The Maudsley Early Onset Schizophrenia Study: The effect of age of onset and illness duration on fronto-parietal gray matter

Age-related change in cortical thickness in adolescents at clinical high risk for psychosis: a longitudinal study

Progression to psychosis has been associated with increased cortical thinning in the frontal, temporal and parietal lobes in individuals at clinical high risk for the disorder (CHR-P). The timing and spatial extent of these changes are thought to be influenced by age. However, most evidence so far stems from adult samples. Longitudinal studies are essential to understanding the neuroanatomical changes associated to transition to psychosis during adolescence, and their relationship with age. We conducted a longitudinal, multisite study including adolescents at CHR-P and healthy controls (HC), aged 10-17 years. Structural images were acquired at baseline and at 18-month follow-up. Images were processed with the longitudinal pipeline in FreeSurfer. We used a longitudinal two-stage model to compute the regional cortical thickness (CT) change, and analyze between-group differences controlling for age, sex and scan, and corrected for multiple comparisons. Linear regression was used to study the effect of age at baseline. A total of 103 individuals (49 CHR-P and 54 HC) were included in the analysis. During follow-up, the 13 CHR-P participants who transitioned to psychosis exhibited greater CT decrease over time in the right parietal cortex compared to those who did not transition to psychosis and to HC. Age at baseline correlated with longitudinal changes in CT, with younger individuals showing greater cortical thinning in this region. The emergence of psychosis during early adolescence may have an impact on typical neuromaturational processes. This study provides new insights on the cortical changes taking place prior to illness onset.

Age-Related Social Cognitive Performance in Individuals With Psychotic Disorders and Their First-Degree Relatives

BACKGROUND

Social cognitive impairment is a recognized feature of psychotic disorders. However, potential age-related differences in social cognitive impairment have rarely been studied.

STUDY DESIGN

Data came from 905 individuals with a psychotic disorder, 966 unaffected siblings, and 544 never-psychotic controls aged 18-55 who participated in the Genetic Risk and Outcome of Psychosis (GROUP) study. Multilevel linear models were fitted to study group main effects and the interaction between group and age on emotion perception and processing (EPP; degraded facial affect recognition) and theory of mind (ToM; hinting task) performance. Age-related differences in the association between socio-demographic and clinical factors, and EPP and ToM were also explored.

STUDY RESULTS

Across groups, EPP performance was associated with age (β = -0.02, z = -7.60, 95% CI: -0.02, -0.01, P < .001), with older participants performing worse than younger ones. A significant group-by-age interaction on ToM (X2(2) = 13.15, P = .001) indicated that older patients performed better than younger ones, while no age-related difference in performance was apparent among siblings and controls. In patients, the association between negative symptoms and ToM was stronger for younger than older patients (z = 2.16, P = .03).

CONCLUSIONS

The findings point to different age-related performance patterns on tests of 2 key social cognitive domains. ToM performance was better in older individuals, although this effect was only observed for patients. EPP was less accurate in older compared with younger individuals. These findings have implications with respect to when social cognitive training should be offered to patients.

Impact of traumatic life events on clinical variables of individuals with first-episode psychosis and healthy controls

BACKGROUND

Traumatic life events (TLEs) are one of the most robust environmental risk factors for the onset of first-episode psychosis (FEP).

AIMS

To explore TLEs in FEP patients and healthy controls (HC), to analyze gender differences and to examine whether TLEs were associated with sociodemographic, clinical and psychofunctional variables in all FEP sample and split by age.

METHODS

Descriptive and cross-sectional study. Three hundred and thirty-five FEP and 253 HC were recruited at 16 Spanish mental health research centers. The Traumatic Experiences in Psychiatric Outpatients Questionnaire was administered.

RESULTS

We found a higher number of TLEs in FEP than in HC, and the proportion of individuals with three or more TLEs was significantly higher in the FEP group. No differences were found in terms of gender and age. There was no relationship between total number of TLEs and psychotic symptomatology and functional outcomes.

CONCLUSIONS

The number and cumulative TLEs should be taken into account in the detection, epidemiology and process of recovery in FEP.

Application of Mass Multivariate Analysis on Neuroimaging Data Sets for Precision Diagnostics of Depression

We used the Mass Multivariate Method on structural, resting-state, and task-related fMRI data from two groups of patients with schizophrenia and depression in order to define several regions of significant relevance to the differential diagnosis of those conditions. The regions included the left planum polare (PP), the left opercular part of the inferior frontal gyrus (OpIFG), the medial orbital gyrus (MOrG), the posterior insula (PIns), and the parahippocampal gyrus (PHG). This study delivered evidence that a multimodal neuroimaging approach can potentially enhance the validity of psychiatric diagnoses. Structural, resting-state, or task-related functional MRI modalities cannot provide independent biomarkers. Further studies need to consider and implement a model of incremental validity combining clinical measures with different neuroimaging modalities to discriminate depressive disorders from schizophrenia. Biological signatures of disease on the level of neuroimaging are more likely to underpin broader nosological entities in psychiatry.

