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Zhuo C, Fang T, Chen C, Chen M, Sun Y, Ma X, Li R, Tian H, Ping J. Brain imaging features in schizophrenia with co-occurring auditory verbal hallucinations and depressive symptoms-Implication for novel therapeutic strategies to alleviate the reciprocal deterioration. Brain Behav 2021; 11:e01991. [PMID: 33305913 PMCID: PMC7882177 DOI: 10.1002/brb3.1991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Auditory verbal hallucinations (AVHs) and depressive symptoms are highly prevalent in schizophrenia, and recent progress has been made in understanding the reciprocal deterioration of both symptoms through structural and functional brain imaging studies. To date, there is limited literature on this topic. In this review, we synthesized the recent literature on the neuroimaging features of schizophrenia patients with concurrent AVHs and depressive symptoms. METHODS A literature search was conducted with the major databases using the keywords, mainly including schizophrenia, AVHs, depression, neuropsychiatric disorders, brain imaging, and magnetic resonance imaging. RESULTS The existing studies have shown that AVHs and depressive symptoms reciprocally deteriorate in patients with schizophrenia, which has challenged the conventional treatment of the disease. Interestingly, repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) therapies have emerged as two efficacious brain stimulation treatments that can normalize the brain regions associated with the symptoms, as shown through functional and structural brain imaging studies. In light of these important findings, there is an urgent need to conduct in-depth neuronal mechanistic studies to identify targets for stimulation therapy. CONCLUSIONS These new findings may elucidate the pathological mechanisms underlying schizophrenia with concurrent AVHs and depressive symptoms. Furthermore, this review has important clinical implications for developing novel therapeutic strategies to alleviate the reciprocal deterioration AVHs and depressive symptoms of schizophrenia patients.
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Affiliation(s)
- Chuanjun Zhuo
- Key Laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab)Tianjin Fourth Center HospitalTianjin Medical Affiliated Tianjin Fourth Central HospitalNankai University Affiliated Tianjin Fourth Center HospitalTianjinChina
- Department of PsychiatryWenzhou Seventh People’s HospitalWenzhouChina
- Psychiatric‐Neuroimaging‐Genetics‐Comorbidity (PNGC) LaboratoryTianjin Mental Health CenterTianjin Anding HospitalNankai University Affiliated Anding HospitalTianjinChina
| | - Tao Fang
- Key Laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab)Tianjin Fourth Center HospitalTianjin Medical Affiliated Tianjin Fourth Central HospitalNankai University Affiliated Tianjin Fourth Center HospitalTianjinChina
| | - Ce Chen
- Department of PsychiatryWenzhou Seventh People’s HospitalWenzhouChina
| | - Min Chen
- Department of PsychiatrySchool of Mental HealthyJining Medical UniversityJiningChina
| | - Yun Sun
- Psychiatric‐Neuroimaging‐Genetics‐Comorbidity (PNGC) LaboratoryTianjin Mental Health CenterTianjin Anding HospitalNankai University Affiliated Anding HospitalTianjinChina
| | - Xiaoyan Ma
- Psychiatric‐Neuroimaging‐Genetics‐Comorbidity (PNGC) LaboratoryTianjin Mental Health CenterTianjin Anding HospitalNankai University Affiliated Anding HospitalTianjinChina
| | - Ranli Li
- Psychiatric‐Neuroimaging‐Genetics‐Comorbidity (PNGC) LaboratoryTianjin Mental Health CenterTianjin Anding HospitalNankai University Affiliated Anding HospitalTianjinChina
| | - Hongjun Tian
- Key Laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab)Tianjin Fourth Center HospitalTianjin Medical Affiliated Tianjin Fourth Central HospitalNankai University Affiliated Tianjin Fourth Center HospitalTianjinChina
