1
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Hamilton HK, Mathalon DH, Ford JM. P300 in schizophrenia: Then and now. Biol Psychol 2024; 187:108757. [PMID: 38316196 DOI: 10.1016/j.biopsycho.2024.108757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
The 1965 discovery of the P300 component of the electroencephalography (EEG)-based event-related potential (ERP), along with the subsequent identification of its alteration in people with schizophrenia, initiated over 50 years of P300 research in schizophrenia. Here, we review what we now know about P300 in schizophrenia after nearly six decades of research. We describe recent efforts to expand our understanding of P300 beyond its sensitivity to schizophrenia itself to its potential role as a biomarker of risk for psychosis or a heritable endophenotype that bridges genetic risk and psychosis phenomenology. We also highlight efforts to move beyond a syndrome-based approach to understand P300 within the context of the clinical, cognitive, and presumed pathophysiological heterogeneity among people diagnosed with schizophrenia. Finally, we describe several recent approaches that extend beyond measuring the traditional P300 ERP component in people with schizophrenia, including time-frequency analyses and pharmacological challenge studies, that may help to clarify specific cognitive mechanisms that are disrupted in schizophrenia. Moreover, we discuss several promising areas for future research, including studies of animal models that can be used for treatment development.
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Affiliation(s)
- Holly K Hamilton
- University of Minnesota, Department of Psychiatry & Behavioral Sciences, Minneapolis, MN, USA; Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; University of California, San Francisco, Department of Psychiatry & Behavioral Sciences, San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
| | - Daniel H Mathalon
- University of California, San Francisco, Department of Psychiatry & Behavioral Sciences, San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Judith M Ford
- University of California, San Francisco, Department of Psychiatry & Behavioral Sciences, San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
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2
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Zhang Y, Yang T, He Y, Meng F, Zhang K, Jin X, Cui X, Luo X. Value of P300 amplitude in the diagnosis of untreated first-episode schizophrenia and psychosis risk syndrome in children and adolescents. BMC Psychiatry 2023; 23:743. [PMID: 37828471 PMCID: PMC10571359 DOI: 10.1186/s12888-023-05218-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/23/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Identifying the characteristic neurobiological changes of early psychosis is helpful for early clinical diagnosis. However, previous studies on the brain electrophysiology of children and adolescents with psychosis are rare. METHODS This study compared P300 amplitude at multiple electrodes between children and adolescents with first-episode schizophrenia (FES, n = 48), children and adolescents with psychosis risk syndrome (PRS, n = 24), and healthy controls (HC, n = 30). Receiver operating characteristic (ROC) analysis was used to test the ability of P300 amplitude to distinguish FES, PRS and HC individuals. RESULTS The P300 amplitude in the FES group were significantly lower than those in the HC at the Cz, Pz, and Oz electrodes. The P300 amplitude was also significantly lower in the prodromal group than in the HC at the Pz and Oz electrodes. ROC curve analysis showed that at the Pz electrode, the P300 amplitude evoked by the target and standard stimulus showed high sensitivity, specificity, accuracy, and area under the curve value for distinguishing FES from HC individuals. CONCLUSIONS This study found early visual P300 deficits in children and adolescents with FES and PRS, with the exclusion of possible influence of medication and chronic medical conditions, suggesting the value of P300 amplitude for the identification of early psychosis.
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Affiliation(s)
- Yaru Zhang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Tingyu Yang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Yuqiong He
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Fanchao Meng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Kun Zhang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Xingyue Jin
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Xilong Cui
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
| | - Xuerong Luo
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
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3
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Nardone R, Sebastianelli L, Versace V, Ferrazzoli D, Brigo F, Schwenker K, Saltuari L, Trinka E. TMS for the functional evaluation of cannabis effects and for treatment of cannabis addiction: A review. Psychiatry Res 2022; 310:114431. [PMID: 35219263 DOI: 10.1016/j.psychres.2022.114431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/15/2022]
Abstract
The knowledge about the effects of cannabis on human cortical brain processes is increasing. In this regard, transcranial magnetic stimulation (TMS) enables the evaluation of central nervous system function, including drug effects. Moreover, repetitive TMS (rTMS) has been used therapeutically in several substance use disorders. In this scoping review, we summarize and discuss studies that have employed TMS and rTMS techniques in users of cannabis for recreational purposes. In subjects with a history of persistent cannabis use, TMS studies showed reduced short-interval cortical inhibition (SICI). This observation points more at neurobiological changes of chronic cannabis use than to a direct effect of cannabis on gamma-aminobutyric acid (GABA) A receptors. Moreover, individuals vulnerable to becoming long-term users of cannabis may also have underlying pre-existing abnormalities in SICI. Of note, the use of cannabis is associated with an increased risk of schizophrenia, and the down-regulation of GABAergic function may play a role. Less frequent cannabis use and spontaneous craving were observed following rTMS applied to the dorsolateral prefrontal cortex (DLPFC). There is emerging evidence that the posterior cingulate cortex and the precuneus are potential targets for rTMS intervention in cannabis use disorder. However, larger and randomized trials should corroborate these encouraging findings.
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Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Italy
| | - Kerstin Schwenker
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria; Centre for Cognitive Neurosciences Salzburg, Salzburg, Austria; UMIT, University for Medical Informatics and Health Technology, Hall in Tirol, Austria
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4
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Perrottelli A, Giordano GM, Brando F, Giuliani L, Mucci A. EEG-Based Measures in At-Risk Mental State and Early Stages of Schizophrenia: A Systematic Review. Front Psychiatry 2021; 12:653642. [PMID: 34017273 PMCID: PMC8129021 DOI: 10.3389/fpsyt.2021.653642] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/06/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction: Electrophysiological (EEG) abnormalities in subjects with schizophrenia have been largely reported. In the last decades, research has shifted to the identification of electrophysiological alterations in the prodromal and early phases of the disorder, focusing on the prediction of clinical and functional outcome. The identification of neuronal aberrations in subjects with a first episode of psychosis (FEP) and in those at ultra high-risk (UHR) or clinical high-risk (CHR) to develop a psychosis is crucial to implement adequate interventions, reduce the rate of transition to psychosis, as well as the risk of irreversible functioning impairment. The aim of the review is to provide an up-to-date synthesis of the electrophysiological findings in the at-risk mental state and early stages of schizophrenia. Methods: A systematic review of English articles using Pubmed, Scopus, and PsychINFO was undertaken in July 2020. Additional studies were identified by hand-search. Electrophysiological studies that included at least one group of FEP or subjects at risk to develop psychosis, compared to healthy controls (HCs), were considered. The heterogeneity of the studies prevented a quantitative synthesis. Results: Out of 319 records screened, 133 studies were included in a final qualitative synthesis. Included studies were mainly carried out using frequency analysis, microstates and event-related potentials. The most common findings included an increase in delta and gamma power, an impairment in sensory gating assessed through P50 and N100 and a reduction of Mismatch Negativity and P300 amplitude in at-risk mental state and early stages of schizophrenia. Progressive changes in some of these electrophysiological measures were associated with transition to psychosis and disease course. Heterogeneous data have been reported for indices evaluating synchrony, connectivity, and evoked-responses in different frequency bands. Conclusions: Multiple EEG-indices were altered during at-risk mental state and early stages of schizophrenia, supporting the hypothesis that cerebral network dysfunctions appear already before the onset of the disorder. Some of these alterations demonstrated association with transition to psychosis or poor functional outcome. However, heterogeneity in subjects' inclusion criteria, clinical measures and electrophysiological methods prevents drawing solid conclusions. Large prospective studies are needed to consolidate findings concerning electrophysiological markers of clinical and functional outcome.
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Affiliation(s)
- Andrea Perrottelli
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Francesco Brando
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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5
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Foss-Feig JH, Guillory SB, Roach BJ, Velthorst E, Hamilton H, Bachman P, Belger A, Carrion R, Duncan E, Johannesen J, Light GA, Niznikiewicz M, Addington JM, Cadenhead KS, Cannon TD, Cornblatt B, McGlashan T, Perkins D, Seidman LJ, Stone WS, Tsuang M, Walker EF, Woods S, Bearden CE, Mathalon DH. Abnormally Large Baseline P300 Amplitude Is Associated With Conversion to Psychosis in Clinical High Risk Individuals With a History of Autism: A Pilot Study. Front Psychiatry 2021; 12:591127. [PMID: 33633603 PMCID: PMC7901571 DOI: 10.3389/fpsyt.2021.591127] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/05/2021] [Indexed: 11/13/2022] Open
Abstract
Psychosis rates in autism spectrum disorder (ASD) are 5-35% higher than in the general population. The overlap in sensory and attentional processing abnormalities highlights the possibility of related neurobiological substrates. Previous research has shown that several electroencephalography (EEG)-derived event-related potential (ERP) components that are abnormal in schizophrenia, including P300, are also abnormal in individuals at Clinical High Risk (CHR) for psychosis and predict conversion to psychosis. Yet, it is unclear whether P300 is similarly sensitive to psychosis risk in help-seeking CHR individuals with ASD history. In this exploratory study, we leveraged data from the North American Prodrome Longitudinal Study (NAPLS2) to probe for the first time EEG markers of longitudinal psychosis profiles in ASD. Specifically, we investigated the P300 ERP component and its sensitivity to psychosis conversion across CHR groups with (ASD+) and without (ASD-) comorbid ASD. Baseline EEG data were analyzed from 304 CHR patients (14 ASD+; 290 ASD-) from the NAPLS2 cohort who were followed longitudinally over two years. We examined P300 amplitude to infrequent Target (10%; P3b) and Novel distractor (10%; P3a) stimuli from visual and auditory oddball tasks. Whereas P300 amplitude attenuation is typically characteristic of CHR and predictive of conversion to psychosis in non-ASD sample, in our sample, history of ASD moderated this relationship such that, in CHR/ASD+ individuals, enhanced - rather than attenuated - visual P300 (regardless of stimulus type) was associated with psychosis conversion. This pattern was also seen for auditory P3b amplitude to Target stimuli. Though drawn from a small sample of CHR individuals with ASD, these preliminary results point to a paradoxical effect, wherein those with both CHR and ASD history who go on to develop psychosis have a unique pattern of enhanced neural response during attention orienting to both visual and target stimuli. Such a pattern stands out from the usual finding of P300 amplitude reductions predicting psychosis in non-ASD CHR populations and warrants follow up in larger scale, targeted, longitudinal studies of those with ASD at clinical high risk for psychosis.
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Affiliation(s)
- Jennifer H Foss-Feig
- Department of Psychiatry and Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sylvia B Guillory
- Department of Psychiatry and Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Brian J Roach
- San Francisco VA Health Care System, San Francisco, CA, United States
| | - Eva Velthorst
- Department of Psychiatry and Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Holly Hamilton
- San Francisco VA Health Care System, San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Peter Bachman
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Aysenil Belger
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - Ricardo Carrion
- Department of Psychiatry, Zucker Hillside Hospital, New York, NY, United States
| | - Erica Duncan
- Departments of Psychology and Psychiatry, Atlanta VA Health Care System and Emory University, Decatur, GA, United States
| | - Jason Johannesen
- Departments of Psychology and Psychiatry, Yale University, New Haven, CT, United States
| | - Gregory A Light
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | | | - Jean M Addington
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Tyrone D Cannon
- Departments of Psychology and Psychiatry, Yale University, New Haven, CT, United States
| | - Barbara Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, New York, NY, United States
| | - Thomas McGlashan
- Departments of Psychology and Psychiatry, Yale University, New Haven, CT, United States
| | - Diana Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - Larry J Seidman
- Department of Psychiatry, Harvard University, Cambridge, MA, United States
| | - William S Stone
- Department of Psychiatry, Harvard University, Cambridge, MA, United States
| | - Ming Tsuang
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Elaine F Walker
- Departments of Psychology and Psychiatry, Atlanta VA Health Care System and Emory University, Decatur, GA, United States
| | - Scott Woods
- Departments of Psychology and Psychiatry, Yale University, New Haven, CT, United States
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Daniel H Mathalon
- San Francisco VA Health Care System, San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
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6
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Oribe N, Hirano Y, Del Re E, Mesholam-Gately RI, Woodberry KA, Ueno T, Kanba S, Onitsuka T, Shenton ME, Spencer KM, Niznikiewicz MA. Longitudinal evaluation of visual P300 amplitude in clinical high-risk subjects: An event-related potential study. Psychiatry Clin Neurosci 2020; 74:527-534. [PMID: 32519778 DOI: 10.1111/pcn.13083] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/28/2020] [Accepted: 05/31/2020] [Indexed: 12/11/2022]
Abstract
AIM We previously reported abnormal P300 and N200 in a visual oddball task, and progressive P300 amplitude reduction at 1-year follow-up in patients with first-episode schizophrenia. P300 reduction as well as intact P1/N1 were also observed in clinical high-risk subjects (CHR), but whether or not these components change over time is unknown. This study evaluates, longitudinally, the visual P300, as well as P1, N1, and N200, in CHR. METHODS Visual event-related potentials (ERP) were recorded twice, once at baseline and once at 1-year follow-up in CHR (n = 19) and healthy comparison subjects (HC; n = 28). Participants silently counted infrequent target stimuli ('x') among standard stimuli ('y') presented on the screen while the 64-channel electroencephalogram was recorded. RESULTS No CHR converted to psychosis from baseline to 1-year follow-up in this study. Visual P300 amplitude was reduced and the latency was delayed significantly in CHR at both time points compared with HC. Furthermore, CHR subjects who had more positive symptoms showed more amplitude reduction at both time points. P1, N1, and N200 did not differ between groups. CONCLUSION Visual P300 amplitude was found to be reduced in CHR individuals compared with HC. We note that this finding is in subjects who did not convert to psychosis at 1-year follow-up. The association between visual P300 amplitude and symptoms suggests that for CHR who often experience clinical symptoms and seek medical care, visual P300 may be an important index that reflects the pathophysiological impairment underlying such clinical states.