Modular-level alterations of single-subject gray matter networks in schizophrenia

Schizophrenia is often regarded as a psychiatric disorder caused by disrupted connections in the brain. Evidence suggests that the gray matter of schizophrenia patients is damaged in a modular pattern. Recently, abnormal topological organization was observed in the gray matter networks of patients with schizophrenia. However, the modular-level alteration of gray matter networks in schizophrenia remains unclear. In this study, single-subject gray matter networks were constructed for a total of 217 subjects (116 patients with schizophrenia and 101 controls). We analyzed the topological characteristics of the brain network and the strengths of connections between and within modules. Compared with the outcomes in the control group, the global efficiency and participation coefficient values of the single-subject gray matter networks in schizophrenic patients were significantly reduced. The nodal participation coefficient of the regions involving the frontoparietal attention network, default mode network and subcortical network were significantly decreased in subjects with schizophrenia. The intermodule connections between the frontoparietal attention network and visual network and between the default mode network and subcortical network, in the frontoparietal attention network were significantly reduced in the patient group. In the frontoparietal attention network, the intramodule nodal connection strength of the left orbital inferior frontal gyrus and right inferior parietal gyrus was significantly decreased in schizophrenia patients. Reduced intermodule nodal connection strength between the frontoparietal attention network and visual network was associated with the severity of schizophrenia symptoms. These findings suggest that abnormal intramodule and intermodule connections in the structural brain network may a biomarker of schizophrenia symptoms.

Individual-specific functional connectome biomarkers predict schizophrenia positive symptoms during adolescent brain maturation

Even with an overarching functional dysconnectivity model of adolescent-onset schizophrenia (AOS), there have been no functional connectome (FC) biomarkers identified for predicting patients' specific symptom domains. Adolescence is a period of dramatic brain maturation, with substantial interindividual variability in brain anatomy. However, existing group-level hypotheses of AOS lack precision in terms of neuroanatomical boundaries. This study aimed to identify individual-specific FC biomarkers associated with schizophrenic symptom manifestation during adolescent brain maturation. We used a reliable individual-level cortical parcellation approach to map functional brain regions in each subject, that were then used to identify FC biomarkers for predicting dimension-specific psychotic symptoms in 30 antipsychotic-naïve first-episode AOS patients (recruited sample of 39). Age-related changes in biomarker expression were compared between these patients and 31 healthy controls. Moreover, 29 antipsychotic-naïve first-episode AOS patients (analyzed sample of 25) were recruited from another center to test the generalizability of the prediction model. Individual-specific FC biomarkers could significantly and better predict AOS positive-dimension symptoms with a relatively stronger generalizability than at the group level. Specifically, positive symptom domains were estimated based on connections between the frontoparietal control network (FPN) and salience network and within FPN. Consistent with the neurodevelopmental hypothesis of schizophrenia, the FPN-SN connection exhibited aberrant age-associated alteration in AOS. The individual-level findings reveal reproducible FPN-based FC biomarkers associated with AOS positive symptom domains, and highlight the importance of accounting for individual variation in the study of adolescent-onset disorders.

Brain imaging findings in children and adolescents with mental disorders: A cross-sectional review

Background

While brain imaging studies of juvenile patients has expanded in recent years to investigate the cerebral neurophysiologic correlates of psychiatric disorders, this research field remains scarce. The aim of the present review was to cluster the main mental disorders according to the differential brain location of the imaging findings recently reported in children and adolescents reports. A second objective was to describe the worldwide distribution and the main directions of the recent magnetic resonance imaging (MRI) and positron tomography (PET) studies in these patients.

Methods

A survey of 423 MRI and PET articles published between 2005 and 2008 was performed. A principal component analysis (PCA), then an activation likelihood estimate (ALE) meta-analysis, were applied on brain regional information retrieved from articles in order to cluster the various disorders with respect to the cerebral structures where alterations were reported. Furthermore, descriptive analysis characterized the literature production.

Results

Two hundred and seventy-four articles involving children and adolescent patients were analyzed. Both the PCA and ALE methods clustered, three groups of diagnosed psychiatric disorders, according to the brain structural and functional locations: one group of affective disorders characterized by abnormalities of the frontal-limbic regions; a group of mental disorders with “cognition deficits” mainly related to cortex abnormalities; and one psychomotor condition associated with abnormalities in the basal ganglia. The descriptive analysis indicates a focus on attention deficit hyperactivity disorders and autism spectrum disorders, a general steady rise in the number of annual reports, and lead of US research.

Conclusion

This cross-sectional review of child and adolescent mental disorders based on neuroimaging findings suggests overlaps of brain locations that allow to cluster the diagnosed disorders into three sets with respectively marked affective, cognitive, and psychomotor phenomenology. Furthermore, the brain imaging research effort was unequally distributed across disorders, and did not reflect their prevalence.

A Meta-analysis of Structural and Functional Brain Abnormalities in Early-Onset Schizophrenia

Early-onset schizophrenia (EOS) patients demonstrate brain changes that are similar to severe cases of adult-onset schizophrenia. Neuroimaging research in EOS is limited due to the rarity of the disorder. The present meta-analysis aims to consolidate MRI and functional MRI findings in EOS. Seven voxel-based morphometry (VBM) and 8 functional MRI studies met the inclusion criteria, reporting whole-brain analyses of EOS vs healthy controls. Activation likelihood estimation (ALE) was conducted to identify aberrant anatomical or functional clusters across the included studies. Separate ALE analyses were performed, first for all task-dependent studies (Cognition ALE) and then only for working memory ones (WM ALE). The VBM ALE revealed no significant clusters for gray matter volume reductions in EOS. Significant hypoactivations peaking in the right anterior cingulate cortex (rACC) and the right temporoparietal junction (rTPJ) were detected in the Cognition ALE. In the WM ALE, consistent hypoactivations were found in the left precuneus (lPreC), the right inferior parietal lobule (rIPL) and the rTPJ. These hypoactivated areas show strong associations with language, memory, attention, spatial, and social cognition. The functional co-activated networks of each suprathreshold ALE cluster, identified using the BrainMap database, revealed a core co-activation network with similar topography to the salience network. Our results add support to posterior parietal, ACC and rTPJ dysfunction in EOS, areas implicated in the cognitive impairments characterizing EOS. The salience network lies at the core of these cognitive processes, co-activating with the hypoactivating regions, and thus highlighting the importance of salience dysfunction in EOS.

