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Zoghbi AW, Lieberman JA, Girgis RR. The neurobiology of duration of untreated psychosis: a comprehensive review. Mol Psychiatry 2023; 28:168-190. [PMID: 35931757 PMCID: PMC10979514 DOI: 10.1038/s41380-022-01718-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 01/11/2023]
Abstract
Duration of untreated psychosis (DUP) is defined as the time from the onset of psychotic symptoms until the first treatment. Studies have shown that longer DUP is associated with poorer response rates to antipsychotic medications and impaired cognition, yet the neurobiologic correlates of DUP are poorly understood. Moreover, it has been hypothesized that untreated psychosis may be neurotoxic. Here, we conducted a comprehensive review of studies that have examined the neurobiology of DUP. Specifically, we included studies that evaluated DUP using a range of neurobiologic and imaging techniques and identified 83 articles that met inclusion and exclusion criteria. Overall, 27 out of the total 83 studies (32.5%) reported a significant neurobiological correlate with DUP. These results provide evidence against the notion of psychosis as structurally or functionally neurotoxic on a global scale and suggest that specific regions of the brain, such as temporal regions, may be more vulnerable to the effects of DUP. It is also possible that current methodologies lack the resolution needed to more accurately examine the effects of DUP on the brain, such as effects on synaptic density. Newer methodologies, such as MR scanners with stronger magnets, PET imaging with newer ligands capable of measuring subcellular structures (e.g., the PET ligand [11C]UCB-J) may be better able to capture these limited neuropathologic processes. Lastly, to ensure robust and replicable results, future studies of DUP should be adequately powered and specifically designed to test for the effects of DUP on localized brain structure and function with careful attention paid to potential confounds and methodological issues.
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Affiliation(s)
- Anthony W Zoghbi
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, 77030, USA.
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA.
- Institute of Genomic Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA.
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, 10032, USA.
- Office of Mental Health, New York State Psychiatric Institute, New York, NY, 10032, USA.
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Ragy R Girgis
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, 10032, USA.
- Office of Mental Health, New York State Psychiatric Institute, New York, NY, 10032, USA.
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Wen K, Zhao Y, Gong Q, Zhu Z, Li Q, Pan N, Fu S, Radua J, Vieta E, Kumar P, Kemp GJ, Biswal BB. Cortical thickness abnormalities in patients with first episode psychosis: a meta-analysis of psychoradiologic studies and replication in an independent sample. PSYCHORADIOLOGY 2021; 1:185-198. [PMID: 35156043 PMCID: PMC8826222 DOI: 10.1093/psyrad/kkab015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Abnormalities of cortical thickness (CTh) in patients with their first episode psychosis (FEP) have been frequently reported, but findings are inconsistent. OBJECTIVE To define the most consistent CTh changes in patients with FEP by meta-analysis of published whole-brain studies. METHODS The meta-analysis used seed-based d mapping (SDM) software to obtain the most prominent regional CTh changes in FEP, and meta-regression analyses to explore the effects of demographics and clinical characteristics. The meta-analysis results were verified in an independent sample of 142 FEP patients and 142 age- and sex-matched healthy controls (HCs), using both a vertex-wise and a region of interest analysis, with multiple comparisons correction. RESULTS The meta-analysis identified lower CTh in the right middle temporal cortex (MTC) extending to superior temporal cortex (STC), insula, and anterior cingulate cortex (ACC) in FEP compared with HCs. No significant correlations were identified between CTh alterations and demographic or clinical variables. These results were replicated in the independent dataset analysis. CONCLUSION This study identifies a robust pattern of cortical abnormalities in FEP and extends understanding of gray matter abnormalities and pathological mechanisms in FEP.
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Affiliation(s)
- Keren Wen
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Youjin Zhao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, China
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Chengdu 610041, Sichuan, China
| | - Ziyu Zhu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Qian Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Nanfang Pan
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Shiqin Fu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Research Networking Center (CIBERSAM), Barcelona 08036, Catalonia, Spain
- Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Solna 171-77, Stockholm, Sweden
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London WC2R 2LS, UK
| | - Eduard Vieta
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Research Networking Center (CIBERSAM), Barcelona 08036, Catalonia, Spain
- Barcelona Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, Barcelona 08036, Catalonia, Spain
| | - Poornima Kumar
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont 02478, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston 02115, MA, USA
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L69 3GE, UK
| | - Bharat B Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark 07102, NJ, USA
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, China
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Rodriguez-Perez N, Ayesa-Arriola R, Ortiz-García de la Foz V, Setien-Suero E, Tordesillas-Gutierrez D, Crespo-Facorro B. Long term cortical thickness changes after a first episode of non- affective psychosis: The 10 year follow-up of the PAFIP cohort. Prog Neuropsychopharmacol Biol Psychiatry 2021; 108:110180. [PMID: 33212193 DOI: 10.1016/j.pnpbp.2020.110180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/28/2020] [Accepted: 11/12/2020] [Indexed: 12/25/2022]
Abstract
Cortical thickness has been widely studied in individuals with schizophrenia and, in particular, first-episode psychosis. Abnormalities have been described, although there is, to date, a lack of consensus regarding changes across time and correlations with clinical and functional outcomes of the illness. One hundred and twenty-three first-episode psychosis patients and 74 healthy volunteers were subjected to magnetic resonance imaging scans and clinical and functional assessments by different scales at four consecutive visits during a 10 year follow-up period. Linear mixed effects models were applied to our data to compute cortical thickness changes over time in (1) schizophrenia patients versus healthy controls and (2) in patients with good versus poor functional outcome. The associations between cortical thickness percentage changes and clinical and functional status at 10 years were also assessed. The patients presented a thinner cortex than the controls at baseline (b's = -0.06; q ≤ 0.00023) with non-significant coefficients for the interaction term (follow-up time x group) (b's = -0.001; q ≥ 0.681). Poor functioning patients presented statistically significant coefficients for the interaction term (follow-up time x functionality) (left: b = -0.005, q = 0.019; right: b = -0.005, q = 0.022). In contrast, no correlations were found between cortical thickness measurements and clinical variables at 10 years. Overall, there were widespread thickness anomalies in first-episode psychosis patients across cortical regions that remained stable across time. Progressive thickness changes were related to patient functional outcomes, with progressive and steeper cortical thinning in patients with worse functional outcomes and a stabilization in those with better outcomes.
