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Torres-Carmona E, Ueno F, Iwata Y, Nakajima S, Song J, Mar W, Abdolizadeh A, Agarwal SM, de Luca V, Remington G, Gerretsen P, Graff-Guerrero A. Elevated intrinsic cortical curvature in treatment-resistant schizophrenia: Evidence of structural deformation in functional connectivity areas and comparison with alternate indices of structure. Schizophr Res 2024; 269:103-113. [PMID: 38761434 DOI: 10.1016/j.schres.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/14/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Research suggests structural and connectivity abnormalities in patients with treatment-resistant schizophrenia (TRS) compared to first-line responders and healthy-controls. However, measures of these abnormalities are often influenced by external factors like nicotine and antipsychotics, limiting their clinical utility. Intrinsic-cortical-curvature (ICC) presents a millimetre-scale measure of brain gyrification, highly sensitive to schizophrenia differences, and associated with TRS-like traits in early stages of the disorder. Despite this evidence, ICC in TRS remains unexplored. This study investigates ICC as a marker for treatment resistance in TRS, alongside structural indices for comparison. METHODS We assessed ICC in anterior cingulate, dorsolateral prefrontal, temporal, and parietal cortices of 38 first-line responders, 30 clozapine-resistant TRS, 37 clozapine-responsive TRS, and 52 healthy-controls. For comparative purposes, Fold and Curvature indices were also analyzed. RESULTS Adjusting for age, sex, nicotine-use, and chlorpromazine equivalence, principal findings indicate ICC elevations in the left hemisphere dorsolateral prefrontal (p < 0.001, η2partial = 0.142) and temporal cortices (LH p = 0.007, η2partial = 0.060; RH p = 0.011, η2partial = 0.076) of both TRS groups, and left anterior cingulate cortex of clozapine-resistant TRS (p = 0.026, η2partial = 0.065), compared to healthy-controls. Elevations that correlated with reduced cognition (p = 0.001) and negative symptomology (p < 0.034) in clozapine-resistant TRS. Fold and Curvature indices only detected group differences in the right parietal cortex, showing interactions with age, sex, and nicotine use. ICC showed interactions with age. CONCLUSION ICC elevations were found among patients with TRS, and correlated with symptom severity. ICCs relative independence from sex, nicotine-use, and antipsychotics, may support ICC's potential as a viable marker for TRS, though age interactions should be considered.
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Affiliation(s)
- Edgardo Torres-Carmona
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Fumihiko Ueno
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Yusuke Iwata
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Neuropsychiatry, Keio University, Minato, Tokyo, Japan
| | - Shinichiro Nakajima
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Neuropsychiatry, Keio University, Minato, Tokyo, Japan
| | - Jianmeng Song
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Wanna Mar
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Ali Abdolizadeh
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Sri Mahavir Agarwal
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Institute Research Program, CAMH, Toronto, ON, Canada
| | - Vincenzo de Luca
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Institute Research Program, CAMH, Toronto, ON, Canada
| | - Gary Remington
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Institute Research Program, CAMH, Toronto, ON, Canada
| | - Philip Gerretsen
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Institute Research Program, CAMH, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Institute Research Program, CAMH, Toronto, ON, Canada.
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Porgalı Zayman E, Erbay MF. Neuroanatomical comparison of treatment-resistant and treatment-responsive schizophrenia patients using the cloud-based brain magnetic resonance image segmentation and parcellation system: An MRIcloud study. Psychiatry Res Neuroimaging 2024; 339:111789. [PMID: 38354479 DOI: 10.1016/j.pscychresns.2024.111789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024]
Abstract
Recent developments in neuroimaging have improved our understanding of the biological mechanisms underlying schizophrenia. However, neuroimaging findings in treatment-resistant schizophrenia (TRS) remain unclear. In the present study, we aimed to explore potential neuroanatomical regions that may be associated with treatment resistance in schizophrenia patients by comparing neuroanatomical regions of TRS and non-TRS patients using the MRICloud method. A total of 33 schizophrenia patients (meeting DSM 5 diagnostic criteria for schizophrenia) were included in the study. Patients were dichotomized into TRS (n = 18) and non-TRS (n = 15) groups, and all patients underwent MRI. Neuroanatomical regions of TRS and non-TRS patients were compared using the MRICloud method. Disease severity was measured using the Positive and Negative Syndrome Scale (PANSS). Interestingly, a statistically significant greater left Corpus Collosum (CC) thickness was found in TRS patients compared to non-TRS patients. It is clear that further studies comparing TRS patients with non-TRS patients are needed, and these studies should focus on the circuits in the corpus callosum that are thought to play a role in treatment resistance. Further longitudinal studies are also needed to complement the cross-sectional studies, using a multimodal imaging approach in the patients with clearly defined TRS criteria.