Self-Awareness of Psychopathology and Brain Volume in Patients With First Episode Psychosis

Memory impairment, excessive rumination, and increased interpersonal sensitivity are major characteristics of high psychosis risk or first episode psychosis (FEP). Herein, we investigated the relationship between brain volume and self-awareness of psychopathology in patients with FEP. All participants (FEP: 34 and HCs: 34) completed clinical assessments and the following self-reported psychopathology evaluations: prospective and retrospective memory questionnaire (PRMQ), ruminative response scale (RRS), and interpersonal sensitivity measure (IPSM). Structural magnetic resonance imaging was then conducted. The PRMQ, RRS, and IPSM scores were significantly higher in the FEP group than in the healthy controls (HCs). The volumes of the amygdala, hippocampus, and superior temporal gyrus (STG) were significantly lower in the FEP group than in the HCs. There was a significant group-dependent moderation effect between self-awareness of psychopathology (PRMQ, RRS, and IPSM scores) and right STG (rSTG) volume. In the FEP group, self-awareness of psychopathology was positively associated with rSTG volume, while in the HCs, this correlation was negative. Our results indicate that self-awareness of psychopathology impacts rSTG volume in the opposite direction between patients with FEP and HCs. In patients with FEP, awareness of impairment may induce increases in rSTG brain volume. However, HCs showed decreased rSTG volume when they were aware of impairment.

Progressive Grey Matter Volume Changes in Patients with Schizophrenia over 6 Weeks of Antipsychotic Treatment and Their Relationship to Clinical Improvement

Cross-sectional and longitudinal studies have identified widespread and progressive grey matter volume (GMV) reductions in schizophrenia, especially in the frontal lobe. In this study, we found a progressive GMV decrease in the rostral medial frontal cortex (rMFC, including the anterior cingulate cortex) in the patient group during a 6-week follow-up of 40 patients with schizophrenia and 31 healthy controls well-matched for age, gender, and education. The higher baseline GMV in the rMFC predicted better improvement in the positive score on the Positive and Negative Syndrome Scale (PANSS), and this might be related to the improved reality-monitoring. Besides, a higher baseline GMV in the posterior rMFC predicted better remission of general symptoms, and a lesser GMV reduction in this region was correlated with better remission of negative symptoms, probably associated with ameliorated self-referential processing and social cognition. Besides, a shorter disease course and higher educational level contributed to better improvement in the general psychopathological PANSS score, and a family history was negatively associated with improvement of the negative and total PANSS scores. These phenomena might be important for understanding the neuropathological mechanisms underlying the symptoms of schizophrenia and for making clinical decisions.

Omega-3 fatty acid supplementation may prevent loss of gray matter thickness in the left parieto-occipital cortex in first episode schizophrenia: A secondary outcome analysis of the OFFER randomized controlled study

The aim of the study was to assess changes in cortical thickness related to the use of n-3 polyunsaturated fatty acids (PUFA) as add-on therapy in patients with first episode schizophrenia. A double-blind randomized controlled study was conducted using a 26-week intervention composed of concentrated fish oil containing 2.2g/d of eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) or placebo (olive oil). Participants underwent MRI scanning twice to assess changes in cortical thickness: at the beginning and at the end of intervention. Data of suitable quality was obtained from 29 participants. The T1-weighted images for each participant were analyzed using FreeSurfer methodology for longitudinal pipeline. Significant differences in cortical thickness loss were observed between the groups in the parieto-occipital regions of Brodmann areas 7 and 19 of the left hemisphere, dysfunctions in which may be involved in schizophrenia symptomatology. The results of the study support the previous observations carried out in older individuals and patients with mild cognitive impairment, indicating that n-3 PUFA may have neuroprotective properties, especially at early stages of neurodegenerative diseases, such as schizophrenia. If replicated, the results of the present study may encourage clinicians to consider n-3 PUFA as a promising addition to antipsychotics for long-term treatment of schizophrenia.

Structural and functional brain abnormalities in schizophrenia: A cross-sectional study at different stages of the disease

Structural and functional deficits associated with schizophrenia are observed prior to the onset of psychosis and differ according to the stage of illness. However, most previous studies concentrated on a limited period during the illness, and it remains uncertain how these abnormalities develop throughout the entire disease course. In the current study, we investigated the gray matter (GM) and regional neural activity alterations in subjects at 4 different stages of schizophrenia. The subjects comprised 53 genetic high risk (HR) individuals, 26 ultra-high risk (UHR) individuals, 58 patients with first-episode schizophrenia (FES), 41 patients with chronic schizophrenia (ChSz) and 39 healthy controls (HC), all of whom underwent structural and resting-state functional MRI scanning. Gray matter volume (GMV), amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) values were compared voxelwise among the five groups using voxel-based morphometry (VBM) and the software REST. Correlations among structural, functional abnormalities and PANSS scores in the FES group were evaluated by partial correlation analysis and multiple stepwise regression. Pronounced GMV decline was observed in the bilateral occipital lobe, left orbital frontal cortex, bilateral superior parietal lobule (SPL), right middle temporal gyrus (MTG), gyrus rectus and medial superior frontal gyrus (SFG) in the FES group and in the bilateral occipital lobe in the HR group. The FES patients also showed increased ALFF in the caudate and decreased ReHo in the bilateral inferior parietal lobule (IPL) and precuneus. The ChSz patients displayed increased ALFF in the right hippocampus. The GMV of the right MTG and SPL and the ReHo of the precuneus were negatively correlated with the general psychopathology scale, while the GMV of the right MTG was negatively correlated with the total score on the Positive and Negative Syndrome Scale (PANSS). The GMV of the right occipital cortex and SPL were associated with the ALFF of the caudate, the GMV of the right SPL was associated with the ReHo of the bilateral IPL and precuneus. GM deficits and regional dysfunction are evident prior to the onset of psychotic symptoms and are more prominent during the onset of illness than during any other phase. The right MTG and SPL, the striatum and the DMN may play important roles in the pathological changes underlying schizophrenia.