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Affiliation(s)
- Naoya Oribe
- Neural Dynamics Laboratory, Research Service, VA Boston Healthcare System, and Department of Psychiatry, Harvard Medical School, Boston, USA
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Kyushu, Japan
- Department of Clinical Research, National Hospital Organization, Hizen Psychiatric Medical Center, Yoshinogari, Japan
| | - Yoji Hirano
- Neural Dynamics Laboratory, Research Service, VA Boston Healthcare System, and Department of Psychiatry, Harvard Medical School, Boston, USA
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Kyushu, Japan
| | - Elisabetta Del Re
- Departments of Psychiatry and Radiology, Veterans Affairs Boston Healthcare System, and Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
- Cognitive Neuroscience Laboratory, VA Boston Healthcare System, Department of Psychiatry, Harvard Medical School, Brockton, USA
| | - Raquelle I Mesholam-Gately
- Massachusetts Mental Health Center, Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, USA
| | - Kristen A Woodberry
- Massachusetts Mental Health Center, Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, USA
- Center for Psychiatric Research, Maine Medical Center Research Institute, Portland, USA
| | - Takefumi Ueno
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Kyushu, Japan
- Department of Clinical Research, National Hospital Organization, Hizen Psychiatric Medical Center, Yoshinogari, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Kyushu, Japan
- Japan Depression Center, Tokyo, Japan
| | - Toshiaki Onitsuka
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Kyushu, Japan
| | - Martha E Shenton
- Departments of Psychiatry and Radiology, Veterans Affairs Boston Healthcare System, and Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Kevin M Spencer
- Neural Dynamics Laboratory, Research Service, VA Boston Healthcare System, and Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Margaret A Niznikiewicz
- Cognitive Neuroscience Laboratory, VA Boston Healthcare System, Department of Psychiatry, Harvard Medical School, Brockton, USA
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7
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Hamilton HK, Boos AK, Mathalon DH. Electroencephalography and Event-Related Potential Biomarkers in Individuals at Clinical High Risk for Psychosis. Biol Psychiatry 2020; 88:294-303. [PMID: 32507388 PMCID: PMC8300573 DOI: 10.1016/j.biopsych.2020.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 01/17/2023]
Abstract
Clinical outcomes vary among youths at clinical high risk for psychosis (CHR-P), with approximately 20% progressing to full-blown psychosis over 2 to 3 years and 30% achieving remission. Recent research efforts have focused on identifying biomarkers that precede psychosis onset and enhance the accuracy of clinical outcome prediction in CHR-P individuals, with the ultimate goal of developing staged treatment approaches based on the individual's level of risk. Identifying such biomarkers may also facilitate progress toward understanding pathogenic mechanisms underlying psychosis onset, which may support the development of mechanistically informed early interventions for psychosis. In recent years, electroencephalography-based event-related potential measures with established sensitivity to schizophrenia have gained traction in the study of CHR-P and its clinical outcomes. In this review, we describe the evidence for event-related potential abnormalities in CHR-P and discuss how they inform our understanding of information processing deficits as vulnerability markers for emerging psychosis and as indicators of future outcomes. Among the measures studied, P300 and mismatch negativity are notable because deficits predict conversion to psychosis and/or CHR-P remission. However, the accuracy with which these and other measures predict outcomes in CHR-P has been obscured in the prior literature by the tendency to only report group-level differences, underscoring the need for inclusion of individual predictive accuracy metrics in future studies. Nevertheless, both P300 and mismatch negativity show promise as electrophysiological markers of risk for psychosis, as target engagement measures for clinical trials, and as potential translational bridges between human studies and animal models focused on novel drug development for early psychosis.
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Affiliation(s)
- Holly K Hamilton
- San Francisco Veterans Affairs Health Care System, San Francisco, California; Department of Psychiatry, University of California, San Francisco, California
| | - Alison K Boos
- San Francisco Veterans Affairs Health Care System, San Francisco, California; Northern California Institute for Research and Education, San Francisco, California
| | - Daniel H Mathalon
- San Francisco Veterans Affairs Health Care System, San Francisco, California; Department of Psychiatry, University of California, San Francisco, California.
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8
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Kleineidam L, Frommann I, Ruhrmann S, Klosterkötter J, Brockhaus-Dumke A, Wölwer W, Gaebel W, Maier W, Wagner M, Ettinger U. Antisaccade and prosaccade eye movements in individuals clinically at risk for psychosis: comparison with first-episode schizophrenia and prediction of conversion. Eur Arch Psychiatry Clin Neurosci 2019; 269:921-930. [PMID: 30635714 DOI: 10.1007/s00406-018-0973-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 12/19/2018] [Indexed: 02/03/2023]
Abstract
Saccadic eye movements are well-described markers of cerebral function and have been widely studied in schizophrenia spectrum populations. However, less is known about saccades in individuals clinically at risk for schizophrenia. Therefore, we studied individuals in an at-risk mental state (ARMS) (N = 160), patients in their first episode of schizophrenia (N = 32) and healthy controls (N = 75). N = 88 ARMS participants showed an early at-risk mental state (E-ARMS), defined by cognitive-perceptive basic symptoms (COPER) or a combination of risk and loss of function, whereas N = 72 were in a late at-risk mental state (L-ARMS), defined by attenuated psychotic symptoms or brief limited intermittent psychotic symptoms. We examined prosaccades, reflecting overt attentional shifts, and antisaccades, measuring inhibitory control, as well as their relationship as an indicator of the interplay of bottom-up and top-down influences. L-ARMS but not E-ARMS participants had increased antisaccade latencies compared to controls. First-episode patients had higher antisaccade error rates compared to E-ARMS participants and controls, and increased latencies compared to all other groups. Prosaccade latencies did not differ between groups. We observed the expected negative correlation between prosaccade latency and antisaccade error rate, indicating that individuals with shorter prosaccade latencies made more antisaccade errors. The magnitude of the association did not differ between groups. No saccadic measure predicted conversion to psychosis within 2 years. These findings confirm the existence of antisaccade impairments in patients with schizophrenia and provide evidence that volitional response generation in the antisaccade task may be affected even before onset of clinically overt psychosis.
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Affiliation(s)
- Luca Kleineidam
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Ingo Frommann
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Joachim Klosterkötter
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Anke Brockhaus-Dumke
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Rheinhessen-Fachklinik Alzey, Dautenheimer Landstraße 66, 55232, Alzey, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. .,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Ulrich Ettinger
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, 53111, Bonn, Germany
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9
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Lavoie S, Polari AR, Goldstone S, Nelson B, McGorry PD. Staging model in psychiatry: Review of the evolution of electroencephalography abnormalities in major psychiatric disorders. Early Interv Psychiatry 2019; 13:1319-1328. [PMID: 30688016 DOI: 10.1111/eip.12792] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/03/2018] [Accepted: 12/29/2018] [Indexed: 12/29/2022]
Abstract
AIM Clinical staging in psychiatry aims to classify patients according to the severity of their symptoms, from stage 0 (increased risk, asymptomatic) to stage 4 (severe illness), enabling adapted treatment at each stage of the illness. The staging model would gain specificity if one or more quantifiable biological markers could be identified. Several biomarkers reflecting possible causal mechanisms and/or consequences of the pathophysiology are candidates for integration into the clinical staging model of psychiatric illnesses. METHODS This review covers the evolution (from stage 0 to stage 4) of the most important brain functioning impairments as measured with electroencephalography (EEG), in psychosis spectrum and in severe mood disorders. RESULTS The present review of the literature demonstrates that it is currently not possible to draw any conclusion with regard to the state or trait character of any of the EEG impairments in both major depressive disorder and bipolar disorder. As for schizophrenia, the most promising markers of the stage of the illness are the pitch mismatch negativity as well as the p300 event-related potentials, as these components seem to deteriorate with increasing severity of the illness. CONCLUSIONS Given the complexity of major psychiatric disorders, and that not a single impairment can be observed in all patients, future research should most likely consider combinations of markers in the quest for a better identification of the stages of the psychiatric illnesses.
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Affiliation(s)
- Suzie Lavoie
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea R Polari
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne Health, Melbourne, Victoria, Australia
| | - Sherilyn Goldstone
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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10
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Riel H, Lee JB, Fisher DJ, Tibbo PG. Sex differences in event-related potential (ERP) waveforms of primary psychotic disorders: A systematic review. Int J Psychophysiol 2019; 145:119-124. [PMID: 30790596 DOI: 10.1016/j.ijpsycho.2019.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/15/2019] [Accepted: 02/12/2019] [Indexed: 11/29/2022]
Abstract
Research aimed at understanding primary psychotic disorders such as schizophrenia, schizophreniform disorder, and schizoaffective disorder, with electrophysiological methods has flourished over recent years. However, a significant component that is often overlooked or underreported in electrophysiological research of psychosis is the factor of biological sex. Thus, the goal of this systematic review was to summarize the current understanding of EEG sex differences in primary psychotic disorders. Our study found a consistent sex difference relating to the P300 component (male amplitude < females), and that research examining sex differences of ERP waveforms, other than the P300, is very limited with ambiguous findings. This review also addressed the lack of consideration of sex as an influencing factor in electrophysiological research.
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Affiliation(s)
- Hayley Riel
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
| | - Janelle B Lee
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Derek J Fisher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada; Department of Psychology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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11
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Hamilton HK, Roach BJ, Bachman PM, Belger A, Carrion RE, Duncan E, Johannesen JK, Light GA, Niznikiewicz MA, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Cannon TD, Mathalon DH. Association Between P300 Responses to Auditory Oddball Stimuli and Clinical Outcomes in the Psychosis Risk Syndrome. JAMA Psychiatry 2019; 76:1187-1197. [PMID: 31389974 PMCID: PMC6686970 DOI: 10.1001/jamapsychiatry.2019.2135] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE In most patients, a prodromal period precedes the onset of schizophrenia. Although clinical criteria for identifying the psychosis risk syndrome (PRS) show promising predictive validity, assessment of neurophysiologic abnormalities in at-risk individuals may improve clinical prediction and clarify the pathogenesis of schizophrenia. OBJECTIVE To determine whether P300 event-related potential amplitude, which is deficient in schizophrenia, is reduced in the PRS and associated with clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS Auditory P300 data were collected as part of the multisite, case-control North American Prodrome Longitudinal Study (NAPLS-2) at 8 university-based outpatient programs. Participants included 552 individuals meeting PRS criteria and 236 healthy controls with P300 data. Auditory P300 data of participants at risk who converted to psychosis (n = 73) were compared with those of nonconverters who were followed up for 24 months and continued to be symptomatic (n = 135) or remitted from the PRS (n = 90). Data were collected from May 27, 2009, to September 17, 2014, and were analyzed from December 3, 2015, to May 1, 2019. MAIN OUTCOMES AND MEASURES Baseline electroencephalography was recorded during an auditory oddball task. Two P300 subcomponents were measured: P3b, elicited by infrequent target stimuli, and P3a, elicited by infrequent nontarget novel stimuli. RESULTS This study included 788 participants. The PRS group (n = 552) included 236 females (42.8%) (mean [SD] age, 19.21 [4.38] years), and the healthy control group (n = 236) included 111 females (47.0%) (mean [SD] age, 20.44 [4.73] years). Target P3b and novelty P3a amplitudes were reduced in at-risk individuals vs healthy controls (d = 0.37). Target P3b, but not novelty P3a, was significantly reduced in psychosis converters vs nonconverters (d = 0.26), and smaller target P3b amplitude was associated with a shorter time to psychosis onset in at-risk individuals (hazard ratio, 1.45; 95% CI, 1.04-2.00; P = .03). Participants with the PRS who remitted had baseline target P3b amplitudes that were similar to those of healthy controls and greater than those of converters (d = 0.51) and at-risk individuals who remained symptomatic (d = 0.41). CONCLUSIONS AND RELEVANCE In this study, deficits in P300 amplitude appeared to precede psychosis onset. Target P3b amplitudes, in particular, may be sensitive to clinical outcomes in the PRS, including both conversion to psychosis and clinical remission. Auditory target P3b amplitude shows promise as a putative prognostic biomarker of clinical outcome in the PRS.