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Affiliation(s)
- Noelia Rodriguez-Perez
- Hospital Universitario Virgen del Rocío, Department of Psychiatry, Instituto de Investigación Sanitaria de Sevilla, IBiS, Sevilla, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain.
| | - Rosa Ayesa-Arriola
- University Hospital Marqués de Valdecilla, IDIVAL, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - Victor Ortiz-García de la Foz
- University Hospital Marqués de Valdecilla, IDIVAL, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - Esther Setien-Suero
- University Hospital Marqués de Valdecilla, IDIVAL, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - Diana Tordesillas-Gutierrez
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; Neuroimaging Unit, Technological Facilities, IDIVAL, Santander, Spain
| | - Benedicto Crespo-Facorro
- Hospital Universitario Virgen del Rocío, Department of Psychiatry, Instituto de Investigación Sanitaria de Sevilla, IBiS, Sevilla, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; University of Sevilla, Sevilla, Spain.
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Sheffield JM, Huang AS, Rogers BP, Blackford JU, Heckers S, Woodward ND. Insula sub-regions across the psychosis spectrum: morphology and clinical correlates. Transl Psychiatry 2021; 11:346. [PMID: 34088895 PMCID: PMC8178380 DOI: 10.1038/s41398-021-01461-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/04/2021] [Accepted: 05/14/2021] [Indexed: 02/05/2023] Open
Abstract
The insula is a heterogeneous cortical region, comprised of three cytoarchitecturally distinct sub-regions (agranular, dysgranular, and granular), which traverse the anterior-posterior axis and are differentially involved in affective, cognitive, and somatosensory processing. Smaller insula volume is consistently reported in psychosis-spectrum disorders and is hypothesized to result, in part, from abnormal neurodevelopment. To better understand the regional and diagnostic specificity of insula abnormalities in psychosis, their developmental etiology, and clinical correlates, we characterized insula volume and morphology in a large group of adults with a psychotic disorder (schizophrenia spectrum, psychotic bipolar disorder) and a community-ascertained cohort of psychosis-spectrum youth (age 8-21). Insula volume and morphology (cortical thickness, gyrification, sulcal depth) were quantified from T1-weighted structural brain images using the Computational Anatomy Toolbox (CAT12). Healthy adults (n = 196), people with a psychotic disorder (n = 303), and 1368 individuals from the Philadelphia Neurodevelopmental Cohort (PNC) (381 typically developing (TD), 381 psychosis-spectrum (PS) youth, 606 youth with other psychopathology (OP)), were investigated. Insula volume was significantly reduced in adults with psychotic disorders and psychosis-spectrum youth, following an anterior-posterior gradient across granular sub-regions. Morphological abnormalities were limited to lower gyrification in psychotic disorders, which was specific to schizophrenia and associated with cognitive ability. Insula volume and thickness were associated with cognition, and positive and negative symptoms of psychosis. We conclude that smaller insula volume follows an anterior-posterior gradient in psychosis and confers a broad risk for psychosis-spectrum disorders. Reduced gyrification is specific to schizophrenia and may reflect altered prenatal development that contributes to cognitive impairment.
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Affiliation(s)
- Julia M Sheffield
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Anna S Huang
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Baxter P Rogers
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | | | - Stephan Heckers
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Neil D Woodward
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Penadés R, Pujol N, Catalán R, Masana G, García-Rizo C, Bargalló N, González-Rodríguez A, Vidal-Piñeiro D, Bernardo M, Junqué C. Cortical thickness in regions of frontal and temporal lobes is associated with responsiveness to cognitive remediation therapy in schizophrenia. Schizophr Res 2016; 171:110-6. [PMID: 26777884 DOI: 10.1016/j.schres.2016.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 12/01/2015] [Accepted: 01/01/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite the evidence for the efficacy of cognitive remediation therapy (CRT) in patients with schizophrenia, comparatively little is known about the potential predictors of good treatment response. We tried to determine whether improvement in cognition following CRT is positively associated with baseline cortical thickness (CTh) or baseline clinical symptoms level or baseline cognitive performance. METHODS The current work uses data collected in a previous study (Penadés et al., 2013) in which a CRT program was investigated through a controlled randomized trial (NCT 01318850) with three groups: patients receiving cognitive treatment, patients receiving a different psychological intervention as an active and a healthy control groups (HC). CTh was estimated from the T1-weighted MRIs using the FreeSurfer software. RESULTS We found that CRT responsiveness was associated with baseline measures of cortical thickness in the frontal and temporal lobes. Positive changes in non-verbal memory were associated with greater initial thickness in cortical regions involving left superior frontal, left caudal middle frontal, left precuneus and paracentral; superior frontal, right caudal middle frontal gyrus and pars opercularis. Additionally, uncorrected data also suggested that verbal memory improvement could be associated with CTh in some areas of the frontal and temporal lobes. DISCUSSION Our findings are consistent with the hypothesis that greater CTh in specific brain areas could be associated with better response to CRT. Furthermore, brain areas associated with CRT responsiveness were located mainly in regions of frontal and temporal lobes.