Differential Cortical Gray Matter Deficits in Adolescent- and Adult-Onset First-Episode Treatment-Naïve Patients with Schizophrenia

The current study aimed to explore age-variant trait differences of cortical gray matter volume (GMV) in a unique sample of first-episode and treatment-naïve patients with schizophrenia. A total of 158 subjects, including 26 adolescent-onset patients and 49 adult-onset patients as well as 83 age- and gender-matched controls were scanned using a 3T MRI scanner. Voxel-based morphometry (VBM) following Diffeomorphic Anatomical Registration Through Exponentiated Lie algebra (DARTEL) was used to explore group differences between patients and controls in regional GMV. We found that patients with schizophrenia had decreased GMV in the left parietal postcentral region that extended to the left frontal regions, the right middle temporal gyrus, the occipital lobe and the right cerebellum posterior pyramis. Further analysis showed a distinct pattern of gray matter alterations in adolescent-onset patients compared with both healthy controls and adult-onset patients. Relative to healthy controls, adolescent-onset patients showed GMV alterations in the left parietal postcentral gyrus, parahippocampal gyrus and right cerebellum posterior pyramis, while GMV deficits in adult-onset patients were focused on the cingulo-fronto-temporal module and right occipital regions. Our study identified differential cortical gray matter deficits between adolescent- and adulthood-onset patients with schizophrenia, which suggests that the cortical abnormalities in schizophrenia are likely adjusted by the developmental community structure of the human brain.

Incidence of stressful life events and influence of sociodemographic and clinical variables on the onset of first-episode psychosis

This study presents a quantitative analysis of the incidence of stressful life events (SLEs) and the variables gender, age at onset, family history and psychotic symptoms in patients with first-episode psychosis (FEP). A descriptive, cross-sectional methodology was used to interview 68 patients with FEP between 13 and 47 years of age. The Psychiatric Epidemiology Research Interview Life Events Scale collected one-year period prior to onset of FEP - used to analyse the subcategories academic, work, love and marriage, children, residence, legal affairs, finances and social activities-, Positive and Negative Syndrome Scale, and Clinical Global Impression-Schizophrenia scale were used to assess the relevance of certain SLEs during adolescence. Age at onset showed a significant negative correlation with the categories academic and social activities. By contrast, it showed a positive correlation with work and children. A significant relationship was found between paternal family history and social activities and between maternal family history and academic and love and marriage. Finally, an inverse relationship was observed between negative symptoms and the categories children and finance. Depressive symptoms were significantly correlated with the category academic. Our results show the importance of SLEs during adolescence and suggest that there is a clear need to develop preventive actions that promote effective strategies for dealing with the accumulation of psychosocial stress.

Adolescent vs. adult onset of a first episode psychosis: Impact on remission of positive and negative symptoms

OBJECTIVE

Adolescent-onset psychosis has traditionally been characterized as a more severe form of psychosis with a poorer prognosis. However, it is still unclear if patients with an adolescent-onset have worse symptom remission outcomes. Symptom remission is the principal clinical outcome known to predict quality of life and social functioning in the long term. The goal of this study is to clarify the influence of age of onset of psychosis on symptom remission in a sample of first-episode psychosis patients.

METHOD

A total of 246 first-episode psychosis patients were recruited from a specialized early intervention program serving a defined epidemiological catchment area. Age of onset of psychosis (adolescence vs. adulthood) was used as the main predictor, and duration of untreated psychosis (DUP), baseline symptoms, baseline functioning, substance abuse diagnosis, medication adherence and gender were used as covariates in hierarchical regression models predicting the following positive and negative symptom remission outcomes: maximum continuous months in remission and early remission (i.e., occurring in the first three months of follow-up).

RESULTS

After controlling for other variables, onset of psychosis in adulthood and shorter DUP predicted early remission of positive symptoms. This effect was stronger in patients with a diagnosis of a schizophrenia-spectrum disorder. Remission of negative symptoms did not depend on age of onset, and was only predicted by baseline negative symptoms.

CONCLUSION

Patients with onset of psychosis during adulthood are more likely to achieve early positive symptom remission than those with adolescent onset. This effect might be stronger in patients with a diagnosis of a schizophrenia-spectrum disorder.

Progressive brain changes in children and adolescents with early-onset psychosis: A meta-analysis of longitudinal MRI studies

BACKGROUND

Studies on longitudinal brain volume changes in patients with early-onset psychosis (EOP) are particularly valuable for understanding the neurobiological basis of brain abnormalities associated with psychosis. However, findings have not been consistent across studies in this population. We aimed to conduct a meta-analysis on progressive brain volume changes in children and adolescents with EOP.

METHODS

A systematic literature search of magnetic resonance imaging (MRI) studies comparing longitudinal brain volume changes in children and adolescents with EOP and healthy controls was conducted. The annualized rates of relative change in brain volume by region of interest (ROI) were used as raw data for the meta-analysis. The effect of age, sex, duration of illness, and specific diagnosis on volume change was also evaluated.

