Temporal processing dysfunction in schizophrenia as measured by time interval discrimination and tempo reproduction tasks

Cerebellar transcranial magnetic stimulation in psychotic disorders: intermittent, continuous, and sham theta-burst stimulation on time perception and symptom severity

Background

The cerebellum contributes to the precise timing of non-motor and motor functions, and cerebellum abnormalities have been implicated in psychosis pathophysiology. In this study, we explored the effects of cerebellar theta burst stimulation (TBS), an efficient transcranial magnetic stimulation protocol, on temporal discrimination and self-reported mood and psychotic symptoms.

Methods

We conducted a case-crossover study in which patients with psychosis (schizophrenias, schizoaffective disorders, or bipolar disorders with psychotic features) were assigned to three sessions of TBS to the cerebellar vermis: one session each of intermittent (iTBS), continuous (cTBS), and sham TBS. Of 28 enrolled patients, 26 underwent at least one TBS session, and 20 completed all three. Before and immediately following TBS, participants rated their mood and psychotic symptoms and performed a time interval discrimination task (IDT). We hypothesized that cerebellar iTBS and cTBS would modulate these measures in opposing directions, with iTBS being adaptive and cTBS maladaptive.

Results

Reaction time (RT) in the IDT decreased significantly after iTBS vs. Sham (LS-mean difference = -73.3, p = 0.0001, Cohen's d = 1.62), after iTBS vs. cTBS (LS-mean difference = -137.6, p < 0.0001, d = 2.03), and after Sham vs. cTBS (LS-mean difference = -64.4, p < 0.0001, d = 1.33). We found no effect on IDT accuracy. We did not observe any effects on symptom severity after correcting for multiple comparisons.

Conclusion

We observed a frequency-dependent dissociation between the effects of iTBS vs. cTBS to the cerebellar midline on the reaction time of interval discrimination in patients with psychosis. iTBS showed improved (adaptive) while cTBS led to worsening (maladaptive) speed of response. These results demonstrate behavioral target engagement in a cognitive dimension of relevance to patients with psychosis and generate testable hypotheses about the potential therapeutic role of cerebellar iTBS in this clinical population.

Clinical Trial Registration

clinicaltrials.gov, identifier NCT02642029.

The instrumental role of operant paradigms in translational psychiatric research: Insights from a maternal immune activation model of schizophrenia risk

Rigorous behavioral analysis is essential to the translation of research conducted using animal models of neuropsychiatric disease. Here we discuss the use of operant paradigms within our lab as a powerful approach for exploring the biobehavioral bases of disease in the maternal immune activation rat model of schizophrenia. We have investigated a range of disease features in schizophrenia including abnormal perception of time, cognition, learning, motivation, and internal state (psychosis), providing complex insights into brain and behavior. Beyond simple phenotyping, implementing sophisticated operant procedures has been effective in delineating aspects of pathological behavior, identifying interacting pathologies, and isolating contributing mechanisms of disease. We provide comment on the strengths of operant techniques to support high-quality behavioral investigations in fundamental neuropsychiatric research.

One Tap at a Time: Correlating Sensorimotor Synchronization with Brain Signatures of Temporal Processing

The ability to integrate our perceptions across sensory modalities and across time, to execute and coordinate movements, and to adapt to a changing environment rests on temporal processing. Timing is essential for basic daily tasks, such as walking, social interaction, speech and language comprehension, and attention. Impaired temporal processing may contribute to various disorders, from attention-deficit hyperactivity disorder and schizophrenia to Parkinson’s disease and dementia. The foundational importance of timing ability has yet to be fully understood; and popular tasks used to investigate behavioral timing ability, such as sensorimotor synchronization (SMS), engage a variety of processes in addition to the neural processing of time. The present study utilizes SMS in conjunction with a separate passive listening task that manipulates temporal expectancy while recording electroencephalographic data. Participants display a larger N1-P2 evoked potential complex to unexpected beats relative to temporally predictable beats, a differential we call the timing response index (TRI). The TRI correlates with performance on the SMS task: better synchronizers show a larger brain response to unexpected beats. The TRI, derived from the perceptually driven N1-P2 complex, disentangles the perceptual and motor components inherent in SMS and thus may serve as a neural marker of a more general temporal processing.