| | - Jing Ping
- Department of PsychiatryWenzhou Seventh People’s HospitalWenzhouChina
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Chong BTW, Wahab S, Muthukrishnan A, Tan KL, Ch'ng ML, Yoong MT. Prevalence and Factors Associated with Suicidal Ideation in Institutionalized Patients with Schizophrenia. Psychol Res Behav Manag 2020; 13:949-962. [PMID: 33204188 PMCID: PMC7667143 DOI: 10.2147/prbm.s266976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/21/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose The shorter life expectancy and increased risk of suicide in patients with schizophrenia have been well documented. However, study outcomes on suicidality in this special population have been few to date. This study investigated the prevalence and factors associated with suicidal ideation in a population of institutionalized patients with schizophrenia. Methods Two hundred fifty-six patients with schizophrenia between the age of 18 and 65 years were randomly recruited. This cross-sectional study utilised the Calgary Depression Scale for Schizophrenia (CDSS), the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scale (PSYRATS-AH). Univariate analysis was performed using an independent t-test or chi-square test, followed by binary logistic regression to determine the factors associated with increased suicidal risks. Results The socio-demographic factors associated with suicidal ideation included level of education (p=0.039); secondary-level education (OR=5.76, 95% CI:1.49, 22.34, p=0.011) and tertiary-level education (OR=9.30, 95% CI: 1.80, 48.12, p=0.008) posed a greater risk. A history of attempted suicide (OR=2.09, 95% CI: 1.01, 4.36, p=0.049) and the presence of co-morbid physical illnesses (OR=2.07, 95% CI: 1.02, 4.21, p=0.044) were also found to be associated with a suicidal ideation. Other significant factors associated with suicidal thoughts were concurrent depression (OR=9.68, 95% CI: 3.74, 25.05, p<0.001) and a higher PSYRATS score in emotional characteristics of auditory hallucinations (OR=1.13, 95% CI: 1.06, 1.21, p<0.001). Conclusion Suicide in schizophrenia appears to be more closely associated with certain socio-demographic factors and affective symptoms. Appropriate screening and treatment addressing these challenges must be emphasized if suicidal thoughts and actions are to be reduced.
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Affiliation(s)
- Benedict Tak Wai Chong
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Wilayah Persekutuan 56000, Malaysia
| | - Suzaily Wahab
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Wilayah Persekutuan 56000, Malaysia
| | - Arunakiri Muthukrishnan
- Department of Psychiatry, Hospital Bahagia Ulu Kinta, Tanjung Rambutan, Perak Darul Ridzwan 31250, Malaysia
| | - Kok Leong Tan
- Department of Community Medicine, School of Medicine, International Medical University (IMU), Kuala Lumpur, Wilayah Persekutuan 57000, Malaysia
| | - May Lee Ch'ng
- Department of Community Medicine, School of Medicine, International Medical University (IMU), Kuala Lumpur, Wilayah Persekutuan 57000, Malaysia
| | - Mei Theng Yoong
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Wilayah Persekutuan 56000, Malaysia
