k7 haploinsufficiency. These effects are mirrored behaviorally with an attenuated impact of d-amphetamine on sensorimotor gating and locomotion, whereas similar deficits produced by ketamine are preserved, in Map2k7+/- mice. In addition, Map2k7+/- mice show a basal hyperactivity and sensorimotor gating deficit. Overall, these data suggest that Map2k7 modifies brain and monoamine neurotransmitter system function in a manner relevant to the positive and cognitive symptoms of ScZ.
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Affiliation(s)
- Rebecca L Openshaw
- Institute of Neuroscience and Psychology, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
| | - David M Thomson
- Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow, UK
| | - Rhiannon Thompson
- Institute of Neuroscience and Psychology, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
| | - Josef M Penninger
- Institute for Molecular Biotechnology of Austrian Academy of Sciences (IMBA), Vienna, Austria
| | - Judith A Pratt
- Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow, UK
| | - Brian J Morris
- Institute of Neuroscience and Psychology, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
| | - Neil Dawson
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster, UK,To whom correspondence should be addressed; tel: +44 (0)1524 594 896, e-mail:
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Abstract
Structural and functional abnormalities of the cerebellum have been observed in schizophrenia since the first neuroimaging studies. More recently, the functions of the cerebellum have been extended beyond sensorimotor control to include participation in higher-level cognition and affective regulation. Consistently, the "cognitive dysmetria" theory posits that dysfunctions of cortical-subcortical-cerebellar circuitry may be crucial for the pathogenesis of different clinical features of schizophrenia. This conceptual framework offers a set of testable hypotheses, now that various tools to exert direct modulation of cerebellar activity are available. We conducted a systematic review of studies examining the effects of cerebellar modulation in schizophrenia. Two independent authors conducted a search within PubMed for articles published up to April 2019 and identified 10 studies (three randomized controlled trials, two open-label studies, two case reports, one preclinical study) describing the effects of cerebellar circuitry modulation in patients with schizophrenia or animal models. The majority of interventions were uncontrolled and used stimulation of the cerebellar vermis, using transcranial magnetic stimulation or transcranial direct-current stimulation. Most studies detected improvements after cerebellar modulation. Clinical changes mostly pertained the domains of negative symptoms, depressive symptoms and cognitive functions. In conclusion, few studies examined the effects of cerebellar modulation in schizophrenia but yielded promising results. This approach may hold therapeutic potential, pending further methodologically robust replication.
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