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Affiliation(s)
- Holly K. Hamilton
- Department of Psychiatry, University of California, San Francisco,San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Brian J. Roach
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Peter M. Bachman
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aysenil Belger
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Ricardo E. Carrion
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, New York
| | - Erica Duncan
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jason K. Johannesen
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut,Veterans Affairs Connecticut Health Care System, West Haven, Connecticut
| | - Gregory A. Light
- Department of Psychiatry, University of California, San Diego, La Jolla,Veterans Affairs San Diego Healthcare System, La Jolla, California
| | - Margaret A. Niznikiewicz
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Massachusetts General Hospital, Boston, Massachusetts,Veterans Affairs Boston Healthcare System, Brockton, Massachusetts
| | - Jean Addington
- Hotchkiss Brain Institute Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E. Bearden
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles,Department of Psychology, University of California, Los Angeles
| | | | - Barbara A. Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, New York,Department of Molecular Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, New York
| | - Thomas H. McGlashan
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut
| | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Larry J. Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Ming T. Tsuang
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Elaine F. Walker
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia,Department of Psychology, Emory University, Atlanta, Georgia
| | - Scott W. Woods
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut
| | - Tyrone D. Cannon
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut,Department of Psychology, School of Medicine, Yale University, New Haven, Connecticut
| | - Daniel H. Mathalon
- Department of Psychiatry, University of California, San Francisco,San Francisco Veterans Affairs Health Care System, San Francisco, California
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12
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Hamilton HK, Woods SW, Roach BJ, Llerena K, McGlashan TH, Srihari VH, Ford JM, Mathalon DH. Auditory and Visual Oddball Stimulus Processing Deficits in Schizophrenia and the Psychosis Risk Syndrome: Forecasting Psychosis Risk With P300. Schizophr Bull 2019; 45:1068-1080. [PMID: 30753731 PMCID: PMC6737543 DOI: 10.1093/schbul/sby167] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Identification of neurophysiological abnormalities associated with schizophrenia that predate and predict psychosis onset may improve clinical prediction in the psychosis risk syndrome (PRS) and help elucidate the pathogenesis of schizophrenia. Amplitude reduction of the P300 event-related potential component reflects attention-mediated processing deficits and is among the most replicated biological findings in schizophrenia, making it a candidate biomarker of psychosis risk. The relative extent to which deficits in P300 amplitudes elicited by auditory and visual oddball stimuli precede psychosis onset during the PRS and predict transition to psychosis, however, remains unclear. Forty-three individuals meeting PRS criteria, 19 schizophrenia patients, and 43 healthy control (HC) participants completed baseline electroencephalography recording during separate auditory and visual oddball tasks. Two subcomponents of P300 were measured: P3b, elicited by infrequent target stimuli, and P3a, elicited by infrequent nontarget novel stimuli. Auditory and visual target P3b and novel P3a amplitudes were reduced in PRS and schizophrenia participants relative to HC participants. In addition, baseline auditory and visual target P3b, but not novel P3a, amplitudes were reduced in 15 PRS participants who later converted to psychosis, relative to 18 PRS non-converters who were followed for at least 22 months. Furthermore, target P3b amplitudes predicted time to psychosis onset among PRS participants. These results suggest that P300 amplitude deficits across auditory and visual modalities emerge early in the schizophrenia illness course and precede onset of full psychosis. Moreover, target P3b may represent an important neurophysiological vulnerability marker of the imminence of risk for psychosis.
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Affiliation(s)
- Holly K Hamilton
- Mental Health Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT
| | - Brian J Roach
- Mental Health Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA
- Northern California Institute for Research and Education, San Francisco, CA
| | - Katiah Llerena
- Mental Health Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
| | | | | | - Judith M Ford
- Mental Health Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
| | - Daniel H Mathalon
- Mental Health Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
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13
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Graber K, Bosquet Enlow M, Duffy FH, D'Angelo E, Sideridis G, Hyde DE, Morelli N, Tembulkar S, Gonzalez-Heydrich J. P300 amplitude attenuation in high risk and early onset psychosis youth. Schizophr Res 2019; 210:228-238. [PMID: 30685392 DOI: 10.1016/j.schres.2018.12.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/16/2018] [Accepted: 12/19/2018] [Indexed: 11/29/2022]
Abstract
Little research has investigated the use of electrophysiological biomarkers in childhood and adolescence to distinguish early onset psychosis and the clinical high risk state. The P300 evoked potential is a robust neurophysiological marker of schizophrenia that is dampened in patients with schizophrenia and, less consistently, in those with affective psychoses and those at clinical high risk for psychosis (CHR). How it may differ between patients with psychotic disorders (PS) and CHR is less studied, especially in youth. The current study compared P300 activity among children and adolescents, aged 5-18 years, at CHR (n = 43), with PS (n = 28), and healthy controls (HC; n = 24). Participants engaged in an auditory event-related potential (ERP) task to elicit a P300 response and completed clinical interviews to verify symptoms and diagnoses. Linear regression analyses revealed a decrease in P300 amplitude with increased severity of psychotic symptoms. PS participants showed a diminished P300 response compared to those at CHR and HC, particularly among adolescents aged 13-18. This response was most evident at centroparietal and parietal locations in the right hemisphere. The findings suggest that high risk and psychotic symptomatology is linked to attenuated parietal P300 activity in youth as young as 13 years. Further exploration of the P300 as a biomarker for psychosis in very young patients could inform tailored, appropriate interventions at early stages of disease progression. Future research should evaluate whether specific phenotypic and genotypic characteristics are differentially associated with neurophysiological biomarkers and whether P300 attenuation in CHR youth can predict later symptom severity.
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Affiliation(s)
- Kelsey Graber
- Department of Psychiatry, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
| | - Michelle Bosquet Enlow
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
| | - Frank H Duffy
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
| | - Eugene D'Angelo
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
| | - Georgios Sideridis
- Department of Developmental Medicine Research, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
| | - Damon E Hyde
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
| | - Nicholas Morelli
- Department of Psychiatry, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
| | - Sahil Tembulkar
- Department of Psychiatry, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
| | - Joseph Gonzalez-Heydrich
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
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14
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Niznikiewicz MA. Neurobiological approaches to the study of clinical and genetic high risk for developing psychosis. Psychiatry Res 2019; 277:17-22. [PMID: 30926150 DOI: 10.1016/j.psychres.2019.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 01/12/2023]
Abstract
Research on neurobiological impairments in clinical and genetic high risk for developing psychosis individuals (CHR) has identified several brain abnormalities that impact both brain structure and function. The current review will discuss research examining brain abnormalities in clinical and genetic high risk for psychosis using magnetic resonance imaging (MRI) focusing on structural brain abnormalities, diffusion tensor imaging (DTI) focusing on the integrity of white matter tracks, functional MRI focusing on functional brain abnormalities, and EEG and event related potential (ERP) methodologies focusing on indices of cognitive dysfunction in CHR. Studies conducted across these different methodologies sought to identify brain regions and brain processes that would distinguish between those high risk individuals who converted to psychosis versus those who did not. In addition, in some of the studies, the distinction was made between individuals who converted to psychosis, those who did not, and those individuals who remained clinically symptomatic while not converting to psychosis. The brain regions most often identified as abnormal in this subject group were the brain areas often found abnormal in schizophrenia, including frontal and temporal regions. Similarly, several cognitive processes often found to be abnormal in schizophrenia have been also found impaired in CHR.
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Affiliation(s)
- Margaret A Niznikiewicz
- Harvard Medical School and Veterans Administration Boston, Healthcare System, United States.
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15
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Thomas ML, Bismark AW, Joshi YB, Tarasenko M, Treichler EBH, Hochberger WC, Zhang W, Nungaray J, Sprock J, Cardoso L, Tiernan K, Attarha M, Braff DL, Vinogradov S, Swerdlow N, Light GA. Targeted cognitive training improves auditory and verbal outcomes among treatment refractory schizophrenia patients mandated to residential care. Schizophr Res 2018; 202:378-384. [PMID: 30055883 PMCID: PMC7409526 DOI: 10.1016/j.schres.2018.07.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/14/2018] [Accepted: 07/14/2018] [Indexed: 02/08/2023]
Abstract
Computerized targeted cognitive training (TCT) of auditory processing has been shown to improve verbal learning in several clinical trials of schizophrenia outpatients. Less is known, however, about the effectiveness of this promising intervention in more chronic, treatment-refractory patients who are treated in non-academic settings. This study aimed to determine whether TCT improves auditory processing, verbal learning, and clinical symptoms in SZ patients mandated to receive care at a locked residential rehabilitation center. Secondarily, potential factors that moderate TCT's effectiveness including age, symptom severity, antipsychotic medication load, and duration of illness were examined. Schizophrenia patients were randomized to treatment as usual (TAU; n = 22) or TAU augmented with TCT (TAU + TCT; n = 24). Outcomes included a measure of auditory perception (Word-In-Noise test, WIN), verbal learning domain scores from the MATRICS Consensus Cognitive Battery (MCCB), and clinical symptoms (Scale for the Assessment of Positive Symptoms, SAPS; Scale for the Assessment of Negative Symptoms, SANS). TCT produced significant improvements in auditory perception (d = 0.67) and verbal learning (d = 0.65); exploratory analyses revealed a statistically significant reduction in auditory hallucinations (d = -0.64). TCT's effects were only weakly, and mostly non-significantly, moderated by age, clinical symptoms, medication, and illness duration. These findings indicate that even highly symptomatic, functionally disabled patients with chronic illness benefit from this emerging treatment. Ongoing studies will examine the predictive utility of neurophysiological biomarkers and other characteristics assessed at baseline.
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Affiliation(s)
- Michael L Thomas
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States
| | - Andrew W Bismark
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States
| | - Yash B Joshi
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States
| | - Melissa Tarasenko
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States
| | - Emily B H Treichler
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States
| | - William C Hochberger
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States
| | - Wen Zhang
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program (JDP) in Clinical Psychology, San Diego, CA, United States
| | - John Nungaray
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Joyce Sprock
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States
| | - Lauren Cardoso
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Alpine Special Treatment Center Inc., Alpine, CA, United States
| | | | - Mouna Attarha
- Posit Science Corporation, 160 Pine St Suite 200, San Francisco, CA 94111, United States
| | - David L Braff
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States
| | - Sophia Vinogradov
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Neal Swerdlow
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States
| | - Gregory A Light
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States; San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program (JDP) in Clinical Psychology, San Diego, CA, United States.
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16
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Hill KE, Ait Oumeziane B, Novak KD, Rollock D, Foti D. Variation in reward- and error-related neural measures attributable to age, gender, race, and ethnicity. Int J Psychophysiol 2018; 132:353-364. [PMID: 29274364 DOI: 10.1016/j.ijpsycho.2017.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/21/2017] [Accepted: 12/18/2017] [Indexed: 01/23/2023]
Abstract
Event-related potentials (ERPs) have been widely applied to the study of individual differences in reward and error processing, including recent proposals of several ERPs as possible biomarkers of mental illness. A criterion for all biomarkers, however, is that they be generalizable across the relevant populations, something which has yet to be demonstrated for many commonly studied reward- and error-related ERPs. The aim of this study was to examine variation in reward and error-related ERPs across core demographic variables: age, gender, race, and ethnicity. Data was drawn from three studies with relatively large samples (N range 207-527). Results demonstrated that ERPs varied across the demographic variables of interest. Several examples include attenuated reward-related ERPs with increasing age, larger error-related ERPs for men than women, and larger ERPs to feedback after losses for individuals who identified as Hispanic/Latino. Overall, these analyses suggest systematic variation in ERPs that is attributable to core demographic variables, which could give rise to seemingly inconsistent results across studies to the extent that these sample characteristics differ. Future psychophysiological studies should include these analyses as standard practice and assess how these differences might exacerbate, mask, or confound relationships of interest.
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Affiliation(s)
| | | | | | | | - Dan Foti
- Purdue University, United States
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17
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Lepock JR, Mizrahi R, Korostil M, Bagby RM, Pang EW, Kiang M. Event-Related Potentials in the Clinical High-Risk (CHR) State for Psychosis: A Systematic Review. Clin EEG Neurosci 2018; 49:215-225. [PMID: 29382210 DOI: 10.1177/1550059418755212] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
There is emerging evidence that identification and treatment of individuals in the prodromal or clinical high-risk (CHR) state for psychosis can reduce the probability that they will develop a psychotic disorder. Event-related brain potentials (ERPs) are a noninvasive neurophysiological technique that holds promise for improving our understanding of neurocognitive processes underlying the CHR state. We aimed to systematically review the current literature on cognitive ERP studies of the CHR population, in order to summarize and synthesize the results, and their implications for our understanding of the CHR state. Across studies, amplitudes of the auditory P300 and duration mismatch negativity (MMN) ERPs appear reliably reduced in CHR individuals, suggesting that underlying impairments in detecting changes in auditory stimuli are a sensitive early marker of the psychotic disease process. There are more limited data indicating that an earlier-latency auditory ERP response, the N100, is also reduced in amplitude, and in the degree to which it is modulated by stimulus characteristics, in the CHR population. There is also evidence that a number of auditory ERP measures (including P300, MMN and N100 amplitudes, and N100 gating in response to repeated stimuli) can further refine our ability to detect which CHR individuals are most at risk for developing psychosis. Thus, further research is warranted to optimize the predictive power of algorithms incorporating these measures, which could help efforts to target psychosis prevention interventions toward those most in need.
