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Kim J, Song J, Kambari Y, Plitman E, Shah P, Iwata Y, Caravaggio F, Brown EE, Nakajima S, Chakravarty MM, De Luca V, Remington G, Graff-Guerrero A, Gerretsen P. Cortical thinning in relation to impaired insight into illness in patients with treatment resistant schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:27. [PMID: 37120642 PMCID: PMC10148890 DOI: 10.1038/s41537-023-00347-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/12/2023] [Indexed: 05/01/2023]
Abstract
Impaired insight into illness is a common element of schizophrenia that contributes to treatment nonadherence and negative clinical outcomes. Previous studies suggest that impaired insight may arise from brain abnormalities. However, interpretations of these findings are limited due to small sample sizes and inclusion of patients with a narrow range of illness severity and insight deficits. In a large sample of patients with schizophrenia, the majority of which were designated as treatment-resistant, we investigated the associations between impaired insight and cortical thickness and subcortical volumes. A total of 94 adult participants with a schizophrenia spectrum disorder were included. Fifty-six patients (60%) had treatment-resistant schizophrenia. The core domains of insight were assessed with the VAGUS insight into psychosis scale. We obtained 3T MRI T1-weighted images, which were analysed using CIVET and MAGeT-Brain. Whole-brain vertex-wise analyses revealed impaired insight, as measured by VAGUS average scores, was related to cortical thinning in left frontotemporoparietal regions. The same analysis in treatment-resistant patients showed thinning in the same regions, even after controlling for age, sex, illness severity, and chlorpromazine antipsychotic dose equivalents. No association was found in non-treatment-resistant patients. Region-of-interest analyses revealed impaired general illness awareness was associated with cortical thinning in the left supramarginal gyrus when controlling for covariates. Reduced right and left thalamic volumes were associated with VAGUS symptom attribution and awareness of negative consequences subscale scores, respectively, but not after correction for multiple testing. Our results suggest impaired insight into illness is related to cortical thinning in left frontotemporoparietal regions in patients with schizophrenia, particularly those with treatment resistance where insight deficits may be more chronic.
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Affiliation(s)
- Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jianmeng Song
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Yasaman Kambari
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Eric Plitman
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Yusuke Iwata
- University of Yamanashi, Faculty of Medicine, Department of Neuropsychiatry, Yamanashi, Japan
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eric E Brown
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
- Geriatric Mental Health Division, CAMH, Toronto, ON, Canada
| | - Shinichiro Nakajima
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Vincenzo De Luca
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Gary Remington
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
- Schizophrenia Division, CAMH, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Geriatric Mental Health Division, CAMH, Toronto, ON, Canada
- Schizophrenia Division, CAMH, Toronto, ON, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Geriatric Mental Health Division, CAMH, Toronto, ON, Canada.
- Schizophrenia Division, CAMH, Toronto, ON, Canada.
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de Bartolomeis A, Vellucci L, Barone A, Manchia M, De Luca V, Iasevoli F, Correll CU. Clozapine's multiple cellular mechanisms: What do we know after more than fifty years? A systematic review and critical assessment of translational mechanisms relevant for innovative strategies in treatment-resistant schizophrenia. Pharmacol Ther 2022; 236:108236. [PMID: 35764175 DOI: 10.1016/j.pharmthera.2022.108236] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 12/21/2022]
Abstract
Almost fifty years after its first introduction into clinical care, clozapine remains the only evidence-based pharmacological option for treatment-resistant schizophrenia (TRS), which affects approximately 30% of patients with schizophrenia. Despite the long-time experience with clozapine, the specific mechanism of action (MOA) responsible for its superior efficacy among antipsychotics is still elusive, both at the receptor and intracellular signaling level. This systematic review is aimed at critically assessing the role and specific relevance of clozapine's multimodal actions, dissecting those mechanisms that under a translational perspective could shed light on molecular targets worth to be considered for further innovative antipsychotic development. In vivo and in vitro preclinical findings, supported by innovative techniques and methods, together with pharmacogenomic and in vivo functional studies, point to multiple and possibly overlapping MOAs. To better explore this crucial issue, the specific affinity for 5-HT2R, D1R, α2c, and muscarinic receptors, the relatively low occupancy at dopamine D2R, the interaction with receptor dimers, as well as the potential confounder effects resulting in biased ligand action, and lastly, the role of the moiety responsible for lipophilic and alkaline features of clozapine are highlighted. Finally, the role of transcription and protein changes at the synaptic level, and the possibility that clozapine can directly impact synaptic architecture are addressed. Although clozapine's exact MOAs that contribute to its unique efficacy and some of its severe adverse effects have not been fully understood, relevant information can be gleaned from recent mechanistic understandings that may help design much needed additional therapeutic strategies for TRS.
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Affiliation(s)
- Andrea de Bartolomeis
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science and Dentistry, University Medical School of Naples "Federico II", Naples, Italy.
| | - Licia Vellucci
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science and Dentistry, University Medical School of Naples "Federico II", Naples, Italy
| | - Annarita Barone
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science and Dentistry, University Medical School of Naples "Federico II", Naples, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Felice Iasevoli
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science and Dentistry, University Medical School of Naples "Federico II", Naples, Italy
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
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3
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Krajner F, Hadaya L, McQueen G, Sendt KV, Gillespie A, Avila A, Lally J, Hedges EP, Diederen K, Howes OD, Barker GJ, Lythgoe DJ, Kempton MJ, McGuire P, MacCabe JH, Egerton A. Subcortical volume reduction and cortical thinning 3 months after switching to clozapine in treatment resistant schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:13. [PMID: 35236831 PMCID: PMC8891256 DOI: 10.1038/s41537-022-00230-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
The neurobiological effects of clozapine are under characterised. We examined the effects clozapine treatment on subcortical volume and cortical thickness and investigated whether macrostructural changes were linked to alterations in glutamate or N-acetylaspartate (NAA). Data were acquired in 24 patients with treatment-resistant schizophrenia before and 12 weeks after switching to clozapine. During clozapine treatment we observed reductions in caudate and putamen volume, lateral ventricle enlargement (P < 0.001), and reductions in thickness of the left inferior temporal cortex, left caudal middle frontal cortex, and the right temporal pole. Reductions in right caudate volume were associated with local reductions in NAA (P = 0.002). None of the morphometric changes were associated with changes in glutamate levels. These results indicate that clozapine treatment is associated with subcortical volume loss and cortical thinning and that at least some of these effects are linked to changes in neuronal or metabolic integrity.
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Affiliation(s)
- Fanni Krajner
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Laila Hadaya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Grant McQueen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Kyra-Verena Sendt
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Amy Gillespie
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Alessia Avila
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emily P Hedges
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Kelly Diederen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Gareth J Barker
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - David J Lythgoe
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - James H MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.
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Vandevelde A, Métivier L, Dollfus S. Impact cérébral structurel et fonctionnel de la Clozapine chez les patients souffrant de schizophrénie : revue systématique des études longitudinales en neuroimagerie. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:683-700. [PMID: 33131322 PMCID: PMC8329901 DOI: 10.1177/0706743720966459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIF L'objectif de cette revue est d'identifier les corrélats anatomo-fonctionnels cérébraux lors d'un traitement par clozapine (CLZ) ainsi que les marqueurs anatomo-fonctionnels prédictifs de la réponse à la CLZ. MÉTHODES Nous avons réalisé une revue systématique de la littérature avec les bases de données MEDLINE et Web of Science afin d'identifier et d'examiner toutes les études longitudinales en neuroimagerie investiguant l'impact cérébral de la CLZ. RÉSULTATS 30 études ont été incluses et analysées. La CLZ induit une diminution du volume et de la perfusion dans les noyaux gris centraux chez les patients répondeurs. Un plus grand volume de substance grise et perfusion dans ces structures avant l'instauration de la CLZ étaient associés à une meilleure réponse au traitement. La diminution de volume et de perfusion au niveau du cortex préfrontal (CPF) est observée malgré l'instauration de CLZ mais de façon moins importante chez les patients sous CLZ que chez les patients sous antipsychotiques typiques. Un plus grand volume au niveau du CPF avant l'instauration de la CLZ est associé à une meilleure réponse clinique dans la majorité des études. Enfin, la CLZ semble induire une réduction des altérations au niveau de la substance blanche. CONCLUSION Les corrélats anatomo-fonctionnels de la CLZ différent de ceux des autres antipsychotiques avec une action spécifique de la CLZ au niveau des ganglions de la base et du CPF pouvant participer à sa supériorité en termes de réponse clinique. Plusieurs données cliniques et d'imagerie conduisent à l'hypothèse d'un meilleur pronostic associé à une instauration plus rapide de la CLZ.