Impaired memory for temporal context in schizophrenia patients with hallucinations and thought disorganisation

INTRODUCTION

Context processing deficiencies have been established in patients with schizophrenia and it has been proposed that these deficiencies are involved in the formation of positive symptoms.

METHOD

We administered a temporal context discrimination task to 60 schizophrenia patients and 60 healthy individuals. Pictures were presented in two sessions separated by half an hour and the participants were required to remember afterwards whether the pictures had been presented in the first or the second session.

RESULTS

The number of temporal context errors was significantly increased in the patient group. More specifically, it was highly significantly increased in a subgroup of patients presenting hallucinations, while the patients without hallucinations were equivalent to the healthy individuals. Regression analyses revealed that, independently of memory of the pictures themselves, verbal and visual hallucinations, as well as thought disorganisation, were associated with more temporal context errors. In contrast, affective flattening and anhedonia were associated with fewer of these errors.

CONCLUSION

Inability to process or remember the temporal context of production of events might be a mechanism underlying both hallucinations and thought disorganisation.

Effect of Motion Perception on Intertemporal Choice Is Associated With the Altered Time Perception

Intertemporal choice refers to the choice between receiving a small immediate reward or a large delayed one. Previous studies have indicated that time perception plays a critical role in the intertemporal choice, and it could be affected by the features of the target stimulus in the time reproduction task, such as speed of movement and state of motion. However, there is no evidence about whether backward or forward motion perception could alter the intertemporal choice. Thus, in our current study, 29 participants were asked to perform two tasks in a random order. One was the intertemporal choice task after viewing videos containing moving elements with forward/backward directions as well as stationary ones, and another was the time perception task. We found that the discounting rate in intertemporal choice was significantly larger in backward motion condition than in both forward motion and stationary conditions, indicating that backward motion perception made participants more myopic (specifically, more likely to choose the smaller immediate reward instead of the large delayed one) during their decision-makings. Meanwhile, participants overestimated the temporal duration in a time perception task in backward motion condition compared to the other two conditions. Furthermore, the Pearson's correlation analysis showed that the changes of the intertemporal choice induced by backward motion perception could be associated with the altered time perception. As far as we know, we provide the first evidence on influence of motion perception on the intertemporal choice as well as its possible cognitive correlates, which extend previous studies on cognitive basis of the intertemporal choices.

Maternal immune activation in rats produces temporal perception impairments in adult offspring analogous to those observed in schizophrenia

The neurophysiology underlying temporal perception significantly overlaps with areas of dysfunction identified in schizophrenia. Patients commonly exhibit distorted temporal perception, which likely contributes to functional impairments. Thus, study of temporal perception in animal models of the disease may help to understand both cognitive and neurobiological factors involved in functional impairments in patients. As maternal immune activation (MIA) has been shown to be a significant etiological risk factor in development of schizophrenia and other developmental psychiatric diseases, we tested interval timing in a rat model of MIA that has previously been shown to recapitulate several behavioural and neurophysiological impairments observed in the disease. Rats were tested on a temporal-bisection task, in which temporal duration stimuli were categorized as either “short” or “long” by responding to a corresponding lever. Data from this task were modeled to provide estimates of accuracy and sensitivity of temporal perception. Parameter estimates derived from the model fitting showed that MIA rats significantly overestimated the passage of time compared to controls. These results indicate that the MIA rat paradigm recapitulates timing distortions that are phenotypical of schizophrenia. These findings lend further support to the epidemiological validity of this MIA rat model, supporting its relevance for future research into the role of maternal immune activation in producing neurobiological and behavioural impairments in schizophrenia.

The dopaminergic system dynamic in the time perception: a review of the evidence

Dopaminergic system plays a key role in perception, which is an important executive function of the brain. Modulation in dopaminergic system forms an important biochemical underpinning of neural mechanisms of time perception in a very wide range, from milliseconds to seconds to longer daily rhythms. Distinct types of temporal experience are poorly understood, and the relationship between processing of different intervals by the brain has received little attention. A comprehensive understanding of interval timing functions should be sought within a wider context of temporal processing, involving genetic aspects, pharmacological models, cognitive aspects, motor control and the neurological diseases with impaired dopaminergic system. Particularly, an unexplored question is whether the role of dopamine in interval timing can be integrated with the role of dopamine in non-interval timing temporal components. In this review, we explore a wider perspective of dopaminergic system, involving genetic polymorphisms, pharmacological models, executive functions and neurological diseases on the time perception. We conclude that the dopaminergic system has great participation in impact on time perception and neurobiological basis of the executive functions and neurological diseases.