RESULTS

Five original studies with 156 EOP patients (mean age at baseline MRI in the five studies ranged from 13.3 to 16.6years, 67.31% males) and 163 age- and sex-matched healthy controls, with a mean duration of follow-up of 2.46years (range 2.02-3.40), were included. Frontal gray matter (GM) was the only region in which significant differences in volume change over time were found between patients and controls (Hedges' g -0.435, 95% confidence interval (CI): -0.678 to -0.193, p<0.001). Younger age at baseline MRI was associated with greater loss of temporal GM volume over time in patients as compared with controls (p=0.005). Within patients, a diagnosis of schizophrenia was related to greater occipital GM volume loss over time (p=0.001).

CONCLUSIONS

Compared with healthy individuals, EOP patients show greater progressive frontal GM loss over the first few years after illness onset. Age at baseline MRI and diagnosis of schizophrenia appear to be significant moderators of particular specific brain volume changes.

Age at First Episode Modulates Diagnosis-Related Structural Brain Abnormalities in Psychosis

Brain volume and thickness abnormalities have been reported in first-episode psychosis (FEP). However, it is unclear if and how they are modulated by brain developmental stage (and, therefore, by age at FEP as a proxy). This is a multicenter cross-sectional case-control brain magnetic resonance imaging (MRI) study. Patients with FEP (n = 196), 65.3% males, with a wide age at FEP span (12-35 y), and healthy controls (HC) (n = 157), matched for age, sex, and handedness, were scanned at 6 sites. Gray matter volume and thickness measurements were generated for several brain regions using FreeSurfer software. The nonlinear relationship between age at scan (a proxy for age at FEP in patients) and volume and thickness measurements was explored in patients with schizophrenia spectrum disorders (SSD), affective psychoses (AFP), and HC. Earlier SSD cases (ie, FEP before 15-20 y) showed significant volume and thickness deficits in frontal lobe, volume deficits in temporal lobe, and volume enlargements in ventricular system and basal ganglia. First-episode AFP patients had smaller cingulate cortex volume and thicker temporal cortex only at early age at FEP (before 18-20 y). The AFP group also had age-constant (12-35-y age span) volume enlargements in the frontal and parietal lobe. Our study suggests that age at first episode modulates the structural brain abnormalities found in FEP patients in a nonlinear and diagnosis-dependent manner. Future MRI studies should take these results into account when interpreting samples with different ages at onset and diagnosis.

Early visual processing for low spatial frequency fearful face is correlated with cortical volume in patients with schizophrenia

Patients with schizophrenia present with dysfunction of the magnocellular pathway, which might impair their early visual processing. We explored the relationship between functional abnormality of early visual processing and brain volumetric changes in schizophrenia. Eighteen patients and 16 healthy controls underwent electroencephalographic recordings and high-resolution magnetic resonance imaging. During electroencephalographic recordings, participants passively viewed neutral or fearful faces with broad, high, or low spatial frequency characteristics. Voxel-based morphometry was performed to investigate brain volume correlates of visual processing deficits. Event related potential analysis suggested that patients with schizophrenia had relatively impaired P100 processing of low spatial frequency fearful face stimuli compared with healthy controls; patients' gray-matter volumes in the dorsolateral and medial prefrontal cortices positively correlated with this amplitude. In addition, patients' gray-matter volume in the right cuneus positively correlated with the P100 amplitude in the left hemisphere for the high spatial frequency neutral face condition and that in the left dorsolateral prefrontal cortex negatively correlated with the negative score of the Positive and Negative Syndrome Scale. No significant correlations were observed in healthy controls. This study suggests that the cuneus and prefrontal cortex are significantly involved with the early visual processing of magnocellular input in patients with schizophrenia.

A systematic examination of brain volumetric abnormalities in recent-onset schizophrenia using voxel-based, surface-based and region-of-interest-based morphometric analyses

Background

Brain morphometric abnormalities in schizophrenia have been extensively reported in the literature. Whole-brain volumetric reductions are almost universally reported by most studies irrespective of the characteristics of the samples studied (e.g., chronic/recent-onset; medicated/neuroleptic-naïve etc.). However, the same cannot be said of the reported regional morphometric abnormalities in schizophrenia. While certain regional morphometric abnormalities are more frequently reported than others, there are no such abnormalities that are universally reported across studies. Variability of socio-demographic and clinical characteristics across study samples as well as technical and methodological issues related to acquisition and analyses of brain structural images may contribute to inconsistency of brain morphometric findings in schizophrenia. The objective of the present study therefore was to systematically examine brain morphometry in patients with recent-onset schizophrenia to find out if there are significant whole-brain or regional volumetric differences detectable at the appropriate significance threshold, after attempting to control for various confounding factors that could impact brain volumes.

Methods

Structural magnetic resonance images of 90 subjects (schizophrenia = 45; healthy subjects = 45) were acquired using a 3 Tesla magnet. Morphometric analyses were carried out following standard analyses pipelines of three most commonly used strategies, viz., whole-brain voxel-based morphometry, whole-brain surface-based morphometry, and between-group comparisons of regional volumes generated by automated segmentation and parcellation.

Results

In our sample of patients having recent-onset schizophrenia with limited neuroleptic exposure, there were no significant whole brain or regional brain morphometric abnormalities noted at the appropriate statistical significance thresholds with or without including age, gender and intracranial volume or total brain volume in the statistical analyses.

Conclusions

In the background of the conflicting findings in the literature, our findings indicate that brain morphometric abnormalities may not be directly related to the schizophrenia phenotype. Analysis of the reasons for the inconsistent results across studies as well as consideration of alternate sources of variability of brain morphology in schizophrenia such as epistatic and epigenetic mechanisms could perhaps advance our understanding of structural brain alterations in schizophrenia.

Electronic supplementary material

The online version of this article (doi:10.1186/s12952-015-0030-z) contains supplementary material, which is available to authorized users.