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Affiliation(s)
- Anaïs Vandevelde
- Normandie Univ, UNICAEN, ISTS, EA 7466, GIP 55388Cyceron, boulevard Henri-Becquerel, 14000 Caen, France.,26962Normandie Univ, UNICAEN, UFR de médecine (Medical School), 14000 Caen, France.,Anaïs Vandevelde et Lucie Métivier ont participé de la même façon à ce travail et sont co-premier auteurs
| | - Lucie Métivier
- 26962Normandie Univ, UNICAEN, UFR de médecine (Medical School), 14000 Caen, France.,CHU de Caen, centre Esquirol, service de psychiatrie, 14000 Caen, France.,Anaïs Vandevelde et Lucie Métivier ont participé de la même façon à ce travail et sont co-premier auteurs
| | - Sonia Dollfus
- Normandie Univ, UNICAEN, ISTS, EA 7466, GIP 55388Cyceron, boulevard Henri-Becquerel, 14000 Caen, France.,26962Normandie Univ, UNICAEN, UFR de médecine (Medical School), 14000 Caen, France.,CHU de Caen, centre Esquirol, service de psychiatrie, 14000 Caen, France
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Palaniyappan L, Sukumar N. Reconsidering brain tissue changes as a mechanistic focus for early intervention in psychiatry. J Psychiatry Neurosci 2020; 44:373-378. [PMID: 33119489 PMCID: PMC7595740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2024] Open
Affiliation(s)
- Lena Palaniyappan
- From the Robarts Research Institute, Western University (Palaniyappan); the Department of Psychiatry, Western University (Palaniyappan, Sukumar); the Lawson Health Research Institute, Imaging Division (Palaniyappan); and the Department of Medical Biophysics, Western University (Palaniyappan), London, Ont., Canada
| | - Niron Sukumar
- From the Robarts Research Institute, Western University (Palaniyappan); the Department of Psychiatry, Western University (Palaniyappan, Sukumar); the Lawson Health Research Institute, Imaging Division (Palaniyappan); and the Department of Medical Biophysics, Western University (Palaniyappan), London, Ont., Canada
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6
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Palaniyappan L, Sukumar N. Reconsidering brain tissue changes as a mechanistic focus for early intervention in psychiatry. J Psychiatry Neurosci 2020; 45. [PMID: 33119489 PMCID: PMC7595740 DOI: 10.1503/jpn.200172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Lena Palaniyappan
- From the Robarts Research Institute, Western University (Palaniyappan); the Department of Psychiatry, Western University (Palaniyappan, Sukumar); the Lawson Health Research Institute, Imaging Division (Palaniyappan); and the Department of Medical Biophysics, Western University (Palaniyappan), London, Ont., Canada
| | - Niron Sukumar
- From the Robarts Research Institute, Western University (Palaniyappan); the Department of Psychiatry, Western University (Palaniyappan, Sukumar); the Lawson Health Research Institute, Imaging Division (Palaniyappan); and the Department of Medical Biophysics, Western University (Palaniyappan), London, Ont., Canada
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Lee PH, Baker JT, Holmes AJ, Jahanshad N, Ge T, Jung JY, Cruz Y, Manoach DS, Hibar DP, Faskowitz J, McMahon KL, de Zubicaray GI, Martin NG, Wright MJ, Öngür D, Buckner R, Roffman J, Thompson PM, Smoller JW. Partitioning heritability analysis reveals a shared genetic basis of brain anatomy and schizophrenia. Mol Psychiatry 2016; 21:1680-1689. [PMID: 27725656 PMCID: PMC5144575 DOI: 10.1038/mp.2016.164] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 07/14/2016] [Accepted: 08/11/2016] [Indexed: 01/18/2023]
Abstract
Schizophrenia is a devastating neurodevelopmental disorder with a complex genetic etiology. Widespread cortical gray matter loss has been observed in patients and prodromal samples. However, it remains unresolved whether schizophrenia-associated cortical structure variations arise due to disease etiology or secondary to the illness. Here we address this question using a partitioning-based heritability analysis of genome-wide single-nucleotide polymorphism (SNP) and neuroimaging data from 1750 healthy individuals. We find that schizophrenia-associated genetic variants explain a significantly enriched proportion of trait heritability in eight brain phenotypes (false discovery rate=10%). In particular, intracranial volume and left superior frontal gyrus thickness exhibit significant and robust associations with schizophrenia genetic risk under varying SNP selection conditions. Cross-disorder comparison suggests that the neurogenetic architecture of schizophrenia-associated brain regions is, at least in part, shared with other psychiatric disorders. Our study highlights key neuroanatomical correlates of schizophrenia genetic risk in the general population. These may provide fundamental insights into the complex pathophysiology of the illness, and a potential link to neurocognitive deficits shaping the disorder.
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Affiliation(s)
- P H Lee
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - J T Baker
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Schizophrenia and Bipolar Disorder Program, Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA
| | - A J Holmes
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | - N Jahanshad
- Imaging Genetics Center, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - T Ge
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - J-Y Jung
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, CA, USA
| | - Y Cruz
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Harvard Graduate School of Education, Cambridge, MA, USA
| | - D S Manoach
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
| | - D P Hibar
- Imaging Genetics Center, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - J Faskowitz
- Imaging Genetics Center, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - K L McMahon
- Centre for Advanced Imaging, University of Queensland, Brisbane, QLD, Australia
| | - G I de Zubicaray
- Faculty of Health and Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - N G Martin
- Queensland Institute of Medical Research (QIMR) Berghofer, Brisbane, QLD, Australia
| | - M J Wright
- Centre for Advanced Imaging, University of Queensland, Brisbane, QLD, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
| | - D Öngür
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Schizophrenia and Bipolar Disorder Program, Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA
| | - R Buckner
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, USA
- Department of Psychology and Center for Brain Science, Harvard University, Cambridge, MA, USA
| | - J Roffman
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Schizophrenia Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - P M Thompson
- Imaging Genetics Center, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - J W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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8
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Neuroimaging findings from childhood onset schizophrenia patients and their non-psychotic siblings. Schizophr Res 2016; 173:124-131. [PMID: 25819937 PMCID: PMC4583796 DOI: 10.1016/j.schres.2015.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 12/14/2022]
Abstract
Childhood onset schizophrenia (COS), with onset of psychosis before age 13, is a rare form of schizophrenia that represents a more severe and chronic form of the adult onset illness. In this review we examine structural and functional magnetic resonance imaging (MRI) studies of COS and non-psychotic siblings of COS patients in the context of studies of schizophrenia as a whole. Studies of COS to date reveal progressive loss of gray matter volume and cortical thinning, ventricular enlargement, progressive decline in cerebellar volume and a significant but fixed deficit in hippocampal volume. COS is also associated with a slower rate of white matter growth and disrupted local connectivity strength. Sibling studies indicate that non-psychotic siblings of COS patients share many of these brain abnormalities, including decreased cortical thickness and disrupted white matter growth, yet these abnormalities normalize with age. Cross-sectional and longitudinal neuroimaging studies remain some of the few methods for assessing human brain function and play a pivotal role in the quest for understanding the neurobiology of schizophrenia as well as other psychiatric disorders. Parallel studies in non-psychotic siblings provide a unique opportunity to understand both risk and resilience in schizophrenia.