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Affiliation(s)
- Jennifer R Lepock
- 1 Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Romina Mizrahi
- 1 Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,2 Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,3 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Michele Korostil
- 1 Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,2 Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,3 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,4 Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - R Michael Bagby
- 1 Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,2 Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,3 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,5 Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth W Pang
- 1 Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,6 Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.,7 Neuroscience and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada
| | - Michael Kiang
- 1 Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,2 Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,3 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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18
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Hamilton HK, Perez VB, Ford JM, Roach BJ, Jaeger J, Mathalon DH. Mismatch Negativity But Not P300 Is Associated With Functional Disability in Schizophrenia. Schizophr Bull 2018; 44:492-504. [PMID: 29036701 PMCID: PMC5890465 DOI: 10.1093/schbul/sbx104] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Mismatch negativity (MMN) and P300 event-related potential (ERP) reductions in schizophrenia (SZ) reflect preattentive and attention-mediated auditory processing deficits, respectively. Although both have been linked to cognitive deficits in SZ, their relative contributions to real-world functioning are unclear. We sought to determine the functional significance of disrupted auditory processing in SZ by examining MMN and P300 in typically disabled low-functioning patients and in patients with high levels of independent role functioning. MMN to auditory deviants and P300 to infrequent auditory target and nontarget novel stimuli were assessed in 20 high-functioning SZ patients (HF-SZ), 17 low-functioning patients (LF-SZ), and 35 healthy comparison (HC) subjects. There was a group effect on MMN and P300 amplitudes across stimulus types. MMN was significantly diminished in LF-SZ compared to HF-SZ and HC, and HF-SZ demonstrated comparable MMN to HC. In contrast, P300 was significantly reduced in both LF-SZ and HF-SZ compared to HC. Logistic regression suggested independent sensitivity of MMN to functioning in SZ over and above P300 measures. Neither MMN nor P300 were associated with positive or negative symptom severity. Results replicate MMN and P300 abnormalities in SZ, and also suggest that the neural mechanisms associated with the preattentive detection of auditory deviance are most compromised in patients with functional disability. MMN may index pathophysiological processes that are critical for optimal functioning in SZ.
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Affiliation(s)
- Holly K Hamilton
- San Francisco VA Health Care System, San Francisco, CA,University of California, San Francisco, San Francisco, CA
| | - Veronica B Perez
- California School of Professional Psychology, San Diego, CA,University of California, San Diego, San Diego, CA
| | - Judith M Ford
- San Francisco VA Health Care System, San Francisco, CA,University of California, San Francisco, San Francisco, CA
| | - Brian J Roach
- Northern California Institute for Research and Education, San Francisco, CA
| | - Judith Jaeger
- Albert Einstein College of Medicine, New York, NY,CognitionMetrics, LLC, Wilmington, DE
| | - Daniel H Mathalon
- San Francisco VA Health Care System, San Francisco, CA,University of California, San Francisco, San Francisco, CA,To whom correspondence should be addressed; San Francisco VA Health Care System, 4150 Clement Street, 116D, San Francisco, CA 94121; tel: 415-221-4810-x23860; e-mail:
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19
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Sueyoshi K, Sumiyoshi T. Electrophysiological Evidence in Schizophrenia in Relation to Treatment Response. Front Psychiatry 2018; 9:259. [PMID: 29951008 PMCID: PMC6008315 DOI: 10.3389/fpsyt.2018.00259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/25/2018] [Indexed: 01/14/2023] Open
Abstract
Several domains of cognitive function, e.g., verbal memory, information processing, fluency, attention, and executive function are impaired in patients with schizophrenia. Cognitive impairments in schizophrenia have attracted interests as a treatment target, because they are considered to greatly affect functional outcome. Electrophysiological markers, including electroencephalogram (EEG), particularly, event-related potentials, have contributed to psychiatric research and clinical practice. In this review, we provide a summary of studies relating electrophysiological findings to cognitive performance in schizophrenia. Electrophysiological indices may provide an objective marker of cognitive processes, contributing to the development of effective interventions to improve cognitive and social outcomes. Further efforts to understand biological mechanisms of cognitive disturbances, and develop effective therapeutics are warranted.
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Affiliation(s)
- Kazuki Sueyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
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20
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Kotlicka-Antczak M, Pawełczyk A, Karbownik MS, Pawełczyk T, Strzelecki D, Żurner N, Urban-Kowalczyk M. Deficits in the identification of pleasant odors predict the transition of an at-risk mental state to psychosis. Schizophr Res 2017; 181:49-54. [PMID: 27765522 DOI: 10.1016/j.schres.2016.10.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/30/2016] [Accepted: 10/10/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Existing knowledge of the relationship between olfactory identification (OI) ability and clinical risk of psychosis is inconsistent. To address this inconsistency, the aim of the present study was to identify the relationship between OI ability, with regard to the hedonic attributes of odors, and the risk of transition to psychosis in individuals with an ARMS. METHODS A group of 81 individuals meeting the ARMS criteria according to the Comprehensive Assessment of At Risk Mental State were at baseline administered with the University of Pennsylvania Smell Identification Test. The hedonic attributes of odorants were normatively established. Participants were followed up for transition to psychosis for a mean period of 36.1months (SD:27.5months). RESULTS The presence of deficits in the identification of pleasant odors was found to be a risk factor for conversion from an ARMS to schizophrenia. The hazard ratio for each point in deficit scores in the Cox regression model was 1.455 (95% CI: 1.211-1.747), p<0.0001. Significant deficits in the identification of pleasant odors were associated with a risk for conversion at both early and late time points from baseline. CONCLUSIONS The findings imply that the impaired identification of pleasant odorants may be a risk factor for the transition of an ARMS into a psychotic disorder, and highlights the need for further research of OI in "at-risk" cohorts, taking into account the hedonic attributes of odors.
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Affiliation(s)
- Magdalena Kotlicka-Antczak
- Medical University of Łódź, Chair of Psychiatry, Department of Affective and Psychotic Disorders, ul. Czechosłowacka 8/10, 92-216 Łódź, Poland.
| | - Agnieszka Pawełczyk
- Medical University of Łódź, Chair of Psychiatry, Department of Affective and Psychotic Disorders, ul. Czechosłowacka 8/10, 92-216 Łódź, Poland.
| | - Michał S Karbownik
- Medical University of Łódź, Department of Pharmacology and Toxicology, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland.
| | - Tomasz Pawełczyk
- Medical University of Łódź, Chair of Psychiatry, Department of Affective and Psychotic Disorders, ul. Czechosłowacka 8/10, 92-216 Łódź, Poland.
| | - Dominik Strzelecki
- Medical University of Łódź, Chair of Psychiatry, Department of Affective and Psychotic Disorders, ul. Czechosłowacka 8/10, 92-216 Łódź, Poland.
| | - Natalia Żurner
- Adolescent Psychiatry Unit, Central Clinical Hospital of Medical University of Łódź, ul. Czechosłowacka 8/10, 92-216 Łódź, Poland.
| | - Małgorzata Urban-Kowalczyk
- Medical University of Łódź, Chair of Psychiatry, Department of Affective and Psychotic Disorders, ul. Czechosłowacka 8/10, 92-216 Łódź, Poland.
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21
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Devrim-Üçok M, Keskin-Ergen Y, Üçok A. Lack of progressive reduction in P3 amplitude after the first-episode of schizophrenia: A 6-year follow-up study. Psychiatry Res 2016; 243:303-11. [PMID: 27428084 DOI: 10.1016/j.psychres.2016.02.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 01/11/2016] [Accepted: 02/27/2016] [Indexed: 12/13/2022]
Abstract
P3 event-related potential may track the course of neurophysiological pathology in schizophrenia. Reduction in the amplitude of the auditory P3 is a widely replicated finding, already present at the first psychotic episode, in schizophrenia. Whether a progressive deficit is present in auditory P3 in schizophrenia over the course of illness is yet to be clarified. Previous longitudinal studies did not report any change in P3 over time in schizophrenia. However, these studies have been inconclusive, because of their relatively short follow-up periods, lack of follow-up data on controls, and assessment of patients already at the chronic stages of schizophrenia. Auditory P3 potentials, elicited by an oddball paradigm, were assessed in 14 patients with first-episode schizophrenia and 22 healthy controls at baseline and at the 6-year follow-up. P3 amplitudes were smaller in patients with first-episode schizophrenia than in controls. Importantly, over the 6-year interval, the P3 amplitudes were reduced in controls, but they did not change in patients. The lack of P3 reduction over time in patients with schizophrenia might be explained by the maximal reduction in P3 already at baseline or by the alleviation of P3 reduction over time.
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Affiliation(s)
- Müge Devrim-Üçok
- (a)Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, 34093 Çapa, Istanbul, Turkey.
| | - Yasemin Keskin-Ergen
- (a)Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, 34093 Çapa, Istanbul, Turkey
| | - Alp Üçok
- Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, 34093 Çapa, Istanbul, Turkey
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22
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Schultze-Lutter F, Debbané M, Theodoridou A, Wood SJ, Raballo A, Michel C, Schmidt SJ, Kindler J, Ruhrmann S, Uhlhaas PJ. Revisiting the Basic Symptom Concept: Toward Translating Risk Symptoms for Psychosis into Neurobiological Targets. Front Psychiatry 2016; 7:9. [PMID: 26858660 PMCID: PMC4729935 DOI: 10.3389/fpsyt.2016.00009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/14/2016] [Indexed: 12/31/2022] Open
Abstract
In its initial formulation, the concept of basic symptoms (BSs) integrated findings on the early symptomatic course of schizophrenia and first in vivo evidence of accompanying brain aberrations. It argued that the subtle subclinical disturbances in mental processes described as BSs were the most direct self-experienced expression of the underlying neurobiological aberrations of the disease. Other characteristic symptoms of psychosis (e.g., delusions and hallucinations) were conceptualized as secondary phenomena, resulting from dysfunctional beliefs and suboptimal coping styles with emerging BSs and/or concomitant stressors. While BSs can occur in many mental disorders, in particular affective disorders, a subset of perceptive and cognitive BSs appear to be specific to psychosis and are currently employed in two alternative risk criteria. However, despite their clinical recognition in the early detection of psychosis, neurobiological research on the aetiopathology of psychosis with neuroimaging methods has only just begun to consider the neural correlate of BSs. This perspective paper reviews the emerging evidence of an association between BSs and aberrant brain activation, connectivity patterns, and metabolism, and outlines promising routes for the use of BSs in aetiopathological research on psychosis.
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Affiliation(s)
- Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern , Bern , Switzerland
| | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland; Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry , Zurich , Switzerland
| | - Stephen J Wood
- School of Psychology, University of Birmingham , Birmingham , UK
| | - Andrea Raballo
- Norwegian Centre for Mental Disorders Research (NORMENT), Faculty of Medicine, University of Oslo , Oslo , Norway
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern , Bern , Switzerland
| | - Stefanie J Schmidt
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern , Bern , Switzerland
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern , Bern , Switzerland
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne , Cologne , Germany
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow , Glasgow , UK
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23
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Leicht G, Vauth S, Polomac N, Andreou C, Rauh J, Mußmann M, Karow A, Mulert C. EEG-Informed fMRI Reveals a Disturbed Gamma-Band-Specific Network in Subjects at High Risk for Psychosis. Schizophr Bull 2016; 42:239-49. [PMID: 26163477 PMCID: PMC4681551 DOI: 10.1093/schbul/sbv092] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Abnormalities of oscillatory gamma activity are supposed to reflect a core pathophysiological mechanism underlying cognitive disturbances in schizophrenia. The auditory evoked gamma-band response (aeGBR) is known to be reduced across all stages of the disease. The present study aimed to elucidate alterations of an aeGBR-specific network mediated by gamma oscillations in the high-risk state of psychosis (HRP) by means of functional magnetic resonance imaging (fMRI) informed by electroencephalography (EEG). METHODS EEG and fMRI were simultaneously recorded from 27 HRP individuals and 26 healthy controls (HC) during performance of a cognitively demanding auditory reaction task. We used single trial coupling of the aeGBR with the corresponding blood oxygen level depending response (EEG-informed fMRI). RESULTS A gamma-band-specific network was significantly lower active in HRP subjects compared with HC (random effects analysis, P < .01, Bonferroni-corrected for multiple comparisons) accompanied by a worse task performance. This network involved the bilateral auditory cortices, the thalamus and frontal brain regions including the anterior cingulate cortex, as well as the bilateral dorsolateral prefrontal cortex. CONCLUSIONS For the first time we report a reduced activation of an aeGBR-specific network in HRP subjects brought forward by EEG-informed fMRI. Because the HRP reflects the clinical risk for conversion to psychotic disorders including schizophrenia and the aeGBR has repeatedly been shown to be altered in patients with schizophrenia the results of our study point towards a potential applicability of aeGBR disturbances as a marker for the prediction of transition of HRP subjects to schizophrenia.