Meta-analysis of functional magnetic resonance imaging studies of timing and cognitive control in schizophrenia and bipolar disorder: Evidence of a primary time deficit

Schizophrenia (SZ) and Bipolar Disorder (BD) are associated with deficits in both timing and cognitive control functions. However, the underlying neurological dysfunctions remain poorly understood. The main goal of this study was to identify brain structures activated both by increases in cognitive activity and during timing tasks in patients with SZ and BD relative to controls. We conducted two signed differential mapping (SDM) meta-analyses of functional magnetic resonance imaging studies assessing the brain response to increasing levels of cognitive difficulty: one concerned SZ, and the other BD patients. We conducted a similar SDM meta-analysis on neuroimaging of timing in SZ (no studies in BD could be included). Finally, we carried out a multimodal meta-analysis to identify common brain regions in the findings of the two previous meta-analyses. We found that SZ patients showed hypoactivation in timing-related cortical-subcortical areas. The dysfunction observed during timing partially coincided with deficits for cognitive control functions. We hypothesize that a dysfunctional temporal/cognitive control network underlies the persistent cognitive impairment observed in SZ.

When one's sense of agency goes wrong: Absent modulation of time perception by voluntary actions and reduction of perceived length of intervals in passivity symptoms in schizophrenia

Passivity symptoms in schizophrenia are characterised by an absence of agency for actions, thoughts and other somatic experiences. Time perception and intentional binding have both been linked to agency and schizophrenia but have not been examined in passivity symptoms. Time perception and intentional binding were assessed in people with schizophrenia (n=15 with, n=24 without passivity symptoms) and 43 healthy controls using an interval estimation procedure (200, 400 and 600ms intervals) with active, passive and observed movements. People with passivity symptoms did not display action-modulation of time perception, while those without passivity symptoms estimated intervals to be the same after active and observed movements. Additionally, both clinical samples reported intervals to be shorter with increasing interval length. We propose that impaired predictive processes may produce an overreliance on external cues and, together with shorter perceived intervals, lead to the subjective loss of agency.

Explicit Time Deficit in Schizophrenia: Systematic Review and Meta-Analysis Indicate It Is Primary and Not Domain Specific

Although timing deficits are a robust finding in schizophrenia (SZ), the notion of a genuine time perception disorder in SZ is still being debated because distortions in timing might depend on neuropsychological deficits that are characteristics of the illness. Here we used meta-analytic methods to summarize the evidence of timing deficits in SZ and moderator analyses to determine whether defective timing in SZ arises from nontemporal sources or from defective time perception. PubMed Services, PsycNET, and Scopus were searched through March 2015, and all references in articles were investigated to find other relevant studies. Studies were selected if they included subjects with a primary diagnosis of SZ compared to a healthy control (HC) group and if they reported behavioral measures of duration estimation (perceptual and motor explicit timing). Data from 24 studies published from 1956 to 2015, which comprised 747 SZ individuals and 808 HC, were included. Results indicate that SZ individuals are less accurate than HC in estimating time duration across a wide range of tasks. Subgroup analyses showed that the fundamental timing deficit in SZ is independent from the length of the to-be-timed duration (automatic and cognitively controlled timing) and from methods of stimuli estimation (perceptual and motor timing). Thus, time perception per se is disturbed in SZ (not just task-specific timing processes) and this perturbation is independent from more generalized cognitive impairments. Behavioral evidence of disturbed automatic timing should be more thoroughly investigated with the aim of defining it as a cognitive phenotype for more homogeneous diagnostic subgrouping.