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Knöchel C, Stäblein M, Prvulovic D, Ghinea D, Wenzler S, Pantel J, Alves G, Linden DEJ, Harrison O, Carvalho A, Reif A, Oertel-Knöchel V. Shared and distinct gray matter abnormalities in schizophrenia, schizophrenia relatives and bipolar disorder in association with cognitive impairment. Schizophr Res 2016; 171:140-8. [PMID: 26833265 DOI: 10.1016/j.schres.2016.01.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/22/2015] [Accepted: 01/12/2016] [Indexed: 01/01/2023]
Abstract
Cognitive impairments have been linked to structural and functional alterations in frontal and subcortical brain regions, ultimately leading to fronto-thalamic connectivity disturbances. We hypothesized that such neuronal disruptions in frontal and subcortical structures may account for neuropsychological deficits in schizophrenia (SZ), schizophrenia relatives and bipolar disorder (BD). We acquired T1-weighted anatomical MRI sequences in 209 participants: 57 SZ patients, 47 first-degree relatives of SZ patients, 48 BD I patients and 57 healthy controls. We computed group comparisons of gray matter (GM) volume in frontal and basal ganglia regions-of-interest, followed by correlation analysis between psychomotor speed, executive functioning and learning and GM volumes in candidate regions. Several frontal GM volume reductions as well as GM increases in the thalamus and the putamen were exhibited in SZ patients as compared to controls. The same finding was observed - less pronounced - when comparing SZ relatives and controls. BD patients presented GM volume increases in the basal ganglia in comparison to controls. In SZ patients, increases in bilateral thalamus GM volume and decreases in left middle and superior frontal gyrus volume were significantly associated with worse cognitive performance. In summary, our results indicate distinct imbalances across frontal-subcortical circuits in BD, SZ relatives and SZ. The functional relevance of the findings were mainly limited to the SZ patients group: in this group, abnormalities were directly associated with cognitive performance. This result is in line with the finding that the volume alterations were strongest in SZ patients and followed by BD patients and SZ relatives.
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Affiliation(s)
- Christian Knöchel
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany.
| | - Michael Stäblein
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany
| | - David Prvulovic
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Denisa Ghinea
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Sofia Wenzler
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Johannes Pantel
- Institute of General Practice, Goethe University, Frankfurt, Germany
| | - Gilberto Alves
- Translational Psychiatry Research Group, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - David E J Linden
- MRC Centre for Neuropsychiatric Genetics & Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, United Kingdom
| | - Octavia Harrison
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Andre Carvalho
- Translational Psychiatry Research Group, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Andreas Reif
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Viola Oertel-Knöchel
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany
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10
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Garcia GJ, Chagas MH, Silva CH, Machado-de-Sousa JP, Crippa JA, Hallak JE. Structural and functional neuroimaging findings associated with the use of clozapine in schizophrenia: a systematic review. BRAZILIAN JOURNAL OF PSYCHIATRY 2015; 37:71-9. [PMID: 25806554 DOI: 10.1590/1516-4446-2014-1387] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/02/2014] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Schizophrenia is one of the most severe psychiatric disorders, and its current treatment relies on antipsychotic medications with only partial effectiveness. Clozapine is an atypical antipsychotic with a specific profile of action indicated for treatment-resistant schizophrenia. Neuroimaging studies assessing the effects of clozapine could help shed light on the neural underpinnings of the effects of this drug in the brain. The objective of this study was to review the available literature on the structural and functional neuroimaging findings associated with use of clozapine. METHOD We conducted a systematic review of the indexed literature using the PubMed, BIREME, and ISI Web of Knowledge search engines and the following keywords: clozapine, neuroimaging, computed tomography, MRI, functional magnetic resonance, PET, SPECT, and DTI. RESULTS A total of 23 articles were included in the review. In structural studies, the use of clozapine was associated with volume reductions in the basal ganglia, especially the caudate nucleus, where functional neuroimaging studies also found decreased perfusion. In the frontal lobe, clozapine treatment was associated with increased gray matter volume and reduced perfusion. CONCLUSION The results of the studies reviewed suggest that the use of clozapine is associated with distinctive structural and functional neuroimaging findings that are not shared with other antipsychotics.
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Affiliation(s)
- Giovana J Garcia
- Department of Neuroscience and Behavior, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Marcos H Chagas
- Department of Neuroscience and Behavior, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Carlos H Silva
- Department of Neuroscience and Behavior, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - João P Machado-de-Sousa
- Department of Neuroscience and Behavior, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - José A Crippa
- Department of Neuroscience and Behavior, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Jaime E Hallak
- Department of Neuroscience and Behavior, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
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11
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Ahmed M, Cannon DM, Scanlon C, Holleran L, Schmidt H, McFarland J, Langan C, McCarthy P, Barker GJ, Hallahan B, McDonald C. Progressive Brain Atrophy and Cortical Thinning in Schizophrenia after Commencing Clozapine Treatment. Neuropsychopharmacology 2015; 40:2409-17. [PMID: 25829144 PMCID: PMC4538355 DOI: 10.1038/npp.2015.90] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 02/10/2015] [Accepted: 03/10/2015] [Indexed: 01/20/2023]
Abstract
Despite evidence that clozapine may be neuroprotective, there are few longitudinal magnetic resonance imaging (MRI) studies that have specifically explored an association between commencement of clozapine treatment for schizophrenia and changes in regional brain volume or cortical thickness. A total of 33 patients with treatment-resistant schizophrenia and 31 healthy controls matched for age and gender underwent structural MRI brain scans at baseline and 6-9 months after commencing clozapine. MRI images were analyzed using SIENA (Structural Image Evaluation, using Normalization, of Atrophy) and FreeSurfer to investigate changes over time in brain volume and cortical thickness respectively. Significantly greater reductions in volume were detected in the right and left medial prefrontal cortex and in the periventricular area in the patient group regardless of treatment response. Widespread further cortical thinning was observed in patients compared with healthy controls. The majority of patients improved symptomatically and functionally over the study period, and patients who improved were more likely to have less cortical thinning of the left medial frontal cortex and the right middle temporal cortex. These findings demonstrate on-going reductions in brain volume and progressive cortical thinning in patients with schizophrenia who are switched to clozapine treatment. It is possible that this gray matter loss reflects a progressive disease process irrespective of medication use or that it is contributed to by switching to clozapine treatment. The clinical improvement of most patients indicates that antipsychotic-related gray matter volume loss may not necessarily be harmful or reflect neurotoxicity.
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Affiliation(s)
- Mohamed Ahmed
- Clinical Neuroimaging Laboratory, Department of Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Galway, Ireland
| | - Dara M Cannon
- Clinical Neuroimaging Laboratory, Department of Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Galway, Ireland
| | - Cathy Scanlon
- Clinical Neuroimaging Laboratory, Department of Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Galway, Ireland
| | - Laurena Holleran
- Clinical Neuroimaging Laboratory, Department of Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Galway, Ireland
| | - Heike Schmidt
- Clinical Neuroimaging Laboratory, Department of Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Galway, Ireland
| | - John McFarland
- Clinical Neuroimaging Laboratory, Department of Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Galway, Ireland
| | - Camilla Langan
- Clinical Neuroimaging Laboratory, Department of Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Galway, Ireland
| | - Peter McCarthy
- Department of Radiology, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Galway, Ireland
| | - Gareth J Barker
- Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, London, UK
| | - Brian Hallahan
- Clinical Neuroimaging Laboratory, Department of Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Galway, Ireland
| | - Colm McDonald
- Clinical Neuroimaging Laboratory, Department of Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Galway, Ireland
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12
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Schweren LJS, Hartman CA, Zwiers MP, Heslenfeld DJ, van der Meer D, Franke B, Oosterlaan J, Buitelaar JK, Hoekstra PJ. Combined stimulant and antipsychotic treatment in adolescents with attention-deficit/hyperactivity disorder: a cross-sectional observational structural MRI study. Eur Child Adolesc Psychiatry 2015; 24:959-68. [PMID: 25395383 DOI: 10.1007/s00787-014-0645-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 11/01/2014] [Indexed: 10/24/2022]
Abstract
Meta-analyses suggest normalizing effects of methylphenidate on structural fronto-striatal abnormalities in patients with attention-deficit/hyperactivity disorder (ADHD). A subgroup of patients receives atypical antipsychotics concurrent with methylphenidate. Long-term safety and efficacy of combined treatment are unknown. The current study provides an initial investigation of structural brain correlates of combined methylphenidate and antipsychotic treatment in patients with ADHD. Structural magnetic resonance imaging was obtained in 31 patients who had received combined methylphenidate and antipsychotic treatment, 31 matched patients who had received methylphenidate but not antipsychotics, and 31 healthy controls (M age 16.7 years). We analyzed between-group effects in total cortical and subcortical volume, and in seven frontal cortical and eight subcortical-limbic volumes of interest, each involved in dopaminergic neurotransmission. Patients in the combined treatment group, but not those in the methylphenidate only group, showed a reduction in total cortical volume compared to healthy controls (Cohen's d = 0.69, p < 0.004), which was apparent in most frontal volumes of interest. Further, the combined treatment group, but not the methylphenidate group, showed volume reduction in bilateral ventral diencephalon (Left Cohen's d = 0.48, p < 0.04; Right Cohen's d = 0.46, p < 0.05) and the left thalamus (Cohen's d = 0.47, p < 0.04). These findings may indicate antipsychotic treatment counteracting the normalizing effects of methylphenidate on brain structure. However, it cannot be ruled out that pre-existing clinical differences between both patient groups may have resulted in anatomical differences at the time of scanning. The absence of an untreated ADHD group hinders unequivocal interpretation and implications of our findings.