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Affiliation(s)
- Gregor Leicht
- Department of Psychiatry and Psychotherapy, Psychiatry Neuroimaging Branch (PNB) and
| | - Sebastian Vauth
- Department of Psychiatry and Psychotherapy, Psychiatry Neuroimaging Branch (PNB) and,These authors contributed equally to the article
| | - Nenad Polomac
- Department of Psychiatry and Psychotherapy, Psychiatry Neuroimaging Branch (PNB) and
| | - Christina Andreou
- Department of Psychiatry and Psychotherapy, Psychiatry Neuroimaging Branch (PNB) and
| | - Jonas Rauh
- Department of Psychiatry and Psychotherapy, Psychiatry Neuroimaging Branch (PNB) and
| | - Marius Mußmann
- Department of Psychiatry and Psychotherapy, Psychiatry Neuroimaging Branch (PNB) and
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Mulert
- Department of Psychiatry and Psychotherapy, Psychiatry Neuroimaging Branch (PNB) and
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24
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Bodatsch M, Brockhaus-Dumke A, Klosterkötter J, Ruhrmann S. Forecasting psychosis by event-related potentials-systematic review and specific meta-analysis. Biol Psychiatry 2015; 77:951-8. [PMID: 25636178 DOI: 10.1016/j.biopsych.2014.09.025] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 09/18/2014] [Accepted: 09/19/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Prediction and prevention of psychosis have become major research topics. Clinical approaches warrant objective biological parameters to enhance validity in prediction of psychosis onset. In this regard, event-related potentials (ERPs) have been identified as promising tools for improving psychosis prediction. METHODS Herein, the focus is on sensory gating, mismatch negativity (MMN) and P300, thereby discussing which parameters allow for a timely and valid detection of future converters to psychosis. In a first step, we systematically reviewed the studies that resulted from a search of the MEDLINE database. In a second step, we performed a meta-analysis of those investigations reporting transitions that statistically compared ERPs in converting versus nonconverting subjects. RESULTS Sensory gating, MMN, and P300 have been demonstrated to be impaired in subjects clinically at risk of developing a psychotic disorder. In the meta-analysis, duration MMN achieved the highest effect size measures. CONCLUSIONS In summary, MMN studies have produced the most convincing results until now, including independent replication of the predictive validity. However, a synopsis of the literature revealed a relative paucity of ERP studies addressing the psychosis risk state. Considering the high clinical relevance of valid psychosis prediction, future research should question for the most informative paradigms and should allow for meta-analytic evaluation with regard to specificity and sensitivity of the most appropriate parameters.
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Affiliation(s)
- Mitja Bodatsch
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne.
| | - Anke Brockhaus-Dumke
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne; Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Rheinhessen-Fachklinik Alzey, Alzey, Germany
| | | | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne
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25
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Turetsky BI, Dress EM, Braff DL, Calkins ME, Green MF, Greenwood TA, Gur RE, Gur RC, Lazzeroni LC, Nuechterlein KH, Radant AD, Seidman LJ, Siever LJ, Silverman JM, Sprock J, Stone WS, Sugar CA, Swerdlow NR, Tsuang DW, Tsuang MT, Light G. The utility of P300 as a schizophrenia endophenotype and predictive biomarker: clinical and socio-demographic modulators in COGS-2. Schizophr Res 2015; 163:53-62. [PMID: 25306203 PMCID: PMC4382423 DOI: 10.1016/j.schres.2014.09.024] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/09/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
Abstract
Reduced auditory P300 amplitude is a robust schizophrenia deficit exhibiting the qualities of a viable genetic endophenotype. These include heritability, test-retest reliability, and trait-like stability. Recent evidence suggests that P300 may also serve as a predictive biomarker for transition to psychosis during the schizophrenia prodrome. Historically, the utility of the P300 has been limited by its clinical nonspecificity, cross-site measurement variability, and required EEG expertise. The Consortium on the Genetics of Schizophrenia (COGS-2) study provided an opportunity to examine the consistency of the measure across multiple sites with varying degrees of EEG experience, and to identify important modulating factors that contribute to measurement variability. Auditory P300 was acquired from 649 controls and 587 patients at 5 sites. An overall patient deficit was observed with effect size 0.62. Each site independently observed a significant patient deficit, but site differences also existed. In patients, site differences reflected clinical differences in positive symptomatology and functional capacity. In controls, site differences reflected differences in racial stratification, smoking and substance use history. These factors differentially suppressed the P300 response, but only in control subjects. This led to an attenuated patient-control difference among smokers and among African Americans with history of substance use. These findings indicate that the P300 can be adequately assessed quantitatively, across sites, without substantial EEG expertise. Measurements are suitable for both genetic endophenotype analyses and studies of psychosis risk and conversion. However, careful attention must be given to selection of appropriate comparison samples to avoid misleading false negative results.
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Affiliation(s)
- Bruce I. Turetsky
- Department of Psychiatry, University of Pennsylvania, Philadelphia,
PA
| | - Erich M. Dress
- Department of Psychiatry, University of Pennsylvania, Philadelphia,
PA
| | - David L. Braff
- Department of Psychiatry, University of California San Diego, La
Jolla, CA,VISN-22 Mental Illness, Research, Education and Clinical Center
(MIRECC), VA San Diego Healthcare System
| | - Monica E. Calkins
- Department of Psychiatry, University of Pennsylvania, Philadelphia,
PA
| | - Michael F. Green
- Department of Psychiatry and Biobehavioral Sciences, Geffen School
of Medicine, University of California Los Angeles, Los Angeles, CA,VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | - Raquel E. Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia,
PA
| | - Ruben C. Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia,
PA
| | - Laura C. Lazzeroni
- Department of Psychiatry and Behavioral Sciences, Stanford
University, Palo Alto, CA
| | - Keith H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Geffen School
of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Allen D. Radant
- Department of Psychiatry and Behavioral Sciences, University of
Washington, Seattle, WA,VA Puget Sound Health Care System, Seattle, WA
| | - Larry J. Seidman
- Department of Psychiatry, Harvard Medical School, Boston, MA,Massachusetts Mental Health Center Public Psychiatry Division of the
Beth Israel Deaconess Medical Center, Boston, MA
| | - Larry J. Siever
- Department of Psychiatry, The Mount Sinai School of Medicine, New
York, NY,James J. Peters VA Medical Center, New York, NY
| | - Jeremy M. Silverman
- Department of Psychiatry, The Mount Sinai School of Medicine, New
York, NY,James J. Peters VA Medical Center, New York, NY
| | - Joyce Sprock
- Department of Psychiatry, University of California San Diego, La
Jolla, CA
| | - William S. Stone
- Department of Psychiatry, Harvard Medical School, Boston, MA,Massachusetts Mental Health Center Public Psychiatry Division of the
Beth Israel Deaconess Medical Center, Boston, MA
| | - Catherine A. Sugar
- Department of Biostatistics, University of California Los Angeles
School of Public Health, Los Angeles, CA
| | - Neal R. Swerdlow
- Department of Psychiatry, University of California San Diego, La
Jolla, CA
| | - Debby W. Tsuang
- Department of Psychiatry and Behavioral Sciences, University of
Washington, Seattle, WA,VA Puget Sound Health Care System, Seattle, WA
| | - Ming T. Tsuang
- Department of Psychiatry, University of California San Diego, La
Jolla, CA,Center for Behavioral Genomics, and Institute for Genomic Medicine,
University of California SanDiego, La Jolla, CA,Harvard Institute of Psychiatric Epidemiology and Genetics, Boston,
MA
| | - Gregory Light
- Department of Psychiatry, University of California San Diego, La
Jolla, CA,VISN-22 Mental Illness, Research, Education and Clinical Center
(MIRECC), VA San Diego Healthcare System
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26
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Li Z, Deng W, Liu X, Zheng Z, Li M, Li Y, Han Y, Ma X, Wang Q, Liu X, Li T. Contingent negative variation in patients with deficit schizophrenia or bipolar I disorder with psychotic features: measurement and correlation with clinical characteristics. Nord J Psychiatry 2015; 69:196-203. [PMID: 25263850 DOI: 10.3109/08039488.2014.959562] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Schizophrenia is a highly heterogeneous disease. Event-related potentials have been regarded to establish intermediate phenotypes of schizophrenia. Our previous study found that patients with deficit schizophrenia (DS) are relatively homogeneous and show a significantly longer onset latency of contingent negative variation (CNV) expectancy wave. AIMS To further examine CNV in patients with first-episode and drug-naïve DS or bipolar I disorder (BP I) with psychotic features, and also investigate correlations between CNV and clinical characteristics in DS and BP I. METHOD We elicited a CNV using an alarm (S1)-imperative (S2) paradigm in 30 DS patients or 33 BP I with psychotic features as well as 40 healthy controls. RESULTS CNV amplitude was significantly smaller and reaction time significantly longer in the DS and BP I groups than in healthy controls. Post-imperative negative variation (PINV) interval was significantly shorter in the DS group than in healthy controls. The onset latency of CNV expectancy wave was significantly longer and PINV area significantly smaller in the DS group than in the other groups. In the DS group, CNV amplitude and PINV interval correlated negatively with the subscale of negative symptoms on the Positive and Negative Syndrome Scale (PANSS); CNV amplitude also correlated negatively with disease duration. In the BP I group, CNV amplitude and reaction time showed no correlation with clinical features. CONCLUSIONS CNV amplitude is a common trait marker for psychosis. The onset latency of CNV expectancy wave appears to be a specific trait marker and may be used to identify candidate genes for DS.
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Affiliation(s)
- Zhe Li
- Zhe Li, M.D., The Mental Health Center and the Psychiatric Laboratory, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University , Chengdu, Sichuan 610041 , China
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27
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del Re EC, Spencer KM, Oribe N, Mesholam-Gately RI, Goldstein J, Shenton ME, Petryshen T, Seidman LJ, McCarley RW, Niznikiewicz MA. Clinical high risk and first episode schizophrenia: auditory event-related potentials. Psychiatry Res 2015; 231:126-33. [PMID: 25557063 PMCID: PMC4314407 DOI: 10.1016/j.pscychresns.2014.11.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 11/07/2014] [Accepted: 11/19/2014] [Indexed: 01/15/2023]
Abstract
The clinical high risk (CHR) period is a phase denoting a risk for overt psychosis during which subacute symptoms often appear, and cognitive functions may deteriorate. To compare biological indices during this phase with those during first episode schizophrenia, we cross-sectionally examined sex- and age-matched clinical high risk (CHR, n=21), first episode schizophrenia patients (FESZ, n=20) and matched healthy controls (HC, n=25) on oddball and novelty paradigms and assessed the N100, P200, P3a and P3b as indices of perceptual, attentional and working memory processes. To our knowledge, this is the only such comparison using all of these event-related potentials (ERPs) in two paradigms. We hypothesized that the ERPs would differentiate between the three groups and allow prediction of a diagnostic group. The majority of ERPs were significantly affected in CHR and FESZ compared with controls, with similar effect sizes. Nonetheless, in logistic regression, only the P3a and N100 distinguished CHR and FESZ from healthy controls, suggesting that ERPs not associated with an overt task might be more sensitive to prediction of group membership.
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Affiliation(s)
- Elisabetta C del Re
- VA Boston Healthcare System, Brockton, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Department of Psychiatry and Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA.
| | - Kevin M Spencer
- VA Boston Healthcare System, Brockton, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Naoya Oribe
- VA Boston Healthcare System, Brockton, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Raquelle I Mesholam-Gately
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Harvard Medical School, Massachusetts Mental Health Center Division of Public Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jill Goldstein
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Brigham and Women׳s Hospital, Connors Center for Women׳s Health and Gender Biology, Boston, MA, USA; Departments of Psychiatry and Medicine, Harvard Medical School, Boston, MA, USA
| | - Martha E Shenton
- VA Boston Healthcare System, Brockton, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Laboratory, Department of Psychiatry and Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA, USA
| | - Tracey Petryshen
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Larry J Seidman
- Harvard Medical School, Massachusetts Mental Health Center Division of Public Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Robert W McCarley
- VA Boston Healthcare System, Brockton, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Margaret A Niznikiewicz
- VA Boston Healthcare System, Brockton, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Nieman DH, Ruhrmann S, Dragt S, Soen F, van Tricht MJ, Koelman JHTM, Bour LJ, Velthorst E, Becker HE, Weiser M, Linszen DH, de Haan L. Psychosis prediction: stratification of risk estimation with information-processing and premorbid functioning variables. Schizophr Bull 2014; 40:1482-90. [PMID: 24142369 PMCID: PMC4193687 DOI: 10.1093/schbul/sbt145] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The period preceding the first psychotic episode is regarded as a promising period for intervention. We aimed to develop an optimized prediction model of a first psychosis, considering different sources of information. The outcome of this model may be used for individualized risk estimation. METHODS Sixty-one subjects clinically at high risk (CHR), participating in the Dutch Prediction of Psychosis Study, were assessed at baseline with instruments yielding data on neuropsychology, symptomatology, environmental factors, premorbid adjustment, and neurophysiology. The follow-up period was 36 months. RESULTS At 36 months, 18 participants (29.5%) had made a transition to psychosis. Premorbid adjustment (P = .001, hazard ratio [HR] = 2.13, 95% CI = 1.39/3.28) and parietal P300 amplitude (P = .004, HR = 1.27, 95% CI = 1.08/1.45) remained as predictors in the Cox proportional hazard model. The resulting prognostic score (PS) showed a sensitivity of 88.9% and a specificity of 82.5%. The area under the curve of the PS was 0.91 (95% CI = 0.83-0.98, cross-validation: 0.86), indicating an outstanding ability of the model to discriminate between transition and nontransition. The PS was further stratified into 3 risk classes establishing a prognostic index. In the class with the worst social-personal adjustment and lowest P300 amplitudes, 74% of the subjects made a transition to psychosis. Furthermore, transition emerged on average more than 17 months earlier than in the lowest risk class. CONCLUSIONS Our results suggest that predicting a first psychotic episode in CHR subjects could be improved with a model including premorbid adjustment and information-processing variables in a multistep algorithm combining risk detection and stratification.