Effect of polymorphisms of three genes mediating monoamine signalling on brain morphometry in schizophrenia and healthy subjects

OBJECTIVE

We examined the effect of risk alleles of polymorphisms of three schizophrenia risk genes that mediate monoamine signalling in the brain on regional brain volumes of schizophrenia and healthy control subjects. The risk alleles and the gene polymorphisms studied were: Val allele of catechol o-methyltransferase (COMT) rs4680 polymorphism; short allele of 5-hydroxy tryptamine transporter linked polymorphic region (5HTTLPR) polymorphism; and T allele of 5-hydroxy tryptamine 2A (5HT2A) rs6314 polymorphism.

METHODS

The study was carried out on patients with recent onset schizophrenia (n=41) recruited from the outpatient department of National Institute of Mental Health and Neurosciences, Bangalore, India and healthy control subjects (n=39), belonging to South Indian Dravidian ethnicity. Individual and additive effects of risk alleles of the above gene polymorphisms on brain morphometry were explored using voxel-based morphometry.

RESULTS

Irrespective of phenotypes, individuals with the risk allele T of the rs6314 polymorphism of 5HT2A gene showed greater (at cluster-extent equivalent to family wise error-correction [FWEc] p<0.05) regional brain volumes in the left inferior temporal and left inferior occipital gyri. Those with the risk alleles of the other two polymorphisms showed a trend (at p<0.001, uncorrected) towards lower regional brain volumes. A trend (at p<0.001, uncorrected) towards additive effects of the above 3 risk alleles (subjects with 2 or 3 risk alleles vs. those with 1 or no risk alleles) on brain morphology was also noted.

CONCLUSIONS

The findings of the present study have implications in understanding the role of individual and additive effects of genetic variants in mediating regional brain morphometry in health and disease.

Age or age at onset? Which of them really matters for neuro and social cognition in schizophrenia?

In schizophrenia patients, both an older age and earlier age at onset of the disease are related to worse cognitive functioning. As patients with later schizophrenia onset are also older, analysing the two effects separately can be misleading, as they can either be spurious or cancel one another out. The purpose of the present study was to elucidate the effects of age and onset-age on cognition in schizophrenia patients. Individuals with schizophrenia (N=151), aged 18-59 years, were examined with a MATRICS Consensus Cognitive Battery (MCCB) to get a full picture of their cognitive performance. Results showed age and age at onset indeed interrelated. Regression analyses revealed later onset of schizophrenia related to better social cognition. Patients׳ older age was related to a slower performance in symbol coding task, less effective executive functions, worse visual learning, lower attention, and lower total score in the MCCB. In the above regression analyses we controlled doses of antipsychotic medications. The results suggest that a previously found relationship between older age and social cognition might be spurious, and strengthen observations that it is specifically later onset-age which fosters better social cognition in schizophrenia patients.

Extensive brain structural network abnormality in first-episode treatment-naive patients with schizophrenia: morphometrical and covariation study

BACKGROUND

Alterations in gray matter (GM) are commonly observed in schizophrenia. Accumulating studies suggest that the brain changes associated with schizophrenia are distributed rather than focal, involving interconnected networks of areas as opposed to single regions. In the current study we aimed to explore GM volume (GMV) changes in a relatively large sample of treatment-naive first-episode schizophrenia (FES) patients using optimized voxel-based morphometry (VBM) and covariation analysis.

METHOD

High-resolution T1-weighted images were obtained using 3.0-T magnetic resonance imaging (MRI) from 86 first-episode drug-naive patients with schizophrenia and 86 age- and gender-matched healthy volunteers. Symptom severity was evaluated using the Positive and Negative Syndrome Scale (PANSS). GMV was assessed using optimized VBM and in 16 regions of interest (ROIs), selected on the basis of a previous meta-analysis. The relationships between GMVs in the ROIs were examined using an analysis of covariance (ANCOVA).

RESULTS

The VBM analysis revealed that first-episode patients showed reduced GMV in the hippocampus bilaterally. The ROI analysis identified reductions in GMV in the left inferior frontal gyrus, bilateral hippocampus and right thalamus. The ANCOVA revealed different patterns of regional GMV correlations in patients and controls, including of inter- and intra-insula, inter-amygdala and insula-postcentral gyrus connections.

CONCLUSIONS

Schizophrenia involves regional reductions in GMV and changes in GMV covariance in the insula, amygdala and postcentral gyrus. These findings were evident at the onset of the disorder, before treatment, and therefore cannot be attributable to the effects of chronic illness progression or medication.

Dissociable morphometric differences of the inferior parietal lobule in schizophrenia

Inferior parietal lobule (IPL) forms an integral part of a critical frontoparietal network, which has been implicated in various clinical symptoms and cognitive deficits seen in schizophrenia. Despite its functional relevance, the relatively few studies that have investigated the structural changes in the IPL report inconsistent findings concerning the nature and localization of these changes. We employed a blinded, automated labelling procedure to measure cortical thickness, surface area and the degree of cortical folding of the two distinct subregions of the IPL (Angular Gyrus and Supramarginal Gyrus) in 57 patients with schizophrenia and 41 controls using high-resolution magnetic resonance imaging. Within the IPL, we observed more pronounced morphological changes in supramarginal gyrus compared to angular gyrus in schizophrenia. While supramarginal gyrus in patients showed reduced gyrification, contracted surface area and thinning, the morphometric changes in angular gyrus were largely confined to a reduction in surface area. Significant hemispheric asymmetry was observed in the gyrification of the supramarginal gyrus. Our findings suggest that in addition to abnormalities in the neurodevelopmental processes that contribute to regional surface area and cortical thickness, a specific defect in cortical folding, especially affecting the left hemisphere, is likely to occur in schizophrenia.