Neural mechanisms regulating different forms of risk-related decision-making: Insights from animal models

Over the past 20 years there has been a growing interest in the neural underpinnings of cost/benefit decision-making. Recent studies with animal models have made considerable advances in our understanding of how different prefrontal, striatal, limbic and monoaminergic circuits interact to promote efficient risk/reward decision-making, and how dysfunction in these circuits underlies aberrant decision-making observed in numerous psychiatric disorders. This review will highlight recent findings from studies exploring these questions using a variety of behavioral assays, as well as molecular, pharmacological, neurophysiological, and translational approaches. We begin with a discussion of how neural systems related to decision subcomponents may interact to generate more complex decisions involving risk and uncertainty. This is followed by an overview of interactions between prefrontal-amygdala-dopamine and habenular circuits in regulating choice between certain and uncertain rewards and how different modes of dopamine transmission may contribute to these processes. These data will be compared with results from other studies investigating the contribution of some of these systems to guiding decision-making related to rewards vs. punishment. Lastly, we provide a brief summary of impairments in risk-related decision-making associated with psychiatric disorders, highlighting recent translational studies in laboratory animals.

Temporal perception deficits in schizophrenia: integration is the problem, not deployment of attentions

Patients with schizophrenia are known to have impairments in sensory processing. In order to understand the specific temporal perception deficits of schizophrenia, we investigated and determined to what extent impairments in temporal integration can be dissociated from attention deployment using Attentional Blink (AB). Our findings showed that there was no evident deficit in the deployment of attention in patients with schizophrenia. However, patients showed an increased temporal integration deficit within a hundred-millisecond timescale. The degree of such integration dysfunction was correlated with the clinical manifestations of schizophrenia. There was no difference between individuals with/without schizotypal personality disorder in temporal integration. Differently from previous studies using the AB, we did not find a significant impairment in deployment of attention in schizophrenia. Instead, we used both theoretical and empirical approaches to show that previous findings (using the suppression ratio to correct for the baseline difference) produced a systematic exaggeration of the attention deficits. Instead, we modulated the perceptual difficulty of the task to bring the baseline levels of target detection between the groups into closer alignment. We found that the integration dysfunction rather than deployment of attention is clinically relevant, and thus should be an additional focus of research in schizophrenia.

Understanding schizophrenia as a disorder of consciousness: biological correlates and translational implications from quantum theory perspectives

From neurophenomenological perspectives, schizophrenia has been conceptualized as "a disorder with heterogeneous manifestations that can be integrally understood to involve fundamental perturbations in consciousness". While these theoretical constructs based on consciousness facilitate understanding the 'gestalt' of schizophrenia, systematic research to unravel translational implications of these models is warranted. To address this, one needs to begin with exploration of plausible biological underpinnings of "perturbed consciousness" in schizophrenia. In this context, an attractive proposition to understand the biology of consciousness is "the orchestrated object reduction (Orch-OR) theory" which invokes quantum processes in the microtubules of neurons. The Orch-OR model is particularly important for understanding schizophrenia especially due to the shared 'scaffold' of microtubules. The initial sections of this review focus on the compelling evidence to support the view that "schizophrenia is a disorder of consciousness" through critical summary of the studies that have demonstrated self-abnormalities, aberrant time perception as well as dysfunctional intentional binding in this disorder. Subsequently, these findings are linked with 'Orch-OR theory' through the research evidence for aberrant neural oscillations as well as microtubule abnormalities observed in schizophrenia. Further sections emphasize the applicability and translational implications of Orch-OR theory in the context of schizophrenia and elucidate the relevance of quantum biology to understand the origins of this puzzling disorder as "fundamental disturbances in consciousness".

Myopic decisions under negative emotions correlate with altered time perception

Previous studies have obtained inconsistent findings about emotional influence on inter-temporal choice (IC). In the present study, we first examined the effect of temporary emotional priming induced by affective pictures in a trial-to-trial paradigm on IC. The results showed that negative priming resulted in much higher percentages of trials during which smaller-but-sooner reward (SS%) were chosen compared with positive and neutral priming. Next, we attempted to explore the possible mechanisms underlying such emotional effects. When participants performed a time reproduction task, mean reaction times in negative priming condition were significantly shorter than those in the other two emotional contexts, which indicated that negative emotional priming led to overestimation of time. Moreover, such overestimation was negatively correlated with performance in the IC task. In contrast, temporary changes of emotional contexts did not alter performances in a Go/NoGo task (including commission errors and omission errors). In sum, our present findings suggested that myopic decisions under negative emotions were associated with altered time perception but not response inhibition.