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Zhuo C, Wang C, Song X, Xu X, Li G, Lin X, Xu Y, Tian H, Jiang D, Wang W, Zhou C. A unified model of shared brain structural alterations in patients with different mental disorders who experience own-thought auditory verbal hallucinations-A pilot study. Brain Behav 2020; 10:e01614. [PMID: 32304354 PMCID: PMC7303372 DOI: 10.1002/brb3.1614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/10/2020] [Accepted: 03/15/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To explore shared brain structural alterations in patients diagnosed with mental disorders who experience own-thought auditory verbal hallucinations (OTAVHs). METHODS A cohort of 143 first-diagnosis, nonmedicated patients with OTAVHs was enrolled: 25 with schizophrenia (FUSCH-OTAVH), 20 with major depression disorder (FUMDD-OTAVH), 28 with bipolar disorder (FUBD-OTAVH), 22 patients with posttraumatic stress disorder (FUPTSD-OTAVH), 21 with anxiety disorder (FUAD-OTAVH), and 27 with borderline personality disorder (FUBPD-OTAVH); 25 healthy controls (HCs) participated. The Auditory Hallucinations Rating Scale (AHRS), multiple psychometric scales, voxel-based morphometry (VBM), tract-based spatial statistics (TBSS), and multiple regression were used. RESULTS Compared with HCs, patients had increased occipital cortex, dorsal prefrontal cortex (PFC), and striatum gray matter volumes (GMVs), a reduced insular cortex (IC) GMV, and an impaired frontooccipital fasciculus. The following differences were found versus HCs: FUSCH-OTAVH, reduced PFC and occipital GMVs, increased striatum and thalamus GMVs, impaired arcuate fasciculus, u-shaped bundle, optic tract, and upper longitudinal fasciculus (LF); FUMDD-OTAVH, increased posterior frontotemporal junction and hippocampus GMVs; FUMN-OTAVH, increased posterior frontotemporal junction and parietal cortex GMVs, reduced hippocampus GMV, impaired upper LF; FUPTSD-OTAVH, increased temporal, hippocampus, and nucleus accumbens GMVs; FUBPD-OTAVH, increased frontotemporal junction and hippocampus GMVs, impaired upper/lower LF; and FUAD-OTAVH, increased frontal and temporal cortex, hippocampus GMVs. CONCLUSIONS The present findings provide evidence consistent with a bottom-up and top-down reciprocal action dysfunction hypothesis of AVHs and with the dopamine hypothesis of AVHs. We observed specific features related to OTAVHs in patients with different mental disorders. The findings, though complex, provide clues for further studies of specific mental disorders.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Biological Psychiatry, School of Mental Health, Jining Medical University, Jining, China.,The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China.,Biological Psychiatry International Joint Laboratory of Henan, Zhengzhou University, Zhengzhou, China.,Henan Psychiatric Transformation Research Key Laboratory, Zhengzhou University, Zhengzhou, China.,Department of Psychiatry and Neuroimaging Centre, Wenzhou Seventh People's Hospital, Wenzhou, China.,Department of Psychiatry, First Hospital, First Clinical Medical College of Shanxi Medical University, Taiyuan, China.,MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, China.,Department of Psychiatric-Neuroimging-Genetics and Comorbidity Labotorary (PNGC_Lab), Tianjin Anding Hospital, Tianjin, China.,Canada and China Joint Laboratory of Biological Psychiatry, Xiamen Xianye Hospital, Xiamen, China
| | - Chunxiang Wang
- Department of Radiology, MRI Center, Tianjin Children Hospital, Tianjin Medical University Affiliated Tianjin Children Hospital, Tianjin, China
| | - Xueqin Song
- The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China.,Biological Psychiatry International Joint Laboratory of Henan, Zhengzhou University, Zhengzhou, China.,Henan Psychiatric Transformation Research Key Laboratory, Zhengzhou University, Zhengzhou, China
| | - Xuexin Xu
- Department of Radiology, MRI Center, Tianjin Children Hospital, Tianjin Medical University Affiliated Tianjin Children Hospital, Tianjin, China
| | - Gongying Li
- Department of Biological Psychiatry, School of Mental Health, Jining Medical University, Jining, China
| | - Xiaodong Lin
- Department of Psychiatry and Neuroimaging Centre, Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Yong Xu