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Affiliation(s)
- Rafael Penadés
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clinic, Barcelona, Spain.
| | - Nuria Pujol
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain
| | - Rosa Catalán
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clinic, Barcelona, Spain
| | - Guillem Masana
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clinic, Barcelona, Spain
| | - Clemente García-Rizo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clinic, Barcelona, Spain
| | - Nuria Bargalló
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centre de Diagnòstic per la Imatge (CDIC), Hospital Clinic, Barcelona, Spain; Magnetic Resonance Imaging Core Facility, IDIBAPS, Barcelona, Spain
| | - Alexandre González-Rodríguez
- Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clinic, Barcelona, Spain
| | - Dídac Vidal-Piñeiro
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Miquel Bernardo
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clinic, Barcelona, Spain
| | - Carme Junqué
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Abstract
Childhood-onset schizophrenia is a rare pediatric onset psychiatric disorder continuous with and typically more severe than its adult counterpart. Neuroimaging research conducted on this population has revealed similarly severe neural abnormalities. When taken as a whole, neuroimaging research in this population shows generally decreased cortical gray matter coupled with white matter connectivity abnormalities, suggesting an anatomical basis for deficits in executive function. Subcortical abnormalities are pronounced in limbic structures, where volumetric deficits are likely related to social skill deficits, and cerebellar deficits that have been correlated to cognitive abnormalities. Structures relevant to motor processing also show a significant alteration, with volumetric increase in basal ganglia structures likely due to antipsychotic administration. Neuroimaging of this disorder shows an important clinical image of exaggerated cortical loss, altered white matter connectivity, and differences in structural development of subcortical areas during the course of development and provides important background to the disease state.
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Shin DJ, Lee TY, Jung WH, Kim SN, Jang JH, Kwon JS. Away from home: the brain of the wandering mind as a model for schizophrenia. Schizophr Res 2015; 165:83-9. [PMID: 25864955 DOI: 10.1016/j.schres.2015.03.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 02/16/2015] [Accepted: 03/22/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND The notion that schizophrenia patients' (SZ) sense of being detached from external reality is a core feature of the disorder has existed since the early days of its recognition and is still largely emphasized in first person accounts of SZs; however, its etiology, neurophysiological mechanism, and significance for clinical symptoms are unclear. Mind-wandering is a ubiquitous experience of being detached from reality, the underlying neural mechanism of which closely resembles the brain in a resting-state. METHODS The resting-state functional magnetic resonance imaging data of 33 SZs and 33 matched healthy controls (CNT) were acquired. All subjects answered the mind-wandering subscale of the Imaginal Processing Inventory Questionnaire. Functional connectivity maps were constructed using 82 regions of interest comprising default-mode, salience, and frontoparietal networks. RESULTS SZs exhibit significantly higher mind-wandering frequency relative to CNT. The elevated mind-wandering frequency in SZs significantly correlated with positive and general symptom severity. The mind-wandering frequency was inversely correlated with connectivity degree in the right ventromedial prefrontal cortex, the brain region involved in self-experience in SZs. CONCLUSIONS Our results suggest that self-disturbances in SZs can explain SZs' disconnection to the external world, leading to the manifestation of positive psychotic symptoms. This study demonstrates strong preliminary evidence that contributes significantly to resolve the complex relationship between self, world, and the brain of SZs, which may lie at the "core" of psychotic experiences.
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Affiliation(s)
- Da-Jung Shin
- Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
| | - Tae Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wi Hoon Jung
- Institute of Human Behavioral Medicine, Seoul National University-MRC, Seoul, Republic of Korea
| | - Sung Nyun Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joon Hwan Jang
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University-MRC, Seoul, Republic of Korea.
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Tordesillas-Gutierrez D, Koutsouleris N, Roiz-Santiañez R, Meisenzahl E, Ayesa-Arriola R, Marco de Lucas E, Soriano-Mas C, Suarez-Pinilla P, Crespo-Facorro B. Grey matter volume differences in non-affective psychosis and the effects of age of onset on grey matter volumes: A voxelwise study. Schizophr Res 2015; 164:74-82. [PMID: 25687531 DOI: 10.1016/j.schres.2015.01.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 01/19/2015] [Accepted: 01/21/2015] [Indexed: 01/18/2023]
Abstract
Previous evidence indicates that structural brain alterations are already present in the early phases of psychosis. In this study we aim to investigate the relationships among the different diagnoses in the spectrum of non-affective psychosis. A hundred-and-one first-episode psychosis patients (FEP) and 69 healthy volunteers, matched for age, gender, handedness and educational level were analyzed by structural MRI and high-dimensional voxel-based morphometry as implemented in SPM8 software. We obtained three main results: (1) FEP patients showed reduction of grey matter volume (GMV) in the frontal, temporal and occipital lobes, left insula and cerebellum. (2) Age of disease onset was an important factor revealing a gradual decrease of GMV (healthy controls>late onset>intermediate onset>early onset) in the frontal, temporal and occipital lobes, insula and cerebellum. (3) A gradual reduction of GMV related to diagnosis spectrum in the frontal, temporal, parietal and occipital lobes of schizophrenia patients being the most affected. These results suggest that an earlier onset of psychosis is linked to an earlier disease-related disruption of structural brain development, which may be most pronounced in schizophrenia compared to other psychoses.