Neural basis of altered physical and social causality judgements in schizophrenia

Patients with schizophrenia (SZ) often make aberrant cause and effect inferences in non-social and social situations. Likewise, patients may perceive cause-and-effect relationships abnormally as a result of an alteration in the physiology of perception. The neural basis for dysfunctions in causality judgements in the context of both physical motion and social motion is unknown. The current study used functional magnetic resonance imaging (fMRI) to investigate a group of patients with SZ and a group of control subjects performing judgements of causality on animated collision sequences (launch-events, Michotte, 1963) and comparable "social" motion stimuli. In both types of animations, similar motion trajectories of the affected object were configured, using parametrical variations of space (angle deviation) and time (delay). At the behavioural level, SZ patients made more physical and less social causal judgements than control subjects, and their judgements were less influenced by motion attributes (angle/time delay). In the patients group, fMRI revealed greater BOLD-responses, during both physical and social causality judgements (group×task interaction), in the left inferior frontal gyrus (L.IFG). Across conditions (main effect), L.IFG-interconnectivity with bilateral occipital cortex was reduced in the patient group. This study provides the first insight into the neural correlates of altered causal judgements in SZ. Patients with SZ tended to over-estimate physical and under-estimate social causality. In both physical and social contexts, patients are influenced less by motion parameters (space and time) than control subjects. Imaging findings of L.IFG-disconnectivity and task-related hyper-activation in the patient group could indicate common dysfunctions in the neural activations needed to integrate external cue-information (space/time) with explicit (top-down) cause-effect judgements of object motions in physical and social settings.

Developing treatments for cognitive deficits in schizophrenia: the challenge of translation

Schizophrenia is a life-long debilitating mental disorder affecting tens of millions of people worldwide. The serendipitous discovery of antipsychotics focused pharmaceutical research on developing a better antipsychotic. Our understanding of the disorder has advanced however, with the knowledge that cognitive enhancers are required for patients in order to improve their everyday lives. While antipsychotics treat psychosis, they do not enhance cognition and hence are not antischizophrenics. Developing pro-cognitive therapeutics has been extremely difficult, however, especially when no approved treatment exists. In lieu of stumbling on an efficacious treatment, developing targeted compounds can be facilitated by understanding the neural mechanisms underlying altered cognitive functioning in patients. Equally importantly, these cognitive domains will need to be measured similarly in animals and humans so that novel targets can be tested prior to conducting expensive clinical trials. To date, the limited similarity of testing across species has resulted in a translational bottleneck. In this review, we emphasize that schizophrenia is a disorder characterized by abnormal cognitive behavior. Quantifying these abnormalities using tasks having cross-species validity would enable the quantification of comparable processes in rodents. This approach would increase the likelihood that the neural substrates underlying relevant behaviors will be conserved across species. Hence, we detail cross-species tasks which can be used to test the effects of manipulations relevant to schizophrenia and putative therapeutics. Such tasks offer the hope of providing a bridge between non-clinical and clinical testing that will eventually lead to treatments developed specifically for patients with deficient cognition.

Time perception networks and cognition in schizophrenia: a review and a proposal

Timing is an essential function for the survival of many living organisms. Despite its significance, it is relatively under-researched, particularly in schizophrenia. We examined neurophysiological, neuropathological, imaging and genetic studies of both healthy subjects and subjects suffering from schizophrenia in relation to time perception as measured by interval timing. We found that the data from studies in healthy populations indicate that time perception may be inter-linked with numerous other cognitive functions and share common brain networks. The same networks are implicated in the pathophysiology of schizophrenia. There is also evidence that several neurotransmitter systems, particularly the dopaminergic D2 system, are involved in interval timing. Patients with schizophrenia have been shown to suffer from a distorted sense of time, which has an impact on their cognitive function and results in both positive and negative symptoms. Therefore, genes involved in interval timing can be considered candidate genes for distorted cognition in schizophrenia. We discuss the hypothesis that time perception dysfunction is a primary cognitive dysfunction in schizophrenia.