- Department of Psychiatry, First Hospital, First Clinical Medical College of Shanxi Medical University, Taiyuan, China.,MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Hongjun Tian
- Department of Psychiatric-Neuroimging-Genetics and Comorbidity Labotorary (PNGC_Lab), Tianjin Anding Hospital, Tianjin, China
| | - Deguo Jiang
- Department of Psychiatry and Neuroimaging Centre, Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Wenqiang Wang
- Canada and China Joint Laboratory of Biological Psychiatry, Xiamen Xianye Hospital, Xiamen, China
| | - Chunhua Zhou
- Department of Pharmacology, The First Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
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Zhuo C, Lin X, Wang C, Song X, Xu X, Li G, Xu Y, Tian H, Zhang Y, Wang W, Zhou C. Unified and disease specific alterations to brain structure in patients across six categories of mental disorders who experience own-thought auditory verbal hallucinations: A pilot study. Brain Res Bull 2020; 160:33-39. [PMID: 32298780 DOI: 10.1016/j.brainresbull.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 02/28/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To explore the unified and disease specific structural features of the brain in patients spanning six mental disorders who experience own-thought auditory verbal hallucinations (OTAVH). METHODS A pilot study was conducted on 25 patients with schizophrenia (FUSCH-OTAVH), 20 patients with major depression disorder (FUMDD-OTAVH), 28 patients with bipolar disorder (FUBD-OTAVH), 22 patients with posttraumatic stress disorder (FUPTSD-OTAVH), 21 patients with anxiety disorder (FUAD-OTAVH), and 27 patients with borderline personality disorder (FUBPD-OTAVH). Twenty-five healthy controls (HCs) were also recruited. Auditory Hallucinations Rating Scale (AHRS) multiple psychometric scales were adopted to assess the clinical features of voxel-based morphometry (VBM), tract-based spatial statistics (TBSS), and multiple regression in all patients. Common and specific brain features of OTAVH among these mental disorders were investigated. RESULTS Compared to HCs, GMV aberrant pattern across all the six categories patients with OTAVH decreased in the occipital cortex, left parietal lobe, prefrontal cortex (PFC), and insular cortex (IC). Aberrant patterns in white matter (WM) were detected in the corpus callosum and impairment of the fronto-occipital fasciculus. Structural differences in the brain were observed for each mental disorder versus HCs. CONCLUSIONS The unified brain aberrant features of OTAVH across six mental disorders were characterized by decreased GMV and WM impairments in some regions and the specific brain features of each disease were also characterized. In conclusion, this study provides evidence for the structural basis of OTAVH and potential avenues for investigating disease specific brain features of OTAVH.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Biological Psychiatry, School of Mental Health, Jining Medical University, 272191, Jining, Shandong Province, China; The First Affiliated Hospital/Zhengzhou University, Zhengzhou, China; Biological Psychiatry International Joint Laboratory of Henan, Zhengzhou University, Zhengzhou, China; Henan Psychiatric Transformation Research Key Laboratory, Zhengzhou University, Zhengzhou, 450000, China; Department of Psychiatry and Neuroimaging Centre, Wenzhou Seventh People's Hospital, Wenzhou, 325000, Zhejiang Province, China; Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, 030001, China; Department of Psychiatric-Neuroimging-Genetics and Comorbidity Labotorary (PNGC_Lab), Tianjin Anding Hospital, 300300, Tianjin, China; Canada and China Joint Laboratory of Biological Psychiatry, Xiamen Xianye Hospital, Xiamen, 361000, Fujian Province, China.