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Affiliation(s)
- Diana Tordesillas-Gutierrez
- Neuroimaging Unit, Technological Facilities, Valdecilla Biomedical Research Institute IDIVAL, Santander, Cantabria, Spain; CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Spain.
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Bavaria, Germany
| | - Roberto Roiz-Santiañez
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Spain; Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Bavaria, Germany
| | - Rosa Ayesa-Arriola
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Spain; Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain
| | - Enrique Marco de Lucas
- Department of Radiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Carles Soriano-Mas
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Spain; Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Spain
| | - Paula Suarez-Pinilla
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Spain; Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain
| | - Benedicto Crespo-Facorro
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Spain; Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain
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Anderson KK, Rodrigues M, Mann K, Voineskos A, Mulsant BH, George TP, McKenzie KJ. Minimal evidence that untreated psychosis damages brain structures: a systematic review. Schizophr Res 2015; 162:222-33. [PMID: 25649287 DOI: 10.1016/j.schres.2015.01.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/09/2015] [Accepted: 01/11/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A longer duration of untreated psychosis (DUP) is associated with poor outcomes in first-episode psychosis (FEP); however, it is unclear whether this is due to the effects of psychosis on brain structure. We systematically reviewed the literature on the association between the length of untreated psychosis and brain structure in first-episode psychosis. METHODS We searched three electronic databases and conducted forward and backward citation searching to identify relevant papers. Studies were included if they: (1) included patients with a psychotic disorder who were treatment naïve or minimally treated; and (2) had correlated measures of DUP or duration of untreated illness (DUI) with structural measures. RESULTS We identified 48 studies that met the inclusion criteria. Forty-three examined the correlation between DUP and brain structure, and 19 examined the correlation between DUI and brain structure. There was evidence of significant associations in brain regions considered important in psychosis; however, the proportion of significant associations was low and the findings were inconsistent across studies. The majority of included studies were not primarily designed to examine whether DUP/DUI is correlated with brain structure, and there were methodological limitations in many studies that prevent drawing a strong conclusion. CONCLUSION To date, there is minimal evidence of an association between untreated psychosis and brain structure in FEP. Although the body of literature is substantial, there are few hypothesis-driven studies with a primary objective to answer this question. Future studies should be specifically designed to examine whether untreated psychosis has a deleterious effect on brain structure.
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Affiliation(s)
- Kelly K Anderson
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Myanca Rodrigues
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Kamalpreet Mann
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Aristotle Voineskos
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Tony P George
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Kwame J McKenzie
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
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Song X, Quan M, Lv L, Li X, Pang L, Kennedy D, Hodge S, Harrington A, Ziedonis D, Fan X. Decreased cortical thickness in drug naïve first episode schizophrenia: in relation to serum levels of BDNF. J Psychiatr Res 2015; 60:22-8. [PMID: 25282282 DOI: 10.1016/j.jpsychires.2014.09.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/16/2014] [Accepted: 09/11/2014] [Indexed: 01/19/2023]
Abstract
This study was to examine cortical thickness in drug naïve, first episode schizophrenia patients, and to explore its relationship with serum levels of brain-derived neurotrophic factor (BDNF). Forty-five drug naive schizophrenia patients and 28 healthy controls were enrolled in the study. Freesurfer was used to parcellate cortical regions, and vertex-wise group analysis was used for whole brain cortical thickness. The clusters for the brain regions that demonstrated group differences were extracted, and the mean values of thickness were calculated. Serum levels of BDNF were measured using enzyme-linked immunosorbent assay (ELISA). After controlling for age and gender, significantly thinner cortical thickness was found in left insula and superior temporal gyrus in the patient group compared with the healthy control group (HC group) (p's < 0.001). Lower serum levels of BDNF were also found in the patient group compared with the HC group (p = 0.001). Correlation analysis showed a significant positive relationship between thickness of left insula and serum levels of BDNF within the HC group (r = 0.396, p = 0.037) but there was no such relationship within the patient group (r = 0.035, p = 0.819). Cortical thinning is present in drug naïve, first episode schizophrenia patients, indicating neurodevelopmental abnormalities at the onset of schizophrenia. Left insula might be an imaging biomarker in detecting the impaired protective role of neurotrophic factor for the brain development in schizophrenia.
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Affiliation(s)
- Xueqin Song
- The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China.
| | - Meina Quan
- UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Luxian Lv
- Henan Province Biological Psychiatry Key Laboratory, Xinxiang Medical University, Xinxiang, China; Henan Province Mental Hospital, The Second Affiliated Hospital, Xinxiang Medical University, Xinxiang, China
| | - Xue Li
- The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Lijuan Pang
- The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - David Kennedy
- UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Steven Hodge
- UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Amy Harrington
- UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Douglas Ziedonis
- UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Xiaoduo Fan
- UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA.