Prospective memory in schizophrenia: a review

The wide range of psychological and cognitive symptoms associated with schizophrenia can often affect the level of independence that individuals with schizophrenia can achieve in their lives. Prospective memory (PM), or memory associated with future intentions, has been proposed as a useful indicator of select independent living skills. Currently, there is limited research with regards to prospective memory in schizophrenia. The current review systematically summarizes the literature focusing on prospective memory in schizophrenia and concludes that individuals with schizophrenia exhibited both an impairment in PM when compared to healthy controls and a general lack of awareness regarding these deficits. The existing research also suggests that PM deficits are not related to chronicity of illness or medications associated with schizophrenia. Limited findings suggest that PM deficits in individuals with schizophrenia may be associated with the ability to live independently and instrumental activities of daily living.

Time dysperception perspective for acquired brain injury

Distortions of time perception are presented by a number of neuropsychiatric illnesses. Here we survey timing abilities in clinical populations with focal lesions in key brain structures recently implicated in human studies of timing. We also review timing performance in amnesic and traumatic brain injured patients in order to identify the nature of specific timing disorders in different brain damaged populations. We purposely analyzed the complex relationship between both cognitive and contextual factors involved in time estimation, as to characterize the correlation between timed and other cognitive behaviors in each group. We assume that interval timing is a solid construct to study cognitive dysfunctions following brain injury, as timing performance is a sensitive metric of information processing, while temporal cognition has the potential of influencing a wide range of cognitive processes. Moreover, temporal performance is a sensitive assay of damage to the underlying neural substrate after a brain insult. Further research in neurological and psychiatric patients will clarify whether time distortions are a manifestation of, or a mechanism for, cognitive and behavioral symptoms of neuropsychiatric disorders.

Differential reinforcement of an approach response in zebrafish (Danio rerio)

Five zebrafish were trained to approach a target using a fully automated training procedure. During a training session, if the distance between the fish and the target was closer than an arbitrarily set distance, the approach response was reinforced by food. The fish continued to respond under this reinforcement contingency and the distance criterion could be shortened up to eighty times within a 1h session. The initial distance limit was then shortened for the next test training session. Once the initial distance criterion was reduced to a final minimum distance, the distance criterion was fixed at this value for the next nine successive sessions. In a second experiment using different fish, we manipulated approach distances in three conditions. The first condition was identical to the changing criterion training as in Experiment 1. In the second condition, only response distances under a distance criterion were reinforced. And in the last condition, only response distances over the distance criterion were reinforced. Results show that zebrafish can control the distance between themselves and a target. In other words, zebrafish are sensitive to the spatial consequences of their behavior. The present results show that a differential reinforcement paradigm can be successfully applied to zebrafish which therefore enhances their value as a vertebrate model for studies of complex behavior including visuomotor learning.

Impaired interval timing and spatial-temporal integration in mice deficient in CHL1, a gene associated with schizophrenia

Interval timing is crucial for decision-making and motor control and is impaired in many neuropsychiatric disorders, including schizophrenia - a neurodevelopmental disorder with a strong genetic component. Several gene mutations, polymorphisms or rare copy number variants have been associated with schizophrenia. L1 cell adhesion molecules (L1CAMs) are involved in neurodevelopmental processes, and in synaptic function and plasticity in the adult brain. Mice deficient in the Close Homolog to L1 (CHL1) adhesion molecule show alterations of hippocampal and thalamo-cortical neuroanatomy as well as deficits in sensorimotor gating and exploratory behavior. We analyzed interval timing and attentional control of temporal and spatial information in male CHL1 deficient (KO) mice and wild type (WT) controls. In a 20-s peak-interval timing procedure (standard and reversed), KO mice showed a maintained leftward shift of the response function relative to WT, indicative of a deficit in memory encoding/decoding. In trials with 2, 5, or 10-s gaps, KO mice shifted their peak times less than WT controls at longer gap durations, suggesting a decreased (attentional) effect of interruptions. In the spatial-temporal task, KO mice made more working and reference memory errors than controls, suggestive of impaired use of spatial and/or temporal information. When the duration spent on the central platform of the maze was manipulated, WT mice showed fewer spatial errors at the trained duration than at shorter or longer durations, indicative of discrimination based upon spatial-temporal integration. In contrast, performance was similar at all tested durations in KO mice, indicative of control by spatial cues, but not by temporal cues. These results suggest that CHL1 KO mice selectively attend to the more relevant cues of the task, and fail to integrate more complex spatial-temporal information, possibly as a result of reduced memory capacity related to hippocampal impairment, and altered temporal-integration mechanisms possibly due to thalamo-cortical anomalies.