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Affiliation(s)
- L J S Schweren
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Huispostcode CC10, 9700, VB, Groningen, The Netherlands,
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13
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Smith GN, Thornton AE, Lang DJ, MacEwan GW, Kopala LC, Su W, Honer WG. Cortical morphology and early adverse birth events in men with first-episode psychosis. Psychol Med 2015; 45:1825-1837. [PMID: 25499574 DOI: 10.1017/s003329171400292x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reduced cortical gray-matter volume is commonly observed in patients with psychosis. Cortical volume is a composite measure that includes surface area, thickness and gyrification. These three indices show distinct maturational patterns and may be differentially affected by early adverse events. The study goal was to determine the impact of two distinct obstetrical complications (OCs) on cortical morphology. METHOD A detailed birth history and MRI scans were obtained for 36 patients with first-episode psychosis and 16 healthy volunteers. RESULTS Perinatal hypoxia and slow fetal growth were associated with cortical volume (Cohen's d = 0.76 and d = 0.89, respectively) in patients. However, the pattern of associations differed across the three components of cortical volume. Both hypoxia and fetal growth were associated with cortical surface area (d = 0.88 and d = 0.72, respectively), neither of these two OCs was related to cortical thickness, and hypoxia but not fetal growth was associated with gyrification (d = 0.85). No significant associations were found within the control sample. CONCLUSIONS Cortical dysmorphology was associated with OCs. The use of a global measure of cortical morphology or a global measure of OCs obscured important relationships between these measures. Gyrification is complete before 2 years and its strong relationship with hypoxia suggests an early disruption to brain development. Cortical thickness matures later and, consistent with previous research, we found no association between thickness and OCs. Finally, cortical surface area is largely complete by puberty and the present results suggest that events during childhood do not fully compensate for the effects of early disruptive events.
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Affiliation(s)
- G N Smith
- Department of Psychiatry,University of British Columbia,Vancouver,Canada
| | - A E Thornton
- Department of Psychology,Simon Fraser University,Burnaby,Canada
| | - D J Lang
- Department of Radiology,University of British Columbia,Vancouver,Canada
| | - G W MacEwan
- Department of Psychiatry,University of British Columbia,Vancouver,Canada
| | - L C Kopala
- Department of Psychiatry,University of British Columbia,Vancouver,Canada
| | - W Su
- Department of Psychiatry,University of British Columbia,Vancouver,Canada
| | - W G Honer
- Department of Psychiatry,University of British Columbia,Vancouver,Canada
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14
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Effects of lithium on cortical thickness and hippocampal subfield volumes in psychotic bipolar disorder. J Psychiatr Res 2015; 61:180-7. [PMID: 25563516 PMCID: PMC4859940 DOI: 10.1016/j.jpsychires.2014.12.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 11/19/2014] [Accepted: 12/11/2014] [Indexed: 12/13/2022]
Abstract
Relative to healthy controls, lithium free bipolar patients exhibit significant gray matter abnormalities. Lithium, the long-time reference standard medication treatment for bipolar disorder, has been proposed to be neuro-protective against these abnormalities. However, its effects on cortical thickness and hippocampal subfield (HSF) volumes remain unstudied and unclear, respectively, in bipolar disorder. This study included 342 healthy controls (HC), 51 lithium free PBD patients (NoLi), and 51 PBD patients taking lithium (Li). Regional gray matter thickness and HSF volume values were extracted from 3T MRI images. After matching NoLi and Li samples, regions where HC differed from either Li or NoLi were identified. In regions of significant or trending HC-NoLi difference, Li-NoLi comparisons were made. No significant HC-Li thickness or HSF volume differences were found. Significantly thinner occipital cortices were observed in NoLi compared to HC. In these regions, Li consistently exhibited non-significant trends for greater cortical thickness relative to NoLi. Significantly less volume was observed in NoLi compared to both HC and Li in right HSFs. Our results suggest that PBD in patients not treated with Li is associated with thinner occipital cortices and reduced HSF volumes compared with HC. Patients treated with Li exhibited significantly larger HSF volumes than NoLi, and those treated with Li were no different from HC in cortical thickness or hippocampal volumes. This evidence directly supports the hypothesis that Li may counteract the locally thinner and smaller gray matter structure found in PBD.
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15
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Bilder RM. Finding pieces to the puzzle of brain structure in schizophrenia. Biol Psychiatry 2014; 76:432-3. [PMID: 25149348 PMCID: PMC6708596 DOI: 10.1016/j.biopsych.2014.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/01/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Robert M Bilder
- Jane and Terry Semel Institute for Neuroscience & Human Behavior at University of California, Los Angeles, Los Angeles, California..
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16
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Greater clinical and cognitive improvement with clozapine and risperidone associated with a thinner cortex at baseline in first-episode schizophrenia. Schizophr Res 2014; 158:223-9. [PMID: 25088730 DOI: 10.1016/j.schres.2014.06.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/21/2014] [Accepted: 06/24/2014] [Indexed: 12/18/2022]
Abstract
Cortical thickness may be useful as a treatment response predictor in first-episode (FE) patients with schizophrenia, although this possibility has been scarcely assessed. In this study we assessed the possible relation between cortical thickness in regions of interest selected because of previously reported structural alterations in schizophrenia and clinical and cognitive changes after two years of treatment with risperidone or clozapine in 31 neuroleptic-naïve FE patients with schizophrenia (16 of them treated with clozapine and 15 with risperidone). Using the last-observation-carried-forward (LOCF), a larger improvement in positive, negative and total symptoms was predicted by the amount of baseline cortical thinning in the right prefrontal cortex (pars orbitalis). After two years of treatment, cognitive status was reassessed in the 17 patients (11 on clozapine) who had not dropped out. Working memory improvement after reassessment was associated with a greater baseline cortical thinning in the left prefrontal cortex (pars orbitalis), and verbal memory improvement with a greater baseline cortical thinning in the left pars triangularis. Significant but weak cortical thickness decrease from baseline to follow-up was observed in patients in comparison to controls (left pars triangularis and opercularis, and left caudal middle frontal areas). These results may support a positive predictive role for cortical thinning in the frontal region with regard to clinical and cognitive improvement with clozapine and risperidone in FE patients with schizophrenia.
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17
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Klein C, Bespalov A. Development of novel therapy of schizophrenia in children and adolescents. Expert Opin Investig Drugs 2014; 23:1531-40. [PMID: 24970455 DOI: 10.1517/13543784.2014.933806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Typical and atypical antipsychotics are efficacious treatments for early-onset schizophrenia (EOS) with very subtle differences in their efficacy. Therefore, when choosing an antipsychotic, the side-effect profile of the individual antipsychotic needs to be taken into account. There is a growing body of neurobiological and genetic evidence for early-onset patients, but these findings have not yet translated into the clinic. AREAS COVERED The authors summarize the current treatment options for EOS and discuss the novel treatment options that are under evaluation. The authors focus specifically on Phase II and Phase III clinical trials. EXPERT OPINION Currently, there are no truly groundbreaking pharmacological treatment options emerging in EOS. There are several newer antipsychotic agents (iloperidone, lurasidone, asenapine, blonanserin) that are currently in clinical trials. It is unclear whether therapeutic efficacy of any of these agents will be superior or even similar to the existing treatment and the main differentiating factor between individual drugs remains to be their side-effect profile. Beyond these antipsychotics, oxytocin and N-acetylcysteine are the only new pharmacological treatment options that are being evaluated in EOS. Therefore, a major change in the treatment development paradigm is necessary to identify novel and efficacious drugs.