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11
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Cortical thinning in temporo-parietal junction (TPJ) in non-affective first-episode of psychosis patients with persistent negative symptoms. PLoS One 2014. [PMID: 24979583 DOI: 10.1371/journal.pone.0101372.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Negative symptoms represent an unmet therapeutic need in many patients with schizophrenia. In an extension to our previous voxel-based morphometry findings, we employed a more specific, vertex-based approach to explore cortical thinning in relation to persistent negative symptoms (PNS) in non-affective first-episode of psychosis (FEP) patients to advance our understanding of the pathophysiology of primary negative symptoms. METHODS This study included 62 non-affective FEP patients and 60 non-clinical controls; 16 patients were identified with PNS (i.e., at least 1 primary negative symptom at moderate or greater severity sustained for at least 6 consecutive months). Using cortical thickness analyses, we explored for differences between PNS and non-PNS patients as well as between each patient group and healthy controls; cut-off threshold was set at p<0.01, corrected for multiple comparisons. RESULTS A thinner cortex prominently in the right superior temporal gyrus extending into the temporo-parietal junction (TPJ), right parahippocampal gyrus, and left orbital frontal gyrus was identified in PNS patients vs. non-PNS patients. Compared with healthy controls, PNS patients showed a thinner cortex prominently in the right superior temporal gyrus, right parahippocampal gyrus, and right cingulate; non-PNS patients showed a thinner cortex prominently in the parahippocampal gyrus bi-laterally. CONCLUSION Cortical thinning in the early stages of non-affective psychosis is present in the frontal and temporo-parietal regions in patients with PNS. With these brain regions strongly related to social cognitive functioning, our finding suggests a potential link between primary negative symptoms and social cognitive deficits through common brain etiologies.
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12
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Bodnar M, Hovington CL, Buchy L, Malla AK, Joober R, Lepage M. Cortical thinning in temporo-parietal junction (TPJ) in non-affective first-episode of psychosis patients with persistent negative symptoms. PLoS One 2014; 9:e101372. [PMID: 24979583 PMCID: PMC4076331 DOI: 10.1371/journal.pone.0101372] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 05/29/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Negative symptoms represent an unmet therapeutic need in many patients with schizophrenia. In an extension to our previous voxel-based morphometry findings, we employed a more specific, vertex-based approach to explore cortical thinning in relation to persistent negative symptoms (PNS) in non-affective first-episode of psychosis (FEP) patients to advance our understanding of the pathophysiology of primary negative symptoms. METHODS This study included 62 non-affective FEP patients and 60 non-clinical controls; 16 patients were identified with PNS (i.e., at least 1 primary negative symptom at moderate or greater severity sustained for at least 6 consecutive months). Using cortical thickness analyses, we explored for differences between PNS and non-PNS patients as well as between each patient group and healthy controls; cut-off threshold was set at p<0.01, corrected for multiple comparisons. RESULTS A thinner cortex prominently in the right superior temporal gyrus extending into the temporo-parietal junction (TPJ), right parahippocampal gyrus, and left orbital frontal gyrus was identified in PNS patients vs. non-PNS patients. Compared with healthy controls, PNS patients showed a thinner cortex prominently in the right superior temporal gyrus, right parahippocampal gyrus, and right cingulate; non-PNS patients showed a thinner cortex prominently in the parahippocampal gyrus bi-laterally. CONCLUSION Cortical thinning in the early stages of non-affective psychosis is present in the frontal and temporo-parietal regions in patients with PNS. With these brain regions strongly related to social cognitive functioning, our finding suggests a potential link between primary negative symptoms and social cognitive deficits through common brain etiologies.
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Affiliation(s)
- Michael Bodnar
- Prevention and Early Intervention Program for Psychoses (PEPP – Montreal), Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
| | - Cindy L. Hovington
- Department of Neurology & Neurosurgery, McGill University, Montreal, Canada
| | - Lisa Buchy
- Department of Neurology & Neurosurgery, McGill University, Montreal, Canada
| | - Ashok K. Malla
- Prevention and Early Intervention Program for Psychoses (PEPP – Montreal), Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychoses (PEPP – Montreal), Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychoses (PEPP – Montreal), Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
- Department of Neurology & Neurosurgery, McGill University, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- * E-mail:
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13
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Crow TJ, Chance SA, Priddle TH, Radua J, James AC. Laterality interacts with sex across the schizophrenia/bipolarity continuum: an interpretation of meta-analyses of structural MRI. Psychiatry Res 2013; 210:1232-44. [PMID: 24011847 DOI: 10.1016/j.psychres.2013.07.043] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 06/29/2013] [Accepted: 07/31/2013] [Indexed: 12/30/2022]
Abstract
Review of the first comprehensive meta-analysis of VBM (voxel-based morphometry) studies in schizophrenia indicates asymmetrical reductions of anterior cingulate gyrus to the right, and medial temporal lobe (including the uncus) and para-hippocampal gyrus to the left. In subsequent meta-analyses of schizophrenia and bipolar disorder change in these limbic structures is systematically related to change in the insula. Deficits in insula (and para-hippocampal gyrus) to the left, and dorsal anterior cingulate gyrus to the right are greater in schizophrenic psychoses whereas deficits in anterior cingulate to the left and insula to the right are greater in bipolar illness. Thus (1) brain structures implicated in schizophrenia include those implicated in bipolar disorder, (2) the variation that separates the prototypical psychoses may be a subset of that relating to the structural asymmetry (the "torque") characteristic of the human brain, and (3) the meta-analysis of Bora et al. (2012) indicates that laterality of involvement of the insula and cingulate gyrus across the spectrum of bipolar and schizophrenic psychoses is critically dependent upon the sex ratio. Thus structural change underlying the continuum of psychosis relates to the interaction of laterality and sex.