| | - Xiaodong Lin
- Department of Psychiatry and Neuroimaging Centre, Wenzhou Seventh People's Hospital, Wenzhou, 325000, Zhejiang Province, China
| | - Chunxiang Wang
- Department of Radiology, MRI Center, Tianjin Children Hospital, Tianjin Medical University Affiliated Tianjin Children Hospital, Tianjin, 300444, China
| | - Xueqin Song
- The First Affiliated Hospital/Zhengzhou University, Zhengzhou, China; Biological Psychiatry International Joint Laboratory of Henan, Zhengzhou University, Zhengzhou, China; Henan Psychiatric Transformation Research Key Laboratory, Zhengzhou University, Zhengzhou, 450000, China
| | - Xuexin Xu
- Department of Radiology, MRI Center, Tianjin Children Hospital, Tianjin Medical University Affiliated Tianjin Children Hospital, Tianjin, 300444, China
| | - Gongying Li
- Department of Biological Psychiatry, School of Mental Health, Jining Medical University, 272191, Jining, Shandong Province, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Hongjun Tian
- Department of Psychiatric-Neuroimging-Genetics and Comorbidity Labotorary (PNGC_Lab), Tianjin Anding Hospital, 300300, Tianjin, China
| | - Yonghui Zhang
- Department of Psychiatric-Neuroimging-Genetics and Comorbidity Labotorary (PNGC_Lab), Tianjin Anding Hospital, 300300, Tianjin, China
| | - Wenqiang Wang
- Canada and China Joint Laboratory of Biological Psychiatry, Xiamen Xianye Hospital, Xiamen, 361000, Fujian Province, China
| | - Chunhua Zhou
- Department of Pharmacology, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei Province, China
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Differences in functional connectivity density among subtypes of schizophrenic auditory hallucination. Brain Imaging Behav 2020; 14:2587-2593. [PMID: 31938985 DOI: 10.1007/s11682-019-00210-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This study aimed to investigate alterations in brain function among different subtypes of auditory hallucinations (AH) in drug-naïve first episode schizophrenia patients. We recruited 20 patients with drug-naïve first episode schizophrenia who had constant commanding and commenting auditory verbal hallucinations (CCCAVH), 15 drug-naïve first episode schizophrenia patients who had nonverbal auditory hallucinations (NVAH), and 20 healthy controls to participate in this study. We used global functional connectivity density (gFCD) and one-way analysis of covariance to characterize differences in brain function between the two patient groups. Statistical significance was set at P < 0.05. As compared to controls, schizophrenia patients with CCCAVH demonstrated increased gFCD in the right Broca's area, bilateral superior temporal gyri, hippocampus, bilateral insula, and anterior cingulate gyri, and decreased gFCD in the left temporoparietal junction (family-wise error [FEW] correct, P < 0.05). Schizophrenia patients with NVAH demonstrated increased gFCD in the bilateral superior temporal gyri and most of the components of the default mode network (DMN), and decreased gFCD in components of the executive control network (FWE correct, P < 0.05). We found that schizophrenia patients with CCCAVH and NVAH have distinct functional brain patterns. The features observed in patients with CCCAVH are consistent with the "inner speech" hypothesis of AH. Features of patients with NVAH suggest hyperactivity of the superior temporal gyrus and DMN, and hypoactivity of the prefrontal lobe.
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Lin X, Zhuo C, Li G, Li J, Gao X, Chen C, Jiang D. Functional brain alterations in auditory hallucination subtypes in individuals with auditory hallucinations without the diagnosis of specific neurological diseases and mental disorders at the current stage. Brain Behav 2020; 10:e01487. [PMID: 31782626 PMCID: PMC6955821 DOI: 10.1002/brb3.1487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 10/20/2019] [Accepted: 11/10/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We explored common and distinct pathological features of different subtypes of auditory hallucinations (AHs) to elucidate the underlying pathological mechanisms. METHODS We recruited 39 individuals with constant commanding and commenting auditory verbal hallucinations (CCCAVHs), 49 with own thought auditory verbal hallucinations (OTAVHs), 46 with nonverbal AHs (NVAHs), 32 with replay AVHs (RAVHs), and 50 healthy controls. Functional connectivity density mapping was used to investigate global functional connectivity density (gFCD) alterations in these AH groups relative to the control group. RESULTS We observed common brain functional alterations among four subtypes of AHs, such as increased gFCD in the bilateral superior temporal gyrus and mesial frontal lobe, and decreased gFCD in the bilateral medial prefrontal cortex. Increased gFCD was detected in the bilateral insula in CCCAVH individuals, bilateral thalamus in OTAVH individuals, bilateral precuneus in NVAH individuals, and bilateral hippocampus in RAVH individuals. The common and distinct gFCD alterations among four AH subtypes were located in main components of the frontoparietal, default mode, salience, central executive, and memory networks. Different AH subtypes exhibited specific aberrant patterns. CONCLUSIONS Our findings suggest that aberrant functional activity and metabolism in the abovementioned networks play key roles in the occurrence of AHs. Our findings provide evidence for distinct gFCD alterations in specific AH subtypes.