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Affiliation(s)
- Corinna Klein
- Department of Pharmacology, Neuroscience Research, AbbVie Deutschland GmbH & Co KG , Knollstrasse, D-67008 Ludwigshafen , Germany +49 621 589 1370 ; +49 621 589 3232 ;
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18
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Baribeau DA, Anagnostou E. A comparison of neuroimaging findings in childhood onset schizophrenia and autism spectrum disorder: a review of the literature. Front Psychiatry 2013; 4:175. [PMID: 24391605 PMCID: PMC3869044 DOI: 10.3389/fpsyt.2013.00175] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 12/09/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) and childhood onset schizophrenia (COS) are pediatric neurodevelopmental disorders associated with significant morbidity. Both conditions are thought to share an underlying genetic architecture. A comparison of neuroimaging findings across ASD and COS with a focus on altered neurodevelopmental trajectories can shed light on potential clinical biomarkers and may highlight an underlying etiopathogenesis. METHODS A comprehensive review of the medical literature was conducted to summarize neuroimaging data with respect to both conditions in terms of structural imaging (including volumetric analysis, cortical thickness and morphology, and region of interest studies), white matter analysis (include volumetric analysis and diffusion tensor imaging) and functional connectivity. RESULTS In ASD, a pattern of early brain overgrowth in the first few years of life is followed by dysmaturation in adolescence. Functional analyses have suggested impaired long-range connectivity as well as increased local and/or subcortical connectivity in this condition. In COS, deficits in cerebral volume, cortical thickness, and white matter maturation seem most pronounced in childhood and adolescence, and may level off in adulthood. Deficits in local connectivity, with increased long-range connectivity have been proposed, in keeping with exaggerated cortical thinning. CONCLUSION The neuroimaging literature supports a neurodevelopmental origin of both ASD and COS and provides evidence for dynamic changes in both conditions that vary across space and time in the developing brain. Looking forward, imaging studies which capture the early post natal period, which are longitudinal and prospective, and which maximize the signal to noise ratio across heterogeneous conditions will be required to translate research findings into a clinical environment.
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Affiliation(s)
| | - Evdokia Anagnostou
- Autism Research Centre, Bloorview Research Institute, University of Toronto , Toronto, ON , Canada
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19
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Goghari VM, Smith GN, Honer WG, Kopala LC, Thornton AE, Su W, Macewan GW, Lang DJ. Effects of eight weeks of atypical antipsychotic treatment on middle frontal thickness in drug-naïve first-episode psychosis patients. Schizophr Res 2013; 149:149-55. [PMID: 23830856 DOI: 10.1016/j.schres.2013.06.025] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 06/07/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022]
Abstract
Atypical antipsychotic medications generally maintain or increase gray matter amount and functioning. First-episode psychosis patients have lower gray matter volume in the middle frontal gyrus, as well as worse performance on spatial working memory tasks compared to controls. This study investigated the effects of short-term four- and eight-week atypical treatment on middle frontal thickness and spatial working memory in first-episode psychosis patients. Nineteen drug-naïve first-episode psychosis patients treated with risperidone or quetiapine and 26 controls completed structural magnetic resonance imaging, a spatial working memory task, and clinical assessment at three intervals (baseline, four weeks, and eight weeks; all patients and 23 controls completed all three assessments). Caudal and rostral middle frontal thicknesses were measured using the automated program Freesurfer. Positive, negative, and general symptoms of the Positive and Negative Syndrome Scale (PANSS) decreased significantly in patients, with most of the change occurring in the first four weeks of treatment. Patients demonstrated an increase in rostral middle frontal thickness over eight weeks of treatment compared to controls. There was a medium effect size relationship between reduction in negative symptoms at four and eight weeks, and a change in rostral middle frontal thickness over eight weeks. No changes were found in spatial working memory ability. Short-term atypical treatment with risperidone or quetiapine can increase prefrontal cortical thickness in psychosis. These findings are notable given the role of the rostral middle frontal region in cognition and the relationship between better cognitive functioning and better functional outcome in psychosis.
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Affiliation(s)
- Vina M Goghari
- Department of Psychology, Hotchkiss Brain Institute, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
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Zugman A, Gadelha A, Assunção I, Sato J, Ota VK, Rocha DL, Mari JJ, Belangero SI, Bressan RA, Brietzke E, Jackowski AP. Reduced dorso-lateral prefrontal cortex in treatment resistant schizophrenia. Schizophr Res 2013; 148:81-6. [PMID: 23721966 DOI: 10.1016/j.schres.2013.05.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 04/30/2013] [Accepted: 05/02/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Treatment resistance affects up to one third of patients with schizophrenia (SCZ). A better understanding of its biological underlying processes could improve treatment. The aim of this study was to compare cortical thickness between non-resistant SCZ (NR-SCZ), treatment-resistant SCZ (TR-SCZ) patients and healthy controls (HC). METHODOLOGY Structural MRI scans were obtained from 3 groups of individuals: 61 treatment resistant SCZ individuals, 67 non-resistant SCZ and 80 healthy controls. Images were analyzed using cortical surface modelling (implemented in freesurfer package) to identify group differences in cortical thickness. Statistical significant differences were identified using Monte-Carlo simulation method with a corrected p-cluster<0.01. RESULTS Patients in the TR-SCZ group showed a widespread reduction in cortical thickness in frontal, parietal, temporal and occipital regions bilaterally. NR-SCZ group had reduced cortex in two regions (left superior frontal cortex and left caudal middle frontal cortex). TR-SCZ group also showed decreased thickness in the left dorsolateral prefrontal cortex (DLPFC) when compared with patients from NR-SCZ group. CONCLUSIONS The reduction in cortical thickness in DLPFC indicates a more severe form of the disease or a specific finding for this group. Alterations in this region should be explored as a putative marker for treatment resistance. Prospective studies, with individuals being followed from first episode psychosis until refractoriness is diagnosed, are needed to clarify these hypotheses.
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Affiliation(s)
- André Zugman
- Interdiciplinary Laboratory in Clinical Neuroscience (LiNC), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.
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21
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Bartholomeusz CF, Whittle SL, Montague A, Ansell B, McGorry PD, Velakoulis D, Pantelis C, Wood SJ. Sulcogyral patterns and morphological abnormalities of the orbitofrontal cortex in psychosis. Prog Neuropsychopharmacol Biol Psychiatry 2013; 44:168-77. [PMID: 23485592 DOI: 10.1016/j.pnpbp.2013.02.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 02/01/2013] [Accepted: 02/12/2013] [Indexed: 12/13/2022]
Abstract
Three types of OFC sulcogyral patterns have been identified in the general population. The distribution of these three types has been found altered in individuals at genetic risk of psychosis, first episode psychosis (FEP) and chronic schizophrenia. The aim of this study was to replicate and extend previous research by additionally investigating: intermediate and posterior orbital sulci, cortical thickness, and degree of gyrification/folding of the OFC, in a large sample of FEP patients and healthy controls. OFC pattern type was classified based on a method previously devised, using T1-weighted magnetic resonance images. Cortical thickness and local gyrification indices were calculated using FreeSurfer. Occurrence of Type I pattern was decreased and Type II pattern was increased in FEP patients for the right hemisphere. Interestingly, controls displayed an OFC pattern type distribution that was disparate to that previously reported. Significantly fewer intermediate orbital sulci were observed in the left hemisphere of patients. Grey matter thickness of orbitofrontal sulci was reduced bilaterally, and left hemisphere reductions were related to OFC pattern type in patients. There was no relationship between pattern type and degree of OFC gyrification. An interaction was found between the number of intermediate orbital sulci and OFC gyrification; however this group difference was specific to only the small subsample of people with three intermediate orbital sulci. Given that cortical folding is largely determined by birth, our findings suggest that Type II pattern may be a neurodevelopmental risk marker while Type I pattern may be somewhat protective. This finding, along with compromised orbitofrontal sulci thickness, may reflect early abnormalities in cortical development and point toward a possible endophenotypic risk marker of schizophrenia-spectrum disorders.
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Affiliation(s)
- Cali F Bartholomeusz
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, 161 Barry Street, Carlton South, Victoria 3053, Australia.
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David CN, Rapoport JL, Gogtay N. Treatments in context: transcranial direct current brain stimulation as a potential treatment in pediatric psychosis. Expert Rev Neurother 2013; 13:447-58. [PMID: 23545058 PMCID: PMC4063712 DOI: 10.1586/ern.13.29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Childhood-onset schizophrenia is a chronic, severe form of schizophrenia, and is typically treatment resistant. Even after optimized pharmacotherapy, a majority (over 70%) of these pediatric patients present lasting psychotic symptoms and impaired cognition, necessitating the need for novel treatment modalities. Recent work in transcranial magnetic stimulation suggests moderate efficacy in symptom reduction in adult patients with schizophrenia; however, the transcranial magnetic stimulation treatment is cumbersome for this severely ill population. Transcranial direct current stimulation may provide a safe and effective adjuvant treatment for continued residual symptoms of schizophrenia.