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Affiliation(s)
- Timothy J Crow
- SANE POWIC, University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK.
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14
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Moran ME, Weisinger B, Ludovici K, McAdams H, Greenstein D, Gochman P, Miller R, Clasen L, Rapoport J, Gogtay N. At the boundary of the self: the insular cortex in patients with childhood-onset schizophrenia, their healthy siblings, and normal volunteers. Int J Dev Neurosci 2013; 32:58-63. [PMID: 23770018 DOI: 10.1016/j.ijdevneu.2013.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 05/09/2013] [Accepted: 05/23/2013] [Indexed: 02/05/2023] Open
Abstract
The insular cortex (insula), whose normal function involves delineating the boundary between self and non-self stimuli, has been implicated in the pathophysiology of the positive symptoms of schizophrenia, including hallucinations and delusions. Childhood-onset schizophrenia (COS), that includes the onset of psychosis before age 13, is a severe and continuous form of the illness which shows profound and global progressive cortical brain abnormalities during adolescence which merge in the adult pattern with age. Using prospectively acquired anatomic brain magnetic resonance imaging (MRI) scans, a matched sample of COS patients, their nonpsychotic full siblings and healthy volunteers, we measured insular volume using the FreeSurfer automated software. COS patients (n=98; 234 scans) had significantly lower right (p=0.003), left (p<0.001), and total (p<0.001) insular volumes than healthy volunteers (n=100; 248 scans). Right insular volume negatively correlated with positive symptoms as measured by the Scale for the Assessment of Positive Symptoms (SAPS) (p=0.02), while both left (p=0.01) and right (p=0.006) insula volumes were positively correlated with overall functioning, as measured by the Children's Global Assessment Scale (CGAS) scores. COS siblings (n=71; 153 scans), on the other hand, did not differ significantly from normal volunteers suggesting that the insular deficits are more related to the illness state than a familial endophenotype. These results also highlight the salience of the insula in positive symptoms of schizophrenia perhaps resulting from the inability to discriminate between self from the non-self in COS. Further work to connect insular deficits to other neurocircuitries is warranted.
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Affiliation(s)
- Marcel E Moran
- Child Psychiatry Branch, National Institute of Mental Health, NIH, United States.
| | - Brian Weisinger
- Child Psychiatry Branch, National Institute of Mental Health, NIH, United States
| | - Katharine Ludovici
- Child Psychiatry Branch, National Institute of Mental Health, NIH, United States
| | - Harrison McAdams
- Child Psychiatry Branch, National Institute of Mental Health, NIH, United States
| | - Deanna Greenstein
- Child Psychiatry Branch, National Institute of Mental Health, NIH, United States
| | - Pete Gochman
- Child Psychiatry Branch, National Institute of Mental Health, NIH, United States
| | - Rachel Miller
- Child Psychiatry Branch, National Institute of Mental Health, NIH, United States
| | - Liv Clasen
- Child Psychiatry Branch, National Institute of Mental Health, NIH, United States
| | - Judith Rapoport
- Child Psychiatry Branch, National Institute of Mental Health, NIH, United States
| | - Nitin Gogtay
- Child Psychiatry Branch, National Institute of Mental Health, NIH, United States
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15
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Effect of antipsychotic drugs on cortical thickness. A randomized controlled one-year follow-up study of haloperidol, risperidone and olanzapine. Schizophr Res 2012; 141:22-8. [PMID: 22884754 DOI: 10.1016/j.schres.2012.07.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 07/10/2012] [Accepted: 07/21/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Imaging evidence indicates that brain alterations are primary to the full-blown onset of schizophrenia and seem to progress across time. The potential effects of antipsychotic medication on brain structure represent a key factor in understanding brain changes in psychosis. We aimed to investigate the effects of low doses of haloperidol, risperidone and olanzapine on cortical thickness. METHOD We investigated the effects of risperidone (N=16), olanzapine (N=18) and low doses of haloperidol (N=18) in cortical thickness changes during 1-year follow-up period in a large and heterogeneous sample of schizophrenia spectrum patients. The relationship between cortical thickness changes and clinical and cognitive outcome was also assessed. A group of 45 healthy volunteers was also longitudinally evaluated. Magnetic resonance imaging brain scans (1.5T) were obtained and images were analyzed by using BRAINS2. RESULTS There were no significant effects of time (F(1,47)<1.66; P>0.204), treatment group (F(2,47)<1.47; P>0.242) or group-by-time interaction (F(2,47)<1.82; P>0.174) for any of the cortical thickness variables. When the group of healthy controls was included in the analyses, it is of note that group-by-time interaction showed a significant result for the frontal lobe at trend level (F(3,81)=2.686; P=0.052). After the Bonferroni adjustment for multiple comparisons, there were no significant associations between changes in cortical thickness and clinical and cognitive outcome. CONCLUSIONS Low doses of haloperidol, risperidone, and olanzapine seem to equally affect gray matter cortical thickness, overall and lobes, at the medium-term (1 year). The clinical effectiveness of treatments was not significantly related to changes in cortical thickness.