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Affiliation(s)
- Xiaodong Lin
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Chuanjun Zhuo
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, China.,Department of Psychiatry-Brian Micro and Macro Imaging Centre, Department of Psychiatry, School of Mental Health, Jining Medical University, Jining, China.,Psychiatric-Neuroimging-Genetics and Comorbidity Laboratory (PNGC-Lab), Tianjin Mental Health Center, Tianjin Anding Hospital, Tianjin, China
| | - Gongying Li
- Department of Psychiatry-Brian Micro and Macro Imaging Centre, Department of Psychiatry, School of Mental Health, Jining Medical University, Jining, China
| | - Jie Li
- Psychiatric-Neuroimging-Genetics and Comorbidity Laboratory (PNGC-Lab), Tianjin Mental Health Center, Tianjin Anding Hospital, Tianjin, China
| | - Xiangyang Gao
- Center for Health Statistics, Big Data Center of Chronic Disease, Health Management Institute, 301 Hospital of Chinese People's Liberation Army, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Ce Chen
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Deguo Jiang
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, China
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Brain function differences in drug-naïve first-episode auditory verbal hallucination-schizophrenia patients with versus without insight. Chin Med J (Engl) 2019; 132:2199-2205. [PMID: 31478928 PMCID: PMC6797149 DOI: 10.1097/cm9.0000000000000419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Few studies have reported brain function differences in drug-naïve first-episode schizophrenia patients who had auditory verbal hallucinations (AVH) with insight vs. those without insight. This study aimed to investigate brain function differences between drug-naïve first-episode AVH-schizophrenia patients with and without insight. Methods: Forty first-episode drug-naïve AVH-schizophrenia patients with or without insight and 40 healthy controls between December 2016 and December 2018 were recruited in this study. The auditory hallucinations rating scale (AHRS) was used to assess AVH severity, while the insight and treatment attitudes questionnaire was used to distinguish insight. The global functional connectivity density (gFCD) between different groups was compared using a voxel-wise one-way analysis of covariance. The relationship between gFCD and AHRS total scores were analyzed using voxel-wise multiple regression. Results: Finally, 13 first-episode drug-naïve AVH-schizophrenia patients with insight, 15 AVH-schizophrenia patients without insight, and 20 healthy controls were included for analysis. Except for global assessment of functioning scores, there were no significant differences in sociodemographic information between the AVH-schizophrenia and healthy groups (P > 0.05). Compared to the healthy controls, AVH-schizophrenia patients with insight demonstrated a decreased gFCD in the supra-marginal gyrus within the primary auditory cortex, while those without insight demonstrated an increased gFCD in the inferior frontal gyrus and superior temporal gyrus and decreased gFCD in the supplemental motor area. Compared to the AVH-schizophrenia patients with insight, those without insight demonstrated an increased gFCD in the supra-marginal gyrus and posterior superior temporal lobule and a decreased gFCD in the frontal lobe. No significant correlation between gFCD and AVH severity (AHRS total score: r = 0.23, P = 0.590; and frequency: r = 0.42, P = 0.820) was found in both AVH-schizophrenia groups. Conclusions: The gFCD-aberrant brain regions in the AVH-schizophrenia patients without insight were wider compared to those with insight, although the AHRS scores were not significantly different. The AVH-schizophrenia patients without insight had wide functional impairment in the frontal lobule, which may underlie the lack of insight and the abnormal hyperactivity in the inferior frontal gurus and temporal lobe related to the AVH symptoms.