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Affiliation(s)
- Dorien H Nieman
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Joint first authorship.
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Joint first authorship
| | - Sara Dragt
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Francesca Soen
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Mirjam J van Tricht
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Department of Neurology and Clinical Neurophysiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Johannes H T M Koelman
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Lo J Bour
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Eva Velthorst
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Hiske E Becker
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Don H Linszen
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Clark SR, Schubert KO, Baune BT. Towards indicated prevention of psychosis: using probabilistic assessments of transition risk in psychosis prodrome. J Neural Transm (Vienna) 2014; 122:155-69. [PMID: 25319445 DOI: 10.1007/s00702-014-1325-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/08/2014] [Indexed: 12/11/2022]
Abstract
The concept of indicated prevention has proliferated in psychiatry, and accumulating evidence suggests that it may indeed be possible to prevent or delay the onset of a first episode of psychosis though adequate interventions in individuals deemed at clinical high risk (CHR) for such an event. One challenge undermining these efforts is the relatively poor predictive accuracy of clinical assessments used in practice for CHR individuals, often leading to diagnostic and therapeutic uncertainty reflected in clinical guidelines promoting a 'watch and wait' approach to CHR patients. Using data from published studies, and employing predictive models based on the odds-ratio form of Bayes' rule, we simulated scenarios where clinical interview, neurocognitive testing, structural magnetic resonance imaging and electrophysiology are part of the initial assessment process of a CHR individual (extended diagnostic approach). Our findings indicate that for most at-risk patients, at least three of these assessments are necessary to arrive at a clinically meaningful differentiation into high- intermediate-, and low-risk groups. In particular, patients with equivocal results in the initial assessments require additional diagnostic testing to produce an accurate risk profile forming part of the comprehensive initial assessment. The findings may inform future research into reliable identification and personalized therapeutic targeting of CHR patients, to prevent transition to full-blown psychosis.
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Affiliation(s)
- Scott Richard Clark
- School of Medicine, Discipline of Psychiatry, Royal Adelaide Hospital, University of Adelaide, 4th Floor, Eleanor Harrald Building, 5005, Adelaide, SA, Australia
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Hagenmuller F, Heekeren K, Theodoridou A, Walitza S, Haker H, Rössler W, Kawohl W. Early somatosensory processing in individuals at risk for developing psychoses. Front Behav Neurosci 2014; 8:308. [PMID: 25309363 PMCID: PMC4161002 DOI: 10.3389/fnbeh.2014.00308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 08/24/2014] [Indexed: 11/13/2022] Open
Abstract
Human cortical somatosensory evoked potentials (SEPs) allow an accurate investigation of thalamocortical and early cortical processing. SEPs reveal a burst of superimposed early (N20) high-frequency oscillations around 600 Hz. Previous studies reported alterations of SEPs in patients with schizophrenia. This study addresses the question whether those alterations are also observable in populations at risk for developing schizophrenia or bipolar disorders. To our knowledge to date, this is the first study investigating SEPs in a population at risk for developing psychoses. Median nerve SEPs were investigated using multichannel EEG in individuals at risk for developing bipolar disorders (n = 25), individuals with high-risk status (n = 59) and ultra-high-risk status for schizophrenia (n = 73) and a gender and age-matched control group (n = 45). Strengths and latencies of low- and high-frequency components as estimated by dipole source analysis were compared between groups. Low- and high-frequency source activity was reduced in both groups at risk for schizophrenia, in comparison to the group at risk for bipolar disorders. HFO amplitudes were also significant reduced in subjects with high-risk status for schizophrenia compared to healthy controls. These differences were accentuated among cannabis non-users. Reduced N20 source strengths were related to higher positive symptom load. These results suggest that the risk for schizophrenia, in contrast to bipolar disorders, may involve an impairment of early cerebral somatosensory processing. Neurophysiologic alterations in schizophrenia precede the onset of initial psychotic episode and may serve as indicator of vulnerability for developing schizophrenia.
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Affiliation(s)
- Florence Hagenmuller
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Psychiatric Hospital, University of Zurich Zurich, Switzerland ; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich Zurich, Switzerland
| | - Karsten Heekeren
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Psychiatric Hospital, University of Zurich Zurich, Switzerland ; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich Zurich, Switzerland
| | - Anastasia Theodoridou
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Psychiatric Hospital, University of Zurich Zurich, Switzerland ; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich Zurich, Switzerland
| | - Susanne Walitza
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Psychiatric Hospital, University of Zurich Zurich, Switzerland ; Department of Child and Adolescent Psychiatry, University of Zurich Zurich, Switzerland
| | - Helene Haker
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Psychiatric Hospital, University of Zurich Zurich, Switzerland ; Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich Zurich, Switzerland
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Psychiatric Hospital, University of Zurich Zurich, Switzerland ; Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of Sao Paulo Sao Paulo, Brazil
| | - Wolfram Kawohl
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Psychiatric Hospital, University of Zurich Zurich, Switzerland ; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich Zurich, Switzerland
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Solís-Vivanco R, Mondragón-Maya A, León-Ortiz P, Rodríguez-Agudelo Y, Cadenhead KS, de la Fuente-Sandoval C. Mismatch Negativity reduction in the left cortical regions in first-episode psychosis and in individuals at ultra high-risk for psychosis. Schizophr Res 2014; 158:58-63. [PMID: 25064664 DOI: 10.1016/j.schres.2014.07.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 07/03/2014] [Accepted: 07/06/2014] [Indexed: 11/16/2022]
Abstract
Mismatch Negativity (MMN), an electrophysiological component that represents sensory memory processing, has been proposed as a potential vulnerability marker for psychosis. Some studies have reported a more evident MMN amplitude reduction in the left cortical regions in patients with schizophrenia. Little is known about this asymmetric pattern in patients in their first episode of psychosis (FEP) and individuals at ultra-high risk for psychosis (UHR). The aim of this study was to explore the scalp distribution of MMN in 20 FEP patients, 20 UHR subjects and 23 healthy controls. Both clinical groups were antipsychotic naïve. MMN was obtained during a passive auditory paradigm with duration deviant tones and analyzed from 15 frontocentral electrodes. There was a significant group effect in MMN amplitude (F=3.4, p=0.04), showing a decrement in both FEP and UHR compared to controls (FEP mean difference (MD)=-0.48, p=0.02; UHR MD=-0.44, p=0.04), and this amplitude decrement was more evident in the left middle regions for both clinical groups (p<0.01). In conclusion, we found a clear amplitude reduction of duration MMN in FEP patients and UHR individuals, especially in the left cortical regions. The observed pattern in both clinical samples supports the notion that MMN could be a vulnerability marker for psychosis. We propose to continue the study of this MMN laterality effect in future longitudinal studies.
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Affiliation(s)
- Rodolfo Solís-Vivanco
- Neuropsychology Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez (INNNMVS), Insurgentes Sur 3877, Col. La Fama, Tlalpan, Mexico City C.P. 14269, Mexico.
| | - Alejandra Mondragón-Maya
- Neuropsychology Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez (INNNMVS), Insurgentes Sur 3877, Col. La Fama, Tlalpan, Mexico City C.P. 14269, Mexico
| | | | - Yaneth Rodríguez-Agudelo
- Neuropsychology Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez (INNNMVS), Insurgentes Sur 3877, Col. La Fama, Tlalpan, Mexico City C.P. 14269, Mexico
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA; San Diego Veterans Affairs Medical Center, 3350 La Jolla Village Drive, San Diego, CA, USA
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32
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Abstract
Psychotic disorders continue to be among the most disabling and scientifically challenging of all mental illnesses. Accumulating research findings suggest that the etiologic processes underlying the development of these disorders are more complex than had previously been assumed. At the same time, this complexity has revealed a wider range of potential options for preventive intervention, both psychosocial and biological. In part, these opportunities result from our increased understanding of the dynamic and multifaceted nature of the neurodevelopmental mechanisms involved in the disease process, as well as the evidence that many of these entail processes that are malleable. In this article, we review the burgeoning research literature on the prodrome to psychosis, based on studies of individuals who meet clinical high risk criteria. This literature has examined a range of factors, including cognitive, genetic, psychosocial, and neurobiological. We then turn to a discussion of some contemporary models of the etiology of psychosis that emphasize the prodromal period. These models encompass the origins of vulnerability in fetal development, as well as postnatal stress, the immune response, and neuromaturational processes in adolescent brain development that appear to go awry during the prodrome to psychosis. Then, informed by these neurodevelopmental models of etiology, we turn to the application of new research paradigms that will address critical issues in future investigations. It is expected that these studies will play a major role in setting the stage for clinical trials aimed at preventive intervention.
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Chen KC, Lee IH, Yang YK, Landau S, Chang WH, Chen PS, Lu RB, David AS, Bramon E. P300 waveform and dopamine transporter availability: a controlled EEG and SPECT study in medication-naive patients with schizophrenia and a meta-analysis. Psychol Med 2014; 44:2151-2162. [PMID: 24238542 DOI: 10.1017/s0033291713002808] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Reduced P300 event-related potential (ERP) amplitude and latency prolongation have been reported in patients with schizophrenia compared to healthy controls. However, the influence of antipsychotics (and dopamine) on ERP measures are poorly understood and medication confounding remains a possibility. METHOD We explored ERP differences between 36 drug-naive patients with schizophrenia and 138 healthy controls and examined whether P300 performance was related to dopamine transporter (DAT) availability, both without the confounding effects of medication. We also conducted a random effects meta-analysis of the available literature, synthesizing the results of three comparable published articles and our local study. RESULTS No overall significant difference was found in mean P300 ERP between patients and controls in latency or in amplitude. There was a significant gender effect, with females showing greater P300 amplitude than males. A difference between patients and controls in P300 latency was evident with ageing, with latency increasing faster in patients. No effect of DAT availability on P300 latency or amplitude was detected. The meta-analysis computed the latency pooled standardized effect size (PSES; Cohen's d) of -0.13 and the amplitude PSES (Cohen's d) of 0.48, with patients showing a significant reduction in amplitude. CONCLUSIONS Our findings suggest the P300 ERP is not altered in the early stages of schizophrenia before medication is introduced, and the DAT availability does not influence the P300 ERP amplitude or latency. P300 ERP amplitude reduction could be an indicator of the progression of illness and chronicity.
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Affiliation(s)
- K C Chen
- Department of Psychiatry,National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,Tainan,Taiwan
| | - I H Lee
- Department of Psychiatry,National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,Tainan,Taiwan
| | - Y K Yang
- Department of Psychiatry,National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,Tainan,Taiwan
| | - S Landau
- Department of Biostatistics, Institute of Psychiatry,King's College London,UK
| | - W H Chang
- Department of Psychiatry,National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,Tainan,Taiwan
| | - P S Chen
- Department of Psychiatry,National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,Tainan,Taiwan
| | - R B Lu
- Department of Psychiatry,National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,Tainan,Taiwan
| | - A S David
- Department of Psychosis Studies, Institute of Psychiatry,King's College London,UK
| | - E Bramon
- Department of Psychosis Studies, Institute of Psychiatry,King's College London,UK
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35
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van Tricht MJ, Ruhrmann S, Arns M, Müller R, Bodatsch M, Velthorst E, Koelman JHTM, Bour LJ, Zurek K, Schultze-Lutter F, Klosterkötter J, Linszen DH, de Haan L, Brockhaus-Dumke A, Nieman DH. Can quantitative EEG measures predict clinical outcome in subjects at Clinical High Risk for psychosis? A prospective multicenter study. Schizophr Res 2014; 153:42-7. [PMID: 24508483 DOI: 10.1016/j.schres.2014.01.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 12/21/2013] [Accepted: 01/19/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Prediction studies in subjects at Clinical High Risk (CHR) for psychosis are hampered by a high proportion of uncertain outcomes. We therefore investigated whether quantitative EEG (QEEG) parameters can contribute to an improved identification of CHR subjects with a later conversion to psychosis. METHODS This investigation was a project within the European Prediction of Psychosis Study (EPOS), a prospective multicenter, naturalistic field study with an 18-month follow-up period. QEEG spectral power and alpha peak frequencies (APF) were determined in 113 CHR subjects. The primary outcome measure was conversion to psychosis. RESULTS Cox regression yielded a model including frontal theta (HR=1.82; [95% CI 1.00-3.32]) and delta (HR=2.60; [95% CI 1.30-5.20]) power, and occipital-parietal APF (HR=.52; [95% CI .35-.80]) as predictors of conversion to psychosis. The resulting equation enabled the development of a prognostic index with three risk classes (hazard rate 0.057 to 0.81). CONCLUSIONS Power in theta and delta ranges and APF contribute to the short-term prediction of psychosis and enable a further stratification of risk in CHR samples. Combined with (other) clinical ratings, EEG parameters may therefore be a useful tool for individualized risk estimation and, consequently, targeted prevention.