Environmental risk factors and their impact on the age of onset of schizophrenia: Comparing familial to non-familial schizophrenia

BACKGROUND AND AIMS

Several risk factors for schizophrenia have yet been identified. The aim of our study was to investigate how certain childhood and adolescent risk factors predict the age of onset of psychosis in patients with and without a familial component (i.e. a relative with schizophrenia or schizoaffective disorder).

METHODS

Aside from the age of onset of psychosis, we examined the risk factors for schizophrenia including obstetric complications, birth during winter or spring, behavioral deviances or delayed motor and speech development, exposure to adverse life events and exposure to substance use within a group of 100 patients (45 female, 55 male) with a mean age (± standard deviation) of 35.15 ± 13.21.

RESULTS

Birth complications and cannabis abuse are predictors for an earlier onset of schizophrenia in patients with non-familial schizophrenia. No environmental risk factors for an earlier age of onset in familial schizophrenia have been identified.

CONCLUSIONS

Certain environmental risk factors for schizophrenia seem to have an impact on the age of onset of psychosis in non-familial schizophrenia, they do not seem to have an impact on familial schizophrenia.

Parietal lobe volume deficits in adolescents with schizophrenia and adolescents with cannabis use disorders

OBJECTIVE

In early-onset schizophrenia (EOS), the earliest structural brain volumetric abnormalities appear in the parietal cortices. Early exposure to cannabis may represent an environmental risk factor for developing schizophrenia. This study characterized cerebral cortical gray matter structure in adolescents in regions of interest (ROIs) that have been implicated in EOS and cannabis use disorders (CUD).

METHOD

T1-weighted magnetic resonance images were acquired from adolescents with EOS (n = 35), CUD (n = 16), EOS + CUD (n = 13), and healthy controls (HC) (n = 51). Using FreeSurfer, brain volume was examined within frontal, temporal, parietal and subcortical ROIs by a 2 (EOS versus no EOS) × 2 (CUD versus no CUD) design using multivariate analysis of covariance. In ROIs in which volumetric differences were identified, additional analyses of cortical thickness and surface area were conducted.

RESULTS

A significant EOS-by-CUD interaction was observed. In the left superior parietal region, both "pure" EOS and "pure" CUD had smaller gray matter volumes that were associated with lower surface area compared with HC. A similar alteration was observed in the comorbid group compared with HC, but there was no additive volumetric deficit found in the comorbid group compared with the separate groups. In the left thalamus, the comorbid group had smaller gray matter volumes compared with the CUD and HC groups.

CONCLUSIONS

These preliminary data indicate that the presence of a CUD may moderate the relationship between EOS and cerebral cortical gray matter structure in the left superior parietal lobe. Future research will follow this cohort over adolescence to further examine the impact of cannabis use on neurodevelopment.

Schizophrenia as segmental progeria

Schizophrenia is associated with a variety of physical manifestations (i.e. metabolic, neurological) and despite psychotropic medication being blamed for some of these (in particular obesity and diabetes), there is evidence that schizophrenia itself confers an increased risk of physical disease and early death. The observation that schizophrenia and progeroid syndromes share common clinical features and molecular profiles gives rise to the hypothesis that schizophrenia could be conceptualized as a whole body disorder, namely a segmental progeria. Mammalian cells employ the mechanisms of cellular senescence and apoptosis (programmed cell death) as a means to control inevitable DNA damage and cancer. Exacerbation of those processes is associated with accelerated ageing and schizophrenia and this warrants further investigation into possible underlying biological mechanisms, such as epigenetic control of the genome.

White matter abnormalities in adolescent-onset and adult-onset schizophrenia: new directions in research

Evaluation of: Kyriakopoulos M, Perez-Iglesias R, Woolley JB et al.: Effect of age at onset of schizophrenia on white matter abnormalities. Br. J. Psychiatry 195(4), 346–353 (2009). This study demonstrated that brain white matter abnormalities in schizophrenia may depend on developmental stage at the time of the illness. The authors reported different patterns of fractional anisotropy reductions in adolescent-onset compared with adult-onset schizophrenia. In addition, the effect of schizophrenia on fractional anisotropy is modulated by age-at-onset in bilateral prefrontal white matter. These white matter abnormalities appear to mirror the progression of gray matter volume deficits described in previous research. This study raises important questions regarding the progression of such abnormalities and highlights the need for longitudinal studies to investigate the staging of the appearance of structural and connectivity brain abnormalities in schizophrenia.

Cognitive function in early onset schizophrenia: a selective review

Schizophrenia is widely regarded as the clinical outcome of aberrant neurodevelopment caused by a combination of genetic and non-genetic factors. Early Onset Schizophrenia (EOS) manifests in childhood or adolescence and represents a more severe variant of the Adult Onset form of the disorder (AOS). EOS offers a unique opportunity of exploring the impact of disease related mechanisms on the developmental trajectory of cognitive function. The present review focused on the domains of general intellectual ability (IQ), attention, executive function and memory. Significant methodological variability was noted across the different studies that examined these aspects of cognition in EOS patients. Despite this, a consistent pattern emergent from the data suggesting that (a) EOS patients compared to healthy children and adolescents show impairments of medium to large effect size in IQ, attention, memory and executive function (b) despite increased clinical severity, the cognitive profile of EOS patients is comparable to that of AOS patients (c) healthy adolescents show age-related improvement in their ability to perform tests of attention, memory and executive function; this is not present in EOS patients thus resulting in increased age-related deviance in patients’ performance. This apparent decline is mostly attributable to patients’ failure to acquire new information and to use more sophisticated cognitive strategies.