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16
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Rais M, Cahn W, Schnack HG, Hulshoff Pol HE, Kahn RS, van Haren NEM. Brain volume reductions in medication-naive patients with schizophrenia in relation to intelligence quotient. Psychol Med 2012; 42:1847-1856. [PMID: 22357376 DOI: 10.1017/s0033291712000098] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Global brain abnormalities such as brain volume loss and grey- and white-matter deficits are consistently reported in first-episode schizophrenia patients and may already be detectable in the very early stages of the illness. Whether these changes are dependent on medication use or related to intelligence quotient (IQ) is still debated. METHOD Magnetic resonance imaging scans were obtained for 20 medication-naive patients with first-episode schizophrenia and 26 matched healthy subjects. Volume measures of total brain grey and white matter, third and lateral ventricles and cortical thickness/surface were obtained. Differences between the groups were investigated, taking into account the effect of intelligence. RESULTS Medication-naive patients showed statistically significant reductions in whole-brain volume and cerebral grey- and white-matter volume together with lateral ventricle enlargement compared to healthy subjects. IQ was significantly lower in patients compared to controls and was positively associated with brain and white-matter volume in the whole group. No significant differences in cortical thickness were found between the groups but medication-naive patients had a significantly smaller surface in the left superior temporal pole, Heschl's gyrus and insula compared to controls. CONCLUSIONS Our findings suggest that brain volume loss is present at illness onset, and can be explained by the reduced surface of the temporal and insular cortex. These abnormalities are not related to medication, but IQ.
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Affiliation(s)
- M Rais
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
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17
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Kong L, Herold C, Stieltjes B, Essig M, Seidl U, Wolf RC, Wüstenberg T, Lässer MM, Schmid LA, Schnell K, Hirjak D, Thomann PA. Reduced gray to white matter tissue intensity contrast in schizophrenia. PLoS One 2012; 7:e37016. [PMID: 22615876 PMCID: PMC3352852 DOI: 10.1371/journal.pone.0037016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 04/12/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND While numerous structural magnetic resonance imaging (MRI) studies revealed changes of brain volume or density, cortical thickness and fibre integrity in schizophrenia, the effect of tissue alterations on the contrast properties of neural structures has so far remained mostly unexplored. METHODS Whole brain high-resolution MRI at 3 Tesla was used to investigate tissue contrast and cortical thickness in patients with schizophrenia and healthy controls. RESULTS Patients showed significantly decreased gray to white matter contrast in large portions throughout the cortical mantle with preponderance in inferior, middle, superior and medial temporal areas as well as in lateral and medial frontal regions. The extent of these intensity contrast changes exceeded the extent of cortical thinning. Further, contrast changes remained significant after controlling for cortical thickness measurements. CONCLUSIONS Our findings clearly emphasize the presence of schizophrenia related brain tissue changes that alter the imaging properties of brain structures. Intensity contrast measurements might not only serve as a highly sensitive metric but also as a potential indicator of a distinct pathological process that might be independent from volume or thickness alterations.
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Affiliation(s)
- Li Kong
- Structural Neuroimaging Group, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Christina Herold
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | | | - Marco Essig
- German Cancer Research Center, Heidelberg, Germany
| | - Ulrich Seidl
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
- Center of Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
- Center for Mental Health, Klinikum Stuttgart, Stuttgart, Germany
| | - Robert Christian Wolf
- Center of Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Torsten Wüstenberg
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | | | - Lena Anna Schmid
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Knut Schnell
- Center of Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Dusan Hirjak
- Structural Neuroimaging Group, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
- Center of Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Philipp Arthur Thomann
- Structural Neuroimaging Group, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
- Center of Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
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18
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Jung HT, Kim DW, Kim S, Im CH, Lee SH. Reduced source activity of event-related potentials for affective facial pictures in schizophrenia patients. Schizophr Res 2012; 136:150-9. [PMID: 22118731 DOI: 10.1016/j.schres.2011.10.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 10/03/2011] [Accepted: 10/29/2011] [Indexed: 11/19/2022]
Abstract
The ability to recognize facial affect is impaired in schizophrenia patients. This study compared source activities of the event-related potentials (ERPs) for affective facial pictures between schizophrenia patients and healthy controls. Twenty-three schizophrenia patients (11 females) and 24 healthy controls (12 females) were recruited. The standardized low-resolution brain electromagnetic tomography (sLORETA) source activities of four ERP components (P100, N170, N250, and P300) were compared between schizophrenia patients and healthy controls in response to fearful, happy, and neutral facial expressions. Group differences of sLORETA source activities were found only for the N170 component in response to the fearful face. Source activities in the middle frontal gyrus and inferior frontal gyrus were lower in schizophrenia patients compared to healthy controls. Source activity in the insula was lower in male schizophrenia patients compared to male healthy controls. Source activities in the superior temporal gyrus, middle temporal gyrus, insula and inferior frontal gyrus were lower in male compared to female schizophrenia patients. However, there was no gender difference on ERP source activities in the healthy controls. These results support the hypothesis that schizophrenia patients have reduced N170 current source density in response to fearful faces. The area exhibiting reduced current source density includes the frontal and temporal cortex. The present results suggest that there may be gender differences in facial affect processing in schizophrenia patients.