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Affiliation(s)
- Mirjam J van Tricht
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Netherlands; Department of Neurology, Clinical Neurophysiology Unit, Academic Medical Center, University of Amsterdam, Netherlands.
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Germany
| | - Martijn Arns
- Research Institute Brainclinics, Nijmegen, Netherlands; Department of Experimental Psychology, Utrecht University, Netherlands
| | - Ralf Müller
- Department of Psychiatry and Psychotherapy, University of Cologne, Germany
| | - Mitja Bodatsch
- Department of Psychiatry and Psychotherapy, University of Cologne, Germany
| | - Eva Velthorst
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Netherlands
| | - Johannes H T M Koelman
- Department of Neurology, Clinical Neurophysiology Unit, Academic Medical Center, University of Amsterdam, Netherlands
| | - Lo J Bour
- Department of Neurology, Clinical Neurophysiology Unit, Academic Medical Center, University of Amsterdam, Netherlands
| | - Katharina Zurek
- Department of Psychiatry and Psychotherapy, University of Cologne, Germany
| | | | | | - Don H Linszen
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Netherlands
| | - Anke Brockhaus-Dumke
- Department of Psychiatry and Psychotherapy, University of Cologne, Germany; Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Rheinhessen-Fachklinik Alzey, Germany
| | - Dorien H Nieman
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Netherlands
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36
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Auditory event-related potentials and α oscillations in the psychosis prodrome: neuronal generator patterns during a novelty oddball task. Int J Psychophysiol 2013; 91:104-20. [PMID: 24333745 DOI: 10.1016/j.ijpsycho.2013.12.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 12/03/2013] [Accepted: 12/06/2013] [Indexed: 11/23/2022]
Abstract
Prior research suggests that event-related potentials (ERP) obtained during active and passive auditory paradigms, which have demonstrated abnormal neurocognitive function in schizophrenia, may provide helpful tools in predicting transition to psychosis. In addition to ERP measures, reduced modulations of EEG alpha, reflecting top-down control required to inhibit irrelevant information, have revealed attentional deficits in schizophrenia and its prodromal stage. Employing a three-stimulus novelty oddball task, nose-referenced 48-channel ERPs were recorded from 22 clinical high-risk (CHR) patients and 20 healthy controls detecting target tones (12% probability, 500Hz; button press) among nontargets (76%, 350Hz) and novel sounds (12%). After current source density (CSD) transformation of EEG epochs (-200 to 1000ms), event-related spectral perturbations were obtained for each site up to 30Hz and 800ms after stimulus onset, and simplified by unrestricted time-frequency (TF) principal components analysis (PCA). Alpha event-related desynchronization (ERD) as measured by TF factor 610-9 (spectral peak latency at 610ms and 9Hz; 31.9% variance) was prominent over right posterior regions for targets, and markedly reduced in CHR patients compared to controls, particularly in three patients who later developed psychosis. In contrast, low-frequency event-related synchronization (ERS) distinctly linked to novels (260-1; 16.0%; mid-frontal) and N1 sink across conditions (130-1; 3.4%; centro-temporoparietal) did not differ between groups. Analogous time-domain CSD-ERP measures (temporal PCA), consisting of N1 sink, novelty mismatch negativity (MMN), novelty vertex source, novelty P3, P3b, and frontal response negativity, were robust and closely comparable between groups. Novelty MMN at FCz was, however, absent in the three converters. In agreement with prior findings, alpha ERD and MMN may hold particular promise for predicting transition to psychosis among CHR patients.
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37
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Onitsuka T, Oribe N, Nakamura I, Kanba S. Review of neurophysiological findings in patients with schizophrenia. Psychiatry Clin Neurosci 2013; 67:461-70. [PMID: 24102977 DOI: 10.1111/pcn.12090] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2013] [Indexed: 12/25/2022]
Abstract
Schizophrenia has been conceptualized as a failure of cognitive integration, and abnormalities in neural circuitry have been proposed as a basis for this disorder. In this article, we focus on electroencephalography and magnetoencephalography findings in patients with schizophrenia. Auditory-P50, -N100, and -P300 findings, visual-P100, -N170, and -N400 findings, and neural oscillations in patients with schizophrenia are overviewed. Published results suggest that patients with schizophrenia have neurophysiological deficits from the very early phase of sensory processing (i.e., P50, P100, N100) to the relatively late phase (i.e., P300, N400) in both auditory and visual perception. Exploring the associations between neural substrates, including neurotransmitter systems, and neurophysiological findings, will lead to a more comprehensive understanding of the pathophysiology of schizophrenia.
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Affiliation(s)
- Toshiaki Onitsuka
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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38
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Hamm JP, Ethridge LE, Shapiro JR, Pearlson GD, Tamminga CA, Sweeney JA, Keshavan MS, Thaker GK, Clementz BA. Family history of psychosis moderates early auditory cortical response abnormalities in non-psychotic bipolar disorder. Bipolar Disord 2013; 15:774-86. [PMID: 23941660 PMCID: PMC5551040 DOI: 10.1111/bdi.12110] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 04/20/2013] [Accepted: 05/31/2013] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Bipolar I disorder is a disabling illness affecting 1% of people worldwide. Family and twin studies suggest that psychotic bipolar disorder (BDP) represents a homogeneous subgroup with an etiology distinct from non-psychotic bipolar disorder (BDNP) and partially shared with schizophrenia. Studies of auditory electrophysiology [e.g., paired-stimulus and oddball measured with electroencephalography (EEG)] consistently report deviations in psychotic groups (schizophrenia, BDP), yet such studies comparing BDP and BDNP are sparse and, in some cases, conflicting. Auditory EEG responses are significantly reduced in unaffected relatives of psychosis patients, suggesting that they may relate to both psychosis liability and expression. METHODS While 64-sensor EEGs were recorded, age- and gender-matched samples of 70 BDP, 35 BDNP {20 with a family history of psychosis [BDNP(+)]}, and 70 psychiatrically healthy subjects were presented with typical auditory paired-stimuli and auditory oddball paradigms. RESULTS Oddball P3b reductions were present and indistinguishable across all patient groups. P2s to paired stimuli were abnormal only in BDP and BDNP(+). Conversely, N1 reductions to stimuli in both paradigms and P3a reductions were present in both BDP and BDNP(-) groups but were absent in BDNP(+). CONCLUSIONS Although nearly all auditory neural response components studied were abnormal in BDP, BDNP abnormalities at early- and mid-latencies were moderated by family psychosis history. The relationship between psychosis expression, heritable psychosis risk, and neurophysiology within bipolar disorder, therefore, may be complex. Consideration of such clinical disease heterogeneity may be important for future investigations of the pathophysiology of major psychiatric disturbance.
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Affiliation(s)
- Jordan P Hamm
- Department of Psychology, Bioimaging Research Center, University of Georgia, Athens, GA,Department of Neuroscience, Bioimaging Research Center, University of Georgia, Athens, GA
| | - Lauren E Ethridge
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas TX
| | - John R Shapiro
- Department of Psychology, Bioimaging Research Center, University of Georgia, Athens, GA,Department of Neuroscience, Bioimaging Research Center, University of Georgia, Athens, GA
| | - Godfrey D Pearlson
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT,Departments of Psychiatry and Neurobiology, Yale University School of Medicine, New Haven CT
| | - Carol A Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas TX
| | - John A Sweeney
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas TX
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard University, Boston MA
| | - Gunvant K Thaker
- Department of Psychiatry, MPRC, University of Maryland, Baltimore, MD, USA
| | - Brett A Clementz
- Department of Psychology, Bioimaging Research Center, University of Georgia, Athens, GA,Department of Neuroscience, Bioimaging Research Center, University of Georgia, Athens, GA
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Kayser J, Tenke CE, Kroppmann CJ, Alschuler DM, Ben-David S, Fekri S, Bruder GE, Corcoran CM. Olfaction in the psychosis prodrome: electrophysiological and behavioral measures of odor detection. Int J Psychophysiol 2013; 90:190-206. [PMID: 23856353 DOI: 10.1016/j.ijpsycho.2013.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 07/03/2013] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
Abstract
Smell identification deficits (SIDs) are relatively specific to schizophrenia and its negative symptoms, and may predict transition to psychosis in clinical high-risk (CHR) individuals. Moreover, event-related potentials (ERPs) to odors are reduced in schizophrenia. This study examined whether CHR patients show SIDs and abnormal olfactory N1 and P2 potentials. ERPs (49 channels) were recorded from 21 CHR and 20 healthy participants (13 males/group; ages 13-27 years) during an odor detection task using three concentrations of hydrogen sulfide (H2S) or blank air presented unilaterally by a constant-flow olfactometer. Neuronal generator patterns underlying olfactory ERPs were identified and measured by principal components analysis (unrestricted Varimax) of reference-free current source densities (CSD). Replicating previous findings, CSD waveforms to H2S stimuli were characterized by an early N1 sink (345 ms, lateral-temporal) and a late P2 source (600 ms, mid-frontocentroparietal). N1 and P2 varied monotonically with odor intensity (strong > medium > weak) and did not differ across groups. Patients and controls also showed comparable odor detection and had normal odor identification and thresholds (Sniffin' Sticks). However, olfactory ERPs strongly reflected differences in odor intensity and detection in controls, but these associations were substantially weaker in patients. Moreover, severity of negative symptoms in patients was associated with reduced olfactory ERPs and poorer odor detection, identification and thresholds. Three patients who developed psychosis had poorer odor detection and thresholds, and marked reductions of N1 and P2. Thus, despite the lack of overall group differences, olfactory measures may be of utility in predicting transition to psychosis among CHR patients.
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Affiliation(s)
- Jürgen Kayser
- Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY, USA; Division of Cognitive Neuroscience, New York State Psychiatric Institute, New York, NY, USA.
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Mondragón-Maya A, Solís-Vivanco R, León-Ortiz P, Rodríguez-Agudelo Y, Yáñez-Téllez G, Bernal-Hernández J, Cadenhead KS, de la Fuente-Sandoval C. Reduced P3a amplitudes in antipsychotic naïve first-episode psychosis patients and individuals at clinical high-risk for psychosis. J Psychiatr Res 2013; 47:755-61. [PMID: 23507048 DOI: 10.1016/j.jpsychires.2012.12.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/03/2012] [Accepted: 12/14/2012] [Indexed: 11/27/2022]
Abstract
Event related potentials (ERP) associated with early sensory information processing have been proposed as possible vulnerability markers for psychosis. Compared to other ERPs reported in schizophrenia research, like Mismatch Negativity (MMN), little is known about P3a, an ERP related to novelty detection. The aim of this study was to analyze the MMN-P3a complex in 20 antipsychotic naïve first-episode psychosis patients (FEP), 23 antipsychotic naïve individuals at clinical high-risk for psychosis (CHR) and 24 healthy controls. The MMN-P3a amplitudes and latencies were obtained during a passive auditory mismatch frequency deviant ERP paradigm and analyzed in frontal and central scalp regions. There were no significant differences in MMN amplitude between groups. There was a significant group difference in P3a due to reduced amplitude (F[2,64] = 3.7, p = 0.03) in both CHR and FEP groups (Mean difference (MD) = 0.39, p = 0.04 and MD = 0.49, p = 0.02, respectively) compared to the control group and this effect was most prominent on the right side (Group × laterality effect: MD = 0.57, p < 0.01 and MD = 0.58, p < 0.01, respectively). No significant differences were observed for MMN or P3a latencies between groups. Although a P3a decrement in chronic schizophrenia and FEP has been previously reported, our results suggest that this novelty detection impairment is present even in pre-psychosis stages in antipsychotic naïve subjects. This study supports the evidence that P3a could represent a neurophysiological vulnerability marker for the development of psychosis.
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Affiliation(s)
- Alejandra Mondragón-Maya
- Neuropsychology Department, Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur 3877, La Fama, Tlalpan, 14269, Mexico City, Mexico
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41
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Effects of cannabis use on event related potentials in subjects at ultra high risk for psychosis and healthy controls. Int J Psychophysiol 2013; 88:149-56. [DOI: 10.1016/j.ijpsycho.2013.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 02/18/2013] [Accepted: 03/20/2013] [Indexed: 01/10/2023]
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Bodatsch M, Klosterkötter J, Müller R, Ruhrmann S. Basic disturbances of information processing in psychosis prediction. Front Psychiatry 2013; 4:93. [PMID: 23986723 PMCID: PMC3750943 DOI: 10.3389/fpsyt.2013.00093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 08/09/2013] [Indexed: 11/13/2022] Open
Abstract
The basic symptoms (BS) approach provides a valid instrument in predicting psychosis onset and represents moreover a significant heuristic framework for research. The term "basic symptoms" denotes subtle changes of cognition and perception in the earliest and prodromal stages of psychosis development. BS are thought to correspond to disturbances of neural information processing. Following the heuristic implications of the BS approach, the present paper aims at exploring disturbances of information processing, revealed by functional magnetic resonance imaging (fMRI) and electro-encephalographic as characteristics of the at-risk state of psychosis. Furthermore, since high-risk studies employing ultra-high-risk criteria revealed non-conversion rates commonly exceeding 50%, thus warranting approaches that increase specificity, the potential contribution of neural information processing disturbances to psychosis prediction is reviewed. In summary, the at-risk state seems to be associated with information processing disturbances. Moreover, fMRI investigations suggested that disturbances of language processing domains might be a characteristic of the prodromal state. Neurophysiological studies revealed that disturbances of sensory processing may assist psychosis prediction in allowing for a quantification of risk in terms of magnitude and time. The latter finding represents a significant advancement since an estimation of the time to event has not yet been achieved by clinical approaches. Some evidence suggests a close relationship between self-experienced BS and neural information processing. With regard to future research, the relationship between neural information processing disturbances and different clinical risk concepts warrants further investigations. Thereby, a possible time sequence in the prodromal phase might be of particular interest.