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Affiliation(s)
- Christopher N David
- Child Psychiatry Branch, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Building 10, Room 3N202, 10 Center Drive, Bethesda, MD 20890, USA
| | - Judith L Rapoport
- Child Psychiatry Branch, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Building 10, Room 3N202, 10 Center Drive, Bethesda, MD 20890, USA
| | - Nitin Gogtay
- Child Psychiatry Branch, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Building 10, Room 3N202, 10 Center Drive, Bethesda, MD 20890, USA
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Weisinger B, Greenstein D, Mattai A, Clasen L, Lalonde F, Feldman S, Miller R, Tossell JW, Vyas NS, Stidd R, David C, Gogtay N. Lack of gender influence on cortical and subcortical gray matter development in childhood-onset schizophrenia. Schizophr Bull 2013; 39:52-8. [PMID: 21613381 PMCID: PMC3523910 DOI: 10.1093/schbul/sbr049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Progressive cortical gray matter (GM) abnormalities are an established feature of schizophrenia and are more pronounced in rare, severe, and treatment refractory childhood-onset schizophrenia (COS) cases. The effect of sex on brain development in schizophrenia is poorly understood and studies to date have produced inconsistent results. METHODS Using the largest to date longitudinal sample of COS cases (n = 104, scans = 249, Male/Female [M/F] = 57/47), we compared COS sex differences with sex differences in a sample of matched typically developing children (n = 104, scans = 244, M/F = 57/47), to determine whether or not sex had differential effects on cortical and subcortical brain development in COS. RESULTS Our results showed no significant differential sex effects in COS for either GM cortical thickness or subcortical volume development (sex × diagnosis × age interaction; false discovery rate q = 0.05). CONCLUSION Sex appears to play a similar role in cortical and subcortical GM development in COS as it does in normally developing children.
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Affiliation(s)
- Brian Weisinger
- Child Psychiatry Branch, National Institutes of Mental Health, 10/3N202, 10 Center Drive, Bethesda, MD, USA.
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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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Singh MK, Chang KD. The Neural Effects of Psychotropic Medications in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2012; 21:753-71. [PMID: 23040900 PMCID: PMC3590023 DOI: 10.1016/j.chc.2012.07.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Little is known about the neurobiological effects of psychotropic medications used in the treatment of children and adolescents diagnosed with a psychiatric disorder. This review provides a synopsis of the literature demonstrating the neural effects associated with exposure to psychotropic medication in youth using multimodal neuroimaging. The article concludes by illustrating how, taken together, these studies suggest that pharmacological interventions during childhood do indeed affect brain structure and function in a detectable manner, and the effects appear to be ameliorative.
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26
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Abbs B, Achalia RM, Adelufosi AO, Aktener AY, Beveridge NJ, Bhakta SG, Blackman RK, Bora E, Byun MS, Cabanis M, Carrion R, Castellani CA, Chow TJ, Dmitrzak-Weglarz M, Gayer-Anderson C, Gomes FV, Haut K, Hori H, Kantrowitz JT, Kishimoto T, Lee FHF, Lin A, Palaniyappan L, Quan M, Rubio MD, Ruiz de Azúa S, Sahoo S, Strauss GP, Szczepankiewicz A, Thompson AD, Trotta A, Tully LM, Uchida H, Velthorst E, Young JW, O’Shea A, DeLisi LE. The 3rd Schizophrenia International Research Society Conference, 14-18 April 2012, Florence, Italy: summaries of oral sessions. Schizophr Res 2012; 141:e1-e24. [PMID: 22910407 PMCID: PMC3877922 DOI: 10.1016/j.schres.2012.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 07/23/2012] [Indexed: 01/30/2023]
Abstract
The 3rd Schizophrenia International Research Society Conference was held in Florence, Italy, April 14-18, 2012 and this year had as its emphasis, "The Globalization of Research". Student travel awardees served as rapporteurs for each oral session and focused their summaries on the most significant findings that emerged and the discussions that followed. The following report is a composite of these summaries. We hope that it will provide an overview for those who were present, but could not participate in all sessions, and those who did not have the opportunity to attend, but who would be interested in an update on current investigations ongoing in the field of schizophrenia research.
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Affiliation(s)
- Brandon Abbs
- Brigham and Women’s Hospital, Department of Medicine, Connors Center for Women’s Health, Harvard Medical School, Department of Psychiatry, 1620 Tremont Street BC 3-34 Boston, MA 02120, Phone: 617-525-8641, Fax: 617-525-7900
| | - Rashmin M Achalia
- Department of Psychiatry, Government Medical College, Aurangabad, Maharashtra, India. Phone: + 91 9028851672, Fax: + 91 0240 2402418
| | - Adegoke O Adelufosi
- Dbepartment of Psychiatry, Ladoke Akintola University, Teaching Hospital (LAUTECH), Ogbomoso, Oyo State, Nigeria. P.O. Box 2210, Sapon, Abeokuta, Ogun State, Nigeria, Phone: +234 803 5988 054
| | - Ahmet Yiğit Aktener
- Göksun State Hospital, Göksun, Kahramanmaraş, Turkey, Phone: (0090) 532 4465832
| | - Natalie J Beveridge
- School of Biomedical Sciences & Pharmacy, Schizophrenia Research Institute, Room 616 Medical Sciences Building, University of Newcastle, Callaghan NSW 2308, Phone: (02) 4921 8748, Fax: (02) 4921 7903
| | - Savita G Bhakta
- Hofstra-NSLIJHS School of Medicine/The Zucker Hillside Hospital, address: 75 59 263rd street, Glen Oaks, NY-11004, Phone: 718-470-8232, Fax: 718-831-0368
| | - Rachael K Blackman
- University of Minnesota Medical Scientist Training Program (MD/PhD), University of Minnesota Neuroscience Department, and Brain Sciences Center VA Medical Center, Minneapolis, MN, University of Minnesota, Medical Scientist Training Program (MD/PhD), B681 Mayo, 420 Delaware St. SE, Minneapolis, MN 55455, Phone: 612-467-5077
| | - Emre Bora
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, VIC, Australia. Alan Gilbert Building NNF level 3 University of Melbourne, VIC, Australia, Phone: 61 3 8345 5611, Fax: 61 3 8345 5610
| | - MS Byun
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea, address: Department of Psychiatry, Seoul National University College of Medicine, 101 Daehak-no, Chongno-gu, Seoul 110-744, Republic of Korea. Phone: +82-2-2072-2457 Fax: +82-2-747-9063
| | - Maurice Cabanis
- Department of Psychiatry and Psychotherapy, Philipps-University, Rudolf-Bultmann-Straße 8, D-35039 Marburg, Germany, Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Rudolf-Bultmann-Str. 8, D-35039 Marburg, Germany Phone: +49(0)6421-58-66932, Fax: +49(0)6421-58-68939
| | - Ricardo Carrion
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA, 2. Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, North Shore – Long Island Jewish Health System, Manhasset, New York, 11030, USA, Phone: 718-470-8878, Fax: 718-470-8131
| | - Christina A Castellani
- Molecular Genetics Unit, Department of Biology, The University of Western Ontario, London, Ontario, Canada, Phone: 519-661-2111 x86928, Fax: 519-661-3935
| | - Tze Jen Chow
- Universiti Tunku Abdul Rahman, Jalan Genting Kelang, Setapak 53300, Kuala Lumpur, Malaysia, Phone: +603-41079802
| | - M Dmitrzak-Weglarz
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Szpitalna St. 27/33, Poznan, 60-572, Poland, Phone: +48 618491311, Fax: +48 61484392
| | - Charlotte Gayer-Anderson
- Institute of Psychiatry, King’s College London, De Crespigny Park, London, United Kingdom, SE5 8AF, Phone: 0207 848 5060
| | - Felipe V Gomes
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto/SP 14049-900, Brazil
| | - Kristen Haut
- University of California, Los Angeles, 1285 Franz Hall, University of California, Los Angeles, CA, 90095, Phone: 310-794-9673, Fax: 310-794-9740
| | - Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan, Phone: +81 42 341 2711, Fax: +81 42 346 1744
| | - Joshua T Kantrowitz
- New York State Psychiatric Institute/Nathan Kline Institute for Psychiatric Research 1051 Riverside Drive, Room 5807, New York, NY 10023, Phone: 212-543-6711, Fax: 212-543-1350
| | - Taishiro Kishimoto
- (1) The Zucker Hillside Hospital, Psychiatry Research, 75-59 263rd street, Glen Oaks, NY 11004 USA (2) Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, Japan, Phone: +1-718-470-8386, Fax: +718-343-1659
| | - Frankie HF Lee
- 1. Centre for Addiction and Mental Health, 250 College St. Toronto, Ontario, Canada, M5T 1R8, 2. Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada, M5S 1A8, Phone: +1416-535-8501 ext. 4084, Fax: +1416-979-4663
| | - Ashleigh Lin
- School of Psychology, University of Birmingham, Edgbaston, B152TT, United Kingdom, Phone: +44 121 414 6241, Fax: +44 121 414 4897
| | - Lena Palaniyappan