Gyral and sulcal cortical thinning in adolescents with first episode early-onset psychosis

BACKGROUND

Psychosis is associated with volumetric decreases of cortical structures. Whether these volumetric decreases imply abnormalities in cortical thickness, surface, or cortical folding is not clear. Due to differences in cytoarchitecture, cortical gyri and sulci might be differentially affected by psychosis. Therefore, we examined differences in gyral and sulcal cortical thickness, surface, folding, and volume between a minimally treated male adolescent population with early-onset first-episode psychosis (EOP) and a healthy control group, with surface-based morphometry.

METHODS

Magnetic resonance imaging brain scans were obtained from 49 adolescent EOP patients and 34 healthy control subjects. Subjects were younger than 18 years (age range 12 years-18 years), and EOP patients had a duration of positive symptoms of <6 months.

RESULTS

Early-onset first-episode psychosis was associated with local bilateral cortical thinning and volume deficits in both the gyri and sulci of the superior temporal cortex and the inferior, middle, medial, and superior prefrontal cortex. In the pars triangularis and opercularis cortex of patients, gyral cortical thickness was thinner, whereas sulcal thickness was not. Patients exhibited cortical thinning together with a decreased degree of cortical folding in the right superior frontal cortex.

CONCLUSIONS

Cortical thinning of both gyri and sulci seem to underlie most cortical volume deficits in adolescent patients with EOP. Except for the right superior frontal region, the degree of cortical folding was normal in regions showing decreased cortical thickness, suggesting that the process of cortical thinning in adolescent patients with EOP primarily takes place after the formation of cortical folds.

Effect of age at onset of schizophrenia on white matter abnormalities

BACKGROUND

The pattern of brain morphological changes at the early stages of schizophrenia may depend on the age at onset of illness; in children and adolescents with schizophrenia, grey matter deficits are seen in the parietal lobe whereas in individuals with adult onset these are more widespread.

AIMS

To examine whether white matter is similarly affected.

METHOD

Diffusion tensor imaging was used to compare fractional anisotropy measures in individuals with adolescent-onset (n = 17) and adult-onset schizophrenia (n = 17) with those in age- and gender-matched controls.

RESULTS

Compared with their respective controls, individuals with adolescent-onset schizophrenia showed fractional anisotropy decrease in parietal regions; individuals with adult onset showed additional fractional anisotropy reductions in frontal, temporal and cerebellar regions. A differential effect of age at onset (adolescent v. adult) was noted bilaterally in medial prefrontal white matter.

CONCLUSIONS

White matter abnormalities in frontal regions in schizophrenia may depend on developmental stage at the time of illness onset.

[Not Available]

Previous studies have reported continued focal gray matter loss after the clinical onset of schizophrenia. Longitudinal assessments in chronic illness, of white matter in particular, have been less conclusive.

We used diffusion-tensor and structural magnetic resonance imaging in 16 healthy subjects and 49 chronic schizophrenia patients, subdivided into good-outcome (n=23) and poor-outcome (n=26) groups, scanned twice 4 years apart. Fractional anisotropy, gray matter and white matter volumes were parcellated into the Brodmann’s areas and entered into multiway ANCOVAs.

At baseline, schizophrenia patients had 1) lower anisotropy in frontoparietal white matter, 2) larger posterior frontal white matter volumes, and 3) smaller frontal, temporal, and parietal gray matter volumes. On follow-up, healthy subjects showed a more pronounced 1) decline in anisotropy, 2) expansion of regional white matter volumes, and 3) reduction in regional gray matter volumes than schizophrenia patients. Good-outcome patients showed a more pronounced decline in white matter anisotropy and a less pronounced increase in white matter volumes than poor-outcome patients. Poor-outcome patients displayed a greater gray matter loss throughout the brain than good-outcome patients.

In the chronic phase of the illness, longitudinal changes in both gray and white matter are in the direction of an effacement of between-group differences among schizophrenia patients and healthy subjects. Similarly, preexisting white matter differences between good-outcome and poor-outcome patients diminish over time. In contrast, gray matter volumes in poor-outcome patients continue to decline more rapidly than in patients with good outcome. These patterns are consistent with earlier onset of aging-associated changes in schizophrenia.

Duration of Illness, Regional Brain Morphology and Neurocognitive Correlates in Schizophrenia

Introduction: Previous studies examining brain effects of duration of illness in schizophrenia have focused on either cortical or subcortical structures. Hence this study sought to elucidate the regional grey matter changes (both cortical and subcortical) and neurocognitive correlates with increased duration of illness in a large sample of patients with schizophrenia using voxel-based morphometry. Materials and Methods: Ninety patients (72 males and 18 females) with DSM-IV diagnosis of schizophrenia were recruited and assessed using magnetic resonance imaging and a battery of neuropsychological tests. Results: A longer duration of illness was associated with smaller grey matter volumes in the left superior frontal gyrus, bilateral putamen, right superior temporal gyrus, right superior occipital gyrus as well as the right thalamus. No region showed increased grey matter volume above threshold with longer duration of illness. Longer duration of illness was correlated with poorer attention. Conclusions: The grey matter reductions in different brain regions highlighted that a distributed network of cortical and subcortical regions was associated with duration of illness. This is consistent with neural models that implicate involvement of thalamo-cortical circuitry as the disruption in these neural pathways can result in specific deficits such as poorer attention. The results have implications for the understanding of brain changes in schizophrenia, and with further studies, may guide better tailored and targeted clinical management in terms of reducing the impact of duration of illness on neural substrates in schizophrenia in the future. Key words: Duration of Illness, Grey Matter, Magnetic resonance imaging, Voxel-based Morphometry