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Abdul Wahab NA, Zakaria MN, Abdul Rahman AH, Sidek D, Wahab S. Listening to Sentences in Noise: Revealing Binaural Hearing Challenges in Patients with Schizophrenia. Psychiatry Investig 2017; 14:786-794. [PMID: 29209382 PMCID: PMC5714720 DOI: 10.4306/pi.2017.14.6.786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 12/23/2016] [Accepted: 03/19/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The present, case-control, study investigates binaural hearing performance in schizophrenia patients towards sentences presented in quiet and noise. METHODS Participants were twenty-one healthy controls and sixteen schizophrenia patients with normal peripheral auditory functions. The binaural hearing was examined in four listening conditions by using the Malay version of hearing in noise test. The syntactically and semantically correct sentences were presented via headphones to the randomly selected subjects. In each condition, the adaptively obtained reception thresholds for speech (RTS) were used to determine RTS noise composite and spatial release from masking. RESULTS Schizophrenia patients demonstrated significantly higher mean RTS value relative to healthy controls (p=0.018). The large effect size found in three listening conditions, i.e., in quiet (d=1.07), noise right (d=0.88) and noise composite (d=0.90) indicates statistically significant difference between the groups. However, noise front and noise left conditions show medium (d=0.61) and small (d=0.50) effect size respectively. No statistical difference between groups was noted in regards to spatial release from masking on right (p=0.305) and left (p=0.970) ear. CONCLUSION The present findings suggest an abnormal unilateral auditory processing in central auditory pathway in schizophrenia patients. Future studies to explore the role of binaural and spatial auditory processing were recommended.
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Affiliation(s)
- Noor Alaudin Abdul Wahab
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Audiology Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohd. Normani Zakaria
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Abdul Hamid Abdul Rahman
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Dinsuhaimi Sidek
- Department of Otorhinolaryngology, School of Medicine, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Suzaily Wahab
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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9
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Abdul Wahab NA, Wahab S, Abdul Rahman AH, Sidek D, Zakaria MN. The Hyperactivity of Efferent Auditory System in Patients with Schizophrenia: A Transient Evoked Otoacoustic Emissions Study. Psychiatry Investig 2016; 13:82-8. [PMID: 26766950 PMCID: PMC4701690 DOI: 10.4306/pi.2016.13.1.82] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/18/2015] [Accepted: 05/30/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Electrophysiological studies, which are mostly focused on afferent pathway, have proven that auditory processing deficits exist in patients with schizophrenia. Nevertheless, reports on the suppressive effect of efferent auditory pathway on cochlear outer hair cells among schizophrenia patients are limited. The present, case-control, study examined the contralateral suppression of transient evoked otoacoustic emissions (TEOAEs) in patients with schizophrenia. METHODS Participants were twenty-three healthy controls and sixteen schizophrenia patients with normal hearing, middle ear and cochlear outer hair cells function. Absolute non-linear and linear TEOAEs were measured in both ears by delivering clicks stimuli at 80 dB SPL and 60 dB SPL respectively. Subsequently, contralateral suppression was determined by subtracting the absolute TEOAEs response obtained at 60 dBpe SPL during the absence and presence of contralateral white noise delivered at 65 dB HL. No attention tasks were conducted during measurements. RESULTS We found no significant difference in absolute TEOAEs responses at 80 dB SPL, in either diagnosis or ear groups (p>0.05). However, the overall contralateral suppression was significantly larger in schizophrenia patients (p<0.05). Specifically, patients with schizophrenia demonstrated significantly increased right ear contralateral suppression compared to healthy control (p<0.05). CONCLUSION The present findings suggest increased inhibitory effect of efferent auditory pathway especially on the right cochlear outer hair cells. Further studies to investigate increased suppressive effects are crucial to expand the current understanding of auditory hallucination mechanisms in schizophrenia patients.
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Affiliation(s)
- Noor Alaudin Abdul Wahab
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Audiology Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Wilayah Persekutuan, Malaysia
| | - Suzaily Wahab
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Wilayah Persekutuan, Malaysia
| | - Abdul Hamid Abdul Rahman
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Wilayah Persekutuan, Malaysia
| | - Dinsuhaimi Sidek
- Department of Otorhinolaryngology, School of Medicine, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd. Normani Zakaria
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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