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Affiliation(s)
- Mitja Bodatsch
- Department of Psychiatry and Psychotherapy, University of Cologne , Cologne , Germany
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Deficient inhibitory cortical networks in antipsychotic-naive subjects at risk of developing first-episode psychosis and first-episode schizophrenia patients: a cross-sectional study. Biol Psychiatry 2012; 72:744-51. [PMID: 22502988 DOI: 10.1016/j.biopsych.2012.03.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 02/29/2012] [Accepted: 03/06/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND Impaired cortical inhibition is a well-established finding in schizophrenia patients and has been linked to dysfunctional gamma-aminobutyric acid (GABA)ergic transmission. However, there have been no previous studies investigating cortical excitability with particular regard to intracortical inhibitory networks in antipsychotic-naive subjects at risk of developing first-episode psychosis. METHODS A total of 18 subjects at risk, 18 first-episode schizophrenia patients, and 18 healthy control subjects were included in this study. Transcranial magnetic stimulation over the left primary motor cortex was used to determine short-latency intracortical inhibition, intracortical facilitation, and the contralateral silent period (CSP). Short-latency intracortical inhibition can be considered as a parameter of GABA type A (GABA(A))-mediated inhibition and it has been proposed that CSP can test GABA type B (GABA(B))-mediated inhibitory intracortical networks. RESULTS Subjects at risk and first-episode patients showed a reduced short-latency intracortical inhibition compared with healthy control subjects, suggesting reduced GABA(A)-mediated inhibition. First-episode patients had a prolonged CSP duration compared with the other two groups, implying a GABA(B) imbalance only in patients with full-blown psychosis. Analyses did not reveal group differences for intracortical facilitation. CONCLUSIONS These results indicate specific alterations in inhibitory cortical networks in subjects at risk and in first-episode patients. It appears that there is already a cortical inhibitory deficit in at-risk individuals. These results suggest a possible GABA(A) dysfunction early in the disease course, whereas alterations in GABA(B) functionality seem to occur later in the disease's progression. Future longitudinal studies will be needed to clarify this inhibitory deficit and its relation to the transition to psychosis.
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Koutsouleris N, Davatzikos C, Bottlender R, Patschurek-Kliche K, Scheuerecker J, Decker P, Gaser C, Möller HJ, Meisenzahl EM. Early recognition and disease prediction in the at-risk mental states for psychosis using neurocognitive pattern classification. Schizophr Bull 2012; 38:1200-15. [PMID: 21576280 PMCID: PMC3494049 DOI: 10.1093/schbul/sbr037] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Neuropsychological deficits predate overt psychosis and overlap with the impairments in the established disease. However, to date, no single neurocognitive measure has shown sufficient power for a prognostic test. Thus, it remains to be determined whether multivariate neurocognitive pattern classification could facilitate the diagnostic identification of different at-risk mental states (ARMS) for psychosis and the individualized prediction of illness transition. METHODS First, classification of 30 healthy controls (HC) vs 48 ARMS individuals subgrouped into 20 "early," 28 "late" ARMS subjects was performed based on a comprehensive neuropsychological test battery. Second, disease prediction was evaluated by categorizing the neurocognitive baseline data of those ARMS individuals with transition (n = 15) vs non transition (n = 20) vs HC after 4 years of follow-up. Generalizability of classification was estimated by repeated double cross-validation. RESULTS The 3-group cross-validated classification accuracies in the first analysis were 94.2% (HC vs rest), 85.0% (early at-risk subjects vs rest), and, 91.4% (late at-risk subjects vs rest) and 90.8% (HC vs rest), 90.8% (converters vs rest), and 89.0% (nonconverters vs rest) in the second analysis. Patterns distinguishing the early or late ARMS from HC primarily involved the verbal learning/memory domains, while executive functioning and verbal IQ deficits were particularly characteristic of the late ARMS. Disease transition was mainly predicted by executive and verbal learning impairments. CONCLUSIONS Different ARMS and their clinical outcomes may be reliably identified on an individual basis by evaluating neurocognitive test batteries using multivariate pattern recognition. These patterns may have the potential to substantially improve the early recognition of psychosis.
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Affiliation(s)
- Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Nussbaumstrasse 7, 80336 Munich, Germany.
| | - Christos Davatzikos
- Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Ronald Bottlender
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Katja Patschurek-Kliche
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Johanna Scheuerecker
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Petra Decker
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Christian Gaser
- Department of Psychiatry, Friedrich-Schiller-University, Jena, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Eva M. Meisenzahl
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Nussbaumstrasse 7, 80336 Munich, Germany
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Singh F, Mirzakhanian H, Fusar-Poli P, de la Fuente-Sandoval C, Cadenhead KS. Ethical implications for clinical practice and future research in "at risk" individuals. Curr Pharm Des 2012; 18:606-12. [PMID: 22239594 DOI: 10.2174/138161212799316262] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 10/17/2011] [Indexed: 11/22/2022]
Abstract
The last 15 years have witnessed a shift in schizophrenia research with increasing interest in earlier stages of illness with the hope of early intervention and ultimately prevention of psychotic illness. Large-scale longitudinal studies have identified clinical and biological risk factors associated with increased risk of psychotic conversion, which together with symptomatic and demographic risk factors may improve the power of prediction algorithms for psychotic transition. Despite these advances, 45-70% of at risk subjects in most samples do not convert to frank psychosis, but continue to function well below their age matched counterparts. The issue is of utmost importance in light of the upcoming DSM-V and the possible inclusion of the attenuated psychotic symptoms syndrome (APSS) diagnosis, with clinical and ethical implications. Clinical considerations include feasibility of reliably diagnosing the at risk state in non-academic medical centers, variable psychotic conversion rates, a non-uniform definition of conversion and extensive debate about treatment for individuals with an ill-defined outcome. On the ethical side, diagnosing APSS could lead to unnecessary prescribing of antipsychotics with long-term deleterious consequences, slow research by providing a false sense of comfort in the diagnosis, and have psychosocial implications for those who receive a diagnosis. Thus it may be prudent to engage at risk populations early and to use broad-spectrum treatments with low risk benefit ratios to relieve functional impairments, while simultaneously studying all subsets of the at risk population.
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Affiliation(s)
- Fiza Singh
- Department of Psychiatry, University of California San Diego, San Diego, California 92093-0810, USA
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Hsieh MH, Shan JC, Huang WL, Cheng WC, Chiu MJ, Jaw FS, Hwu HG, Liu CC. Auditory event-related potential of subjects with suspected pre-psychotic state and first-episode psychosis. Schizophr Res 2012; 140:243-9. [PMID: 22784684 DOI: 10.1016/j.schres.2012.06.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/01/2012] [Accepted: 06/18/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent schizophrenia research exploring the complicated pathogenesis of schizophrenia has focused on the subjects with at-risk mental states in order to exclude the influence of confounding factors. This study explores 3 sets of auditory-related event potentials in subjects with different risk levels of psychosis. METHODS Subjects were recruited from the SOPRES study in Taiwan. P50 and N100 using an auditory paired-click paradigm and duration MMN were assessed on 32 first-episode psychosis (FEP), 30 ultra-high risk (UHR), 37 E-BARS (early/broad at-risk mental states) participants and 56 controls. RESULTS MMN was correlated with neither P50 nor N100, whereas many parameters of the latter two were intercorrelated with each other. Compared to healthy controls, MMNs were significantly lower in all 3 clinical groups (E-BARS, UHR and FEP). A gradient of sensory-gating deficits, manifested by increased P50 ratios (S2/S1) and decreased N100 differences, across different levels of clinical severity was suggested by a linear trend. For the UHR subjects, P50 gating ratio, N100 gating ratio, N100 difference, and N100S2 amplitude might be potential indicators to discriminate converters from non-converters. CONCLUSIONS By including subjects with E-BARS, our results provide new insight regarding pre-attentive auditory event-related potential in subjects across different risk levels of psychotic disorders. Impaired deviance detection shown by MMNs already exists in people at a pre-psychotic state regardless of clinical severity, while sensory-gating deficits shown by P50/N100 varies depending on the risk levels in prodromal period. Further longitudinal research exploring the relationship between ERPs and subjects with a suspected pre-psychotic state is needed.
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Affiliation(s)
- Ming H Hsieh
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
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Murphy J, Blanchard MM, Rawdon C, Kavanagh F, Kelleher I, Clarke MC, Roche RAP, Cannon M. Language processing abnormalities in adolescents with psychotic-like experiences: an event related potential study. Schizophr Res 2012; 137:91-6. [PMID: 22330177 DOI: 10.1016/j.schres.2012.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 01/09/2012] [Accepted: 01/17/2012] [Indexed: 11/16/2022]
Abstract
Language impairments are a well established finding in patients with schizophrenia and in individuals at-risk for psychosis. A growing body of research has revealed shared risk factors between individuals with psychotic-like experiences (PLEs) from the general population and patients with schizophrenia. In particular, adolescents with PLEs have been shown to be at an increased risk for later psychosis. However, to date there has been little information published on electrophysiological correlates of language comprehension in this at-risk group. A 64 channel EEG recorded electrical activity while 37 (16 At-Risk; 21 Controls) participants completed the British Picture Vocabulary Scale (BPVS-II) receptive vocabulary task. The P300 component was examined as a function of language comprehension. The at-risk group were impaired behaviourally on receptive language and were characterised by a reduction in P300 amplitude relative to the control group. The results of this study reveal electrophysiological evidence for receptive language deficits in adolescents with PLEs, suggesting that the earliest neurobiological changes underlying psychosis may be apparent in the adolescent period.
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Affiliation(s)
- Jennifer Murphy
- Department of Psychology, National University of Ireland, Maynooth, Co. Kildare, Ireland.
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Karlsgodt KH, Jacobson SC, Seal M, Fusar-Poli P. The relationship of developmental changes in white matter to the onset of psychosis. Curr Pharm Des 2012; 18:422-33. [PMID: 22239573 PMCID: PMC7130450 DOI: 10.2174/138161212799316073] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 10/17/2011] [Indexed: 12/17/2022]
Abstract
Schizophrenia is a disorder with a pronounced developmental component. Accordingly, there is a growing interest in characterizing developmental changes in the period leading up to disease onset, in an effort to develop effective preventative interventions. One of the ongoing neurodevelopmental changes known to occur in the late adolescent period that often overlaps with the prodromal phase and time of onset is white matter development and myelination. In this critical review, a disruption in the normal trajectory of white matter development could potentially play an important role in the onset of psychosis. We seek to summarize the existing state of research on white matter development in prodromal subjects, with a particular focus on diffusion tensor imaging (DTI) measures. First, we describe the physiological basis of developmental white matter changes and myelination. Next, we characterize the pattern of white matter changes associated with typical development across adolescence as measured with DTI. Then, we discuss white matter changes observed in adult patients with schizophrenia and in individuals seen in genetic and clinical high risk states. Finally, we discuss the implications of these findings for future research directions and for potential therapeutic interventions.
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Affiliation(s)
- Katherine H Karlsgodt
- Semel Institute for Neuroscience and Behavior, University of California, Los Angeles, CA, USA.
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Ziermans TB, Schothorst PF, Sprong M, Magnée MJCM, van Engeland H, Kemner C. Reduced prepulse inhibition as an early vulnerability marker of the psychosis prodrome in adolescence. Schizophr Res 2012; 134:10-5. [PMID: 22085828 DOI: 10.1016/j.schres.2011.10.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 10/04/2011] [Accepted: 10/20/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND The onset of psychosis is thought to be preceded by neurodevelopmental changes in the brain. However, the timing and nature of these changes have not been established. The aim of the present study was to determine whether three "classic" neurophysiological markers of schizophrenia are also characteristic of young adolescents (12-18 years) at ultra-high risk for psychosis (UHR). METHODS 63 young UHR individuals and 68 typically developing, age-, sex- and IQ-matched controls were recruited for neurophysiological assessment. Data for P50 suppression, prepulse inhibition (PPI) and smooth pursuit eye movements (SPEM) were gathered and compared. RESULTS UHR individuals showed reduced PPI compared to controls, which became more pronounced when controls were directly compared to medication-naive UHR individuals (N=39). There were no group differences in P50 or SPEM measures. CONCLUSIONS These results suggest that PPI is a relatively early vulnerability marker, while changes in other neurophysiological measures may only be detected or affected later during the illness course. Antipsychotic and antidepressant medication may aid in elevating PPI levels and potentially have a neuroprotective effect.
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Affiliation(s)
- Tim B Ziermans
- Department of Child and Adolescent Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.
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