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Affiliation(s)
- Hyung-Tae Jung
- Department of Psychiatry, Seo Ulsan Boram Hospital, Ulsan, Republic of Korea
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19
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Cigarette smoking and white matter microstructure in schizophrenia. Psychiatry Res 2012; 201:152-8. [PMID: 22386966 PMCID: PMC3319200 DOI: 10.1016/j.pscychresns.2011.08.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 08/10/2011] [Accepted: 08/19/2011] [Indexed: 11/22/2022]
Abstract
The majority of patients with schizophrenia smoke cigarettes. Both nicotine use and schizophrenia have been associated with alterations in brain white matter microstructure as measured by diffusion tensor imaging (DTI). The purpose of this study was to examine fractional anisotropy (FA) in smoking and non-smoking patients with schizophrenia and in healthy volunteers. A total of 43 patients (28 smoking and 15 non-smoking) with schizophrenia and 40 healthy, non-smoking participants underwent DTI. Mean FA was calculated in four global regions of interest (ROIs) (whole brain, cerebellum, brainstem, and total cortical) as well as in four regional ROIs (frontal, temporal, parietal and occipital lobes). The non-smoking patient group had a significantly higher intellectual quotient (IQ) compared with the patients who smoked, and our results varied according to whether IQ was included as a covariate. Without IQ correction, significant between-group effects for FA were found in four ROIs: total brain, total cortical, frontal lobe and the occipital lobe. In all cases the FA was lower among the smoking patient group, and highest in the control group. Smoking patients differed significantly from non-smoking patients in the frontal lobe ROI. However, these differences were no longer significant after IQ correction. FA differences between non-smoking patients and controls were not significant. Among smoking and non-smoking patients with schizophrenia but not healthy controls, FA was correlated with IQ. In conclusion, group effects of smoking on FA in schizophrenia might be mediated by IQ. Further, low FA in specific brain areas may be a neural marker for complex pathophysiology and risk for diverse problems such as schizophrenia, low IQ, and nicotine addiction.
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20
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Palaniyappan L, Liddle PF. Does the salience network play a cardinal role in psychosis? An emerging hypothesis of insular dysfunction. J Psychiatry Neurosci 2012; 37:17-27. [PMID: 21693094 PMCID: PMC3244495 DOI: 10.1503/jpn.100176] [Citation(s) in RCA: 381] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The insular cortex is one of the brain regions that show consistent abnormalities in both structural and functional neuroimaging studies of schizophrenia. In healthy individuals, the insula has been implicated in a myriad of physiologic functions. The anterior cingulate cortex (ACC) and insula together constitute the salience network, an intrinsic large-scale network showing strong functional connectivity. Considering the insula as a functional unit along with the ACC provides an integrated understanding of the role of the insula in information processing. In this review, we bring together evidence from imaging studies to understand the role of the salience network in schizophrenia and propose a model of insular dysfunction in psychosis.
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Affiliation(s)
- Lena Palaniyappan
- Division of Psychiatry, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom.
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Waters-Metenier S, Toulopoulou T. Putative structural neuroimaging endophenotypes in schizophrenia: a comprehensive review of the current evidence. FUTURE NEUROLOGY 2011. [DOI: 10.2217/fnl.11.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The genetic contribution to schizophrenia etiopathogenesis is underscored by the fact that the best predictor of developing schizophrenia is having an affected first-degree relative, which increases lifetime risk by tenfold, as well as the observation that when both parents are affected, the risk of schizophrenia increases to approximately 50%, compared with 1% in the general population. The search to elucidate the complex genetic architecture of schizophrenia has employed various approaches, including twin and family studies to examine co-aggregation of brain abnormalities, studies on genetic linkage and studies using genome-wide association to identify genetic variations associated with schizophrenia. ‘Endophenotypes’, or ‘intermediate phenotypes’, are potentially narrower constructs of genetic risk. Hypothetically, they are intermediate in the pathway between genetic variation and clinical phenotypes and can supposedly be implemented to assist in the identification of genetic diathesis for schizophrenia and, possibly, in redefining clinical phenomenology.
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Affiliation(s)
- Sheena Waters-Metenier
- Department of Psychosis Studies, King’s College London, King’s Health Partners, Institute of Psychiatry, London, UK
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22
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Wylie KP, Tregellas JR. The role of the insula in schizophrenia. Schizophr Res 2010; 123:93-104. [PMID: 20832997 PMCID: PMC2957503 DOI: 10.1016/j.schres.2010.08.027] [Citation(s) in RCA: 253] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 08/11/2010] [Accepted: 08/16/2010] [Indexed: 11/30/2022]
Abstract
Involvement of the insular cortex is a common finding in neuroanatomical studies of schizophrenia, yet its contribution to disease pathology remains unknown. This review describes the normal function of the insula and examines pathology of this region in schizophrenia. The insula is a cortical structure with extensive connections to many areas of the cortex and limbic system. It integrates external sensory input with the limbic system and is integral to the awareness of the body's state (interoception). Many deficits observed in schizophrenia involve these functions and may relate to insula pathology. Furthermore, reports describing deficits caused by lesions of the insula parallel deficits observed in schizophrenia. Examples of insula-related functions that are altered in schizophrenia include the processing of both visual and auditory emotional information, pain, and neuronal representations of the self. The last of these functions, processing representations of the self, plays a key role in discriminating between self-generated and external information, suggesting that insula dysfunction may contribute to hallucinations, a cardinal feature of schizophrenia.
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Affiliation(s)
- Korey P Wylie
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Aurora, CO 80045, United States
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