- Translational Neuroimaging, Division of Psychiatry, University of Nottingham address: C09, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, Phone: 01157430407, Fax: 01157430422
| | - Meina Quan
- 1. Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA, 02215. 2. Laboratory of Neuroscience, Department of Psychiatry, VA Boston Healthcare System, Harvard Medical School, 940 Belmont Street, Brockton, MA, 02301, Phone: 617-525-6264, Fax: 617-525-6150
| | - Maria D Rubio
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, 1719 6th Ave S Rm 590, Birmingham, AL 35233, Phone: 205-996-6229
| | - Sonia Ruiz de Azúa
- CIBERSAM (Biomedical Research Center in Mental Health Net), University Hospital of Alava, University of the Basque Country, 29 Olaguibel St., 01004, Vitoria, Spain. Phone: 0034 945007664, Fax: 0034 945007664
| | - Saddichha Sahoo
- Clinical Fellow, Dept of Psychiatry, University of British Columbia, Vancouver, BC, Canada V6T1Z3
| | - Gregory P Strauss
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore, MD 21228, Phone: (410) 402-6104, Fax: (410) 402-7198
| | - Aleksandra Szczepankiewicz
- Laboratory of Molecular and Cell Biology, Department of Psychiatric Genetics, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572 Poznan, Poland, Phone: +48-618491311, Fax: +48-61-8480111
| | - Andrew D Thompson
- Orygen Youth Health Research Centre, 35 Poplar Rd, Parkville, VIC 3052, Australia Phone: +61 3 93422800, Fax: +61 3 9342 2941
| | - Antonella Trotta
- Psychosis Studies, Institute of Psychiatry, King’s College London, United Kingdom, PO52 Psychosis Studies, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, United Kingdom, Phone: +44 (0)743 5214863, Fax: +44 (0)20 7848 0287
| | - Laura M Tully
- Harvard University, Address: 33 Kirkland St., Cambridge MA 02138, Phone: 857-207-5509
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan, Phone: +81.3.3353.1211(x62454), Fax: +81.3.5379.0187
| | - Eva Velthorst
- Academic Medical Center, Department of Early Psychosis, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands, Phone: +31 (0)20 89 13671, Fax: +31 (0)20 89 13635
| | - Jared W Young
- University of California San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA, 92093-0804, Phone: 619 543 3582, Fax: 619 543 2493
| | - Anne O’Shea
- Coordinator of reports. Harvard Medical School, VA Boston Healthcare System, 940 Belmont Street, Brockton, MA 02301, Phone: 774-826-1374
| | - Lynn E. DeLisi
- Corresponding Author, VA Boston Healthcare System and Harvard Medical School, 940 Belmont Street, Brockton, MA 02301, Phone: 774-826-1355, Fax: 774-826-1758, Address all correspondence to Lynn E DeLisi, MD,
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Leckman JF. Thank goodness for Uncle Sam and the National Institute of Mental Health Intramural Program. J Am Acad Child Adolesc Psychiatry 2011; 50:851-3. [PMID: 21871365 DOI: 10.1016/j.jaac.2010.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 05/28/2010] [Indexed: 11/15/2022]
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Mattai AA, Weisinger B, Greenstein D, Stidd R, Clasen L, Miller R, Tossell JW, Rapoport JL, Gogtay N. Normalization of cortical gray matter deficits in nonpsychotic siblings of patients with childhood-onset schizophrenia. J Am Acad Child Adolesc Psychiatry 2011; 50:697-704. [PMID: 21703497 PMCID: PMC3289252 DOI: 10.1016/j.jaac.2011.03.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 03/22/2011] [Accepted: 03/25/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Cortical gray matter (GM) abnormalities in patients with childhood-onset schizophrenia (COS) progress during adolescence ultimately localizing to prefrontal and temporal cortices by early adult age. A previous study of 52 nonpsychotic siblings of COS probands had significant prefrontal and temporal GM deficits that appeared to "normalize" by age 17 years. Here we present a replication with nonoverlapping groups of healthy full siblings and healthy controls. METHOD Using an automated measure and prospectively acquired anatomical brain magnetic resonance images, we mapped cortical GM thickness in nonpsychotic full siblings (n = 43, 68 scans; ages 5 through 26 years) of patients with COS, contrasting them with age-, gender-, and scan interval-matched healthy controls (n = 86, 136 scans). The false-discovery rate procedure was used to control for type I errors due to multiple comparisons. RESULTS As in our previous study, young nonpsychotic siblings (<17 years) showed significant GM deficits in bilateral prefrontal and left temporal cortices and, in addition, smaller deficits in the parietal and right inferior temporal cortices. These deficits in nonpsychotic siblings normalized with age with minimal abnormalities remaining by age 17. CONCLUSIONS Our results support previous findings showing nonpsychotic siblings of COS probands to have early GM deficits that ameliorate with time. At early ages, prefrontal and/or temporal loss may serve as a familial/trait marker for COS. Late adolescence appears to be a critical period for greatest localization of deficits in probands or normalization in nonpsychotic siblings.
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Affiliation(s)
- Anand A Mattai
- Child Psychiatry Branch, National Institute of Mental Health/NIH, 10 Center Drive, Bethesda, MD 20892, USA.
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Gogtay N, Vyas NS, Testa R, Wood SJ, Pantelis C. Age of onset of schizophrenia: perspectives from structural neuroimaging studies. Schizophr Bull 2011; 37:504-13. [PMID: 21505117 PMCID: PMC3080674 DOI: 10.1093/schbul/sbr030] [Citation(s) in RCA: 224] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Many of the major neuropsychiatric illnesses, including schizophrenia, have a typical age of onset in late adolescence. Late adolescence may reflect a critical period in brain development making it particularly vulnerable for the onset of psychopathology. Neuroimaging studies that focus on this age range may provide unique insights into the onset and course of psychosis. In this review, we examine the evidence from 2 unique longitudinal cohorts that span the ages from early childhood through young adulthood; a study of childhood-onset schizophrenia where patients and siblings are followed from ages 6 through to their early twenties, and an ultra-high risk study where subjects (mean age of 19 years) are studied before and after the onset of psychosis. From the available evidence, we make an argument that subtle, regionally specific, and genetically influenced alterations during developmental age windows influence the course of psychosis and the resultant brain phenotype. The importance of examining trajectories of development and the need for future combined approaches, using multimodal imaging together with molecular studies is discussed.
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Affiliation(s)
- Nitin Gogtay
- Child Psychiatry Branch, National Institute of Mental Health, NIH, Bethesda, MD
| | - Nora S. Vyas
- Child Psychiatry Branch, National Institute of Mental Health, NIH, Bethesda, MD
| | - Renee Testa
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Victoria, Australia
| | - Stephen J. Wood
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Victoria, Australia
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Victoria, Australia
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Mattai A, Hosanagar A, Weisinger B, Greenstein D, Stidd R, Clasen L, Lalonde F, Rapoport J, Gogtay N. Hippocampal volume development in healthy siblings of childhood-onset schizophrenia patients. Am J Psychiatry 2011; 168:427-35. [PMID: 21245087 PMCID: PMC3289129 DOI: 10.1176/appi.ajp.2010.10050681] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Previous anatomic studies have established a reduction in hippocampal volume in schizophrenia, but few have investigated the progressive course of these changes and whether they are trait markers. In the present study, the authors examined hippocampal volumes in relation to age for patients with childhood-onset schizophrenia, their nonpsychotic healthy siblings, and healthy comparison subjects. METHOD Anatomic brain magnetic resonance scans were obtained in childhood-onset schizophrenia probands (N=89, 198 scans), their nonpsychotic full siblings (N=78, 172 scans), and matched healthy comparison subjects (N=79, 198 scans) between the ages of 10 and 29 years. Total, left, and right hippocampal volumes were measured using FreeSurfer software and analyzed using a linear mixed-model regression covarying for sex and intracranial volume. RESULTS Childhood-onset schizophrenia probands had a fixed reduction in hippocampal volumes (total, left, and right) relative to both nonpsychotic siblings and healthy comparison subjects, whereas there were no significant volumetric or trajectory differences between nonpsychotic siblings and healthy comparison subjects. CONCLUSIONS Fixed hippocampal volume loss seen in childhood-onset schizophrenia, which is not shared by healthy siblings, appears to be related to the illness. Decreased hippocampal volume is not strongly genetically related but represents an important intermediate disease phenotype.
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Affiliation(s)
- Anand Mattai
- Child Psychiatry Branch, National Institutes of Health, Bethesda, MD 20892, USA.
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Andersen SL, Navalta CP. Annual Research Review: New frontiers in developmental neuropharmacology: can long-term therapeutic effects of drugs be optimized through carefully timed early intervention? J Child Psychol Psychiatry 2011; 52:476-503. [PMID: 21309771 PMCID: PMC3115525 DOI: 10.1111/j.1469-7610.2011.02376.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Our aim is to present a working model that may serve as a valuable heuristic to predict enduring effects of drugs when administered during development. Our primary tenet is that a greater understanding of neurodevelopment can lead to improved treatment that intervenes early in the progression of a given disorder and prevents symptoms from manifesting. The immature brain undergoes significant changes during the transitions between childhood, adolescence, and adulthood. Such changes in innervation, neurotransmitter levels, and their respective signaling mechanisms have profound and observable changes on typical behavior, but also increase vulnerability to psychiatric disorders when the maturational process goes awry. Given the remarkable plasticity of the immature brain to adapt to its external milieu, preventive interventions may be possible. We intend for this review to initiate a discussion of how currently used psychotropic agents can influence brain development. Drug exposure during sensitive periods may have beneficial long-term effects, but harmful delayed consequences may be possible as well. Regardless of the outcome, this information needs to be used to improve or develop alternative approaches for the treatment of childhood disorders. With this framework in mind, we present what is known about the effects of stimulants, antidepressants, and antipsychotics on brain maturation (including animal studies that use more clinically-relevant dosing paradigms or relevant animal models). We endeavor to provocatively set the stage for altering treatment approaches for improving mental health in non-adult populations.
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Affiliation(s)
- Susan L. Andersen
- Laboratory for Developmental Neuropharmacology, Department of Psychiatry, McLean Hospital, Harvard Medical School
| | - Carryl P. Navalta
- Program for Behavioral Science, Department of Psychiatry, Children’s Hospital Boston, Harvard Medical School
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Rapoport JL, Gogtay N. Childhood onset schizophrenia: support for a progressive neurodevelopmental disorder. Int J Dev Neurosci 2010; 29:251-8. [PMID: 20955775 DOI: 10.1016/j.ijdevneu.2010.10.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 10/08/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022] Open
Abstract
Structural brain abnormalities have become an established feature of schizophrenia and increasing evidence points towards the progressive nature of these abnormalities. The brain abnormalities are most profound in early onset cases, which have a severe, treatment refractory phenotype and more salient genetic features. Unique insights could thus be gained in schizophrenia pathology from studying the earliest manifestations of the illness. This paper reviews and updates the findings on anatomic brain development in patients with very early onset schizophrenia while showing preliminary data from ongoing studies. Collectively, our studies demonstrate that childhood-onset schizophrenia (COS) subjects show progressive loss of gray matter, delayed/disrupted white matter (WM) growth, and a progressive decline in cerebellar volume, some of which are shared by their healthy siblings. The developmental patterns or the 'trajectories' of brain development are often more striking than anatomic brain differences at any one point in time; highlighting the importance of longitudinal studies. The sibling findings of partially shared gray matter (GM) deficits which appear to normalize with age, along with other genetic analyses, provide evidence that the brain developmental 'patterns/trajectories' for several regions at particular ages could be useful endophenotypes (trait markers).
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Abstract
PURPOSE OF REVIEW Treatment of children who develop schizophrenia in childhood and early adolescence presents unique considerations. There has been increasing attention to the importance of early intervention and whether treatment effects may be affected by brain development. RECENT FINDINGS Several recent trials support the use of antipsychotics for treatment of schizophrenia in children and adolescents. Clozapine shows greater efficacy in children and adolescents than it has in adults. A large-scale trial comparing a first-generation antipsychotic (molindone) with newer agents did not find significant differences in treatment response, although the newer antipsychotics were associated with more severe weight gain. Data regarding effects of antipsychotics on brain development in children and young adolescents with schizophrenia are sparse, although one report found no difference between effects of clozapine and olanzapine on cortical thickness. SUMMARY Although psychosocial interventions are an important adjunctive treatment, antipsychotic medications continue to be the mainstay of treatment. Careful monitoring of metabolic side effects and age-appropriate intervention is particularly important, as children and adolescents appear to be more likely to develop metabolic abnormalities such as pronounced weight gain, which may significantly impact adherence as well as lead to other health issues.
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Gutiérrez-Galve L, Wheeler-Kingshott CA, Altmann DR, Price G, Chu EM, Leeson VC, Lobo A, Barker GJ, Barnes TR, Joyce EM, Ron MA. Changes in the frontotemporal cortex and cognitive correlates in first-episode psychosis. Biol Psychiatry 2010; 68:51-60. [PMID: 20452574 PMCID: PMC3025327 DOI: 10.1016/j.biopsych.2010.03.019] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 03/04/2010] [Accepted: 03/08/2010] [Indexed: 01/03/2023]
Abstract
BACKGROUND Loss of cortical volume in frontotemporal regions has been reported in patients with schizophrenia and their relatives. Cortical area and thickness are determined by different genetic processes, and measuring these parameters separately may clarify disturbances in corticogenesis relevant to schizophrenia. Our study also explored clinical and cognitive correlates of these parameters. METHODS Thirty-seven patients with first-episode psychosis (34 schizophrenia, 3 schizoaffective disorder) and 38 healthy control subjects matched for age and sex took part in the study. Imaging was performed on an magnetic resonance imaging 1.5-T scanner. Area and thickness of the frontotemporal cortex were measured using a surface-based morphometry method (Freesurfer). All subjects underwent neuropsychologic testing that included measures of premorbid and current IQ, working and verbal memory, and executive function. RESULTS Reductions in cortical area, more marked in the temporal cortex, were present in patients. Overall frontotemporal cortical thickness did not differ between groups, although regional thinning of the right superior temporal region was observed in patients. There was a significant association of both premorbid IQ and IQ at disease onset with area, but not thickness, of the frontotemporal cortex, and working memory span was associated with area of the frontal cortex. These associations remained significant when only patients with schizophrenia were considered. CONCLUSIONS Our results suggest an early disruption of corticogenesis in schizophrenia, although the effect of subsequent environmental factors cannot be excluded. In addition, cortical abnormalities are subject to regional variations and differ from those present in neurodegenerative diseases.
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Affiliation(s)
- Leticia Gutiérrez-Galve
- University College London Institute of Neurology, London, United Kingdom,Hospital Clínico Universitario and Universidad de Zaragoza, Centro de Investigación Biomédica en Red de Salud Mental and Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | | | - Daniel R. Altmann
- University College London Institute of Neurology, London, United Kingdom,Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gary Price
- University College London Institute of Neurology, London, United Kingdom
| | - Elvina M. Chu
- University College London Institute of Neurology, London, United Kingdom
| | - Verity C. Leeson
- University College London Institute of Neurology, London, United Kingdom
| | - Antonio Lobo
- Hospital Clínico Universitario and Universidad de Zaragoza, Centro de Investigación Biomédica en Red de Salud Mental and Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | - Gareth J. Barker
- King's College London, Institute of Psychiatry, Department of Clinical Neuroscience, Centre for Neuroimaging Sciences, London, United Kingdom
| | - Thomas R.E. Barnes
- Imperial College Faculty of Medicine, Charing Cross Campus, London, United Kingdom
| | - Eileen M. Joyce
- University College London Institute of Neurology, London, United Kingdom
| | - María A. Ron
- University College London Institute of Neurology, London, United Kingdom,Address correspondence to Maria A. Ron, Ph.D., FRCP, FRCPsych, University College London Institute of Neurology, London WC1N 3BG, United Kingdom
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