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Tsugawa S, Honda S, Noda Y, Wannan C, Zalesky A, Tarumi R, Iwata Y, Ogyu K, Plitman E, Ueno F, Mimura M, Uchida H, Chakravarty M, Graff-Guerrero A, Nakajima S. Associations Between Structural Covariance Network and Antipsychotic Treatment Response in Schizophrenia. Schizophr Bull 2024; 50:382-392. [PMID: 37978044 PMCID: PMC10919786 DOI: 10.1093/schbul/sbad160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND HYPOTHESIS Schizophrenia is associated with widespread cortical thinning and abnormality in the structural covariance network, which may reflect connectome alterations due to treatment effect or disease progression. Notably, patients with treatment-resistant schizophrenia (TRS) have stronger and more widespread cortical thinning, but it remains unclear whether structural covariance is associated with treatment response in schizophrenia. STUDY DESIGN We organized a multicenter magnetic resonance imaging study to assess structural covariance in a large population of TRS and non-TRS, who had been resistant and responsive to non-clozapine antipsychotics, respectively. Whole-brain structural covariance for cortical thickness was assessed in 102 patients with TRS, 77 patients with non-TRS, and 79 healthy controls (HC). Network-based statistics were used to examine the difference in structural covariance networks among the 3 groups. Moreover, the relationship between altered individual differentiated structural covariance and clinico-demographics was also explored. STUDY RESULTS Patients with non-TRS exhibited greater structural covariance compared with HC, mainly in the fronto-temporal and fronto-occipital regions, while there were no significant differences in structural covariance between TRS and non-TRS or HC. Higher individual differentiated structural covariance was associated with lower general scores of the Positive and Negative Syndrome Scale in the non-TRS group, but not in the TRS group. CONCLUSIONS These findings suggest that reconfiguration of brain networks via coordinated cortical thinning is related to treatment response in schizophrenia. Further longitudinal studies are warranted to confirm if greater structural covariance could serve as a marker for treatment response in this disease.
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Affiliation(s)
- Sakiko Tsugawa
- Department of Neuropsychiatry, Keio University, Tokyo, Japan
| | - Shiori Honda
- Department of Neuropsychiatry, Keio University, Tokyo, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University, Tokyo, Japan
| | - Cassandra Wannan
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Andrew Zalesky
- Department of Biomedical Engineering, Melbourne School of Engineering, the University of Melbourne, Melbourne, Australia
| | - Ryosuke Tarumi
- Department of Neuropsychiatry, Keio University, Tokyo, Japan
- Department of Psychiatry, Komagino Hospital, Tokyo, Japan
| | - Yusuke Iwata
- Department of Neuropsychiatry, University of Yamanashi, Yamanashi, Japan
| | - Kamiyu Ogyu
- Department of Neuropsychiatry, Keio University, Tokyo, Japan
- Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Eric Plitman
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Fumihiko Ueno
- Department of Neuropsychiatry, Keio University, Tokyo, Japan
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University, Tokyo, Japan
| | - Mallar Chakravarty
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Computational Brain Anatomy Laboratory, Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
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4
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Sone D, Young A, Shinagawa S, Tsugawa S, Iwata Y, Tarumi R, Ogyu K, Honda S, Ochi R, Matsushita K, Ueno F, Hondo N, Koreki A, Torres-Carmona E, Mar W, Chan N, Koizumi T, Kato H, Kusudo K, de Luca V, Gerretsen P, Remington G, Onaya M, Noda Y, Uchida H, Mimura M, Shigeta M, Graff-Guerrero A, Nakajima S. Disease Progression Patterns of Brain Morphology in Schizophrenia: More Progressed Stages in Treatment Resistance. Schizophr Bull 2024; 50:393-402. [PMID: 38007605 PMCID: PMC10919766 DOI: 10.1093/schbul/sbad164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
BACKGROUND AND HYPOTHESIS Given the heterogeneity and possible disease progression in schizophrenia, identifying the neurobiological subtypes and progression patterns in each patient may lead to novel biomarkers. Here, we adopted data-driven machine-learning techniques to identify the progression patterns of brain morphological changes in schizophrenia and investigate the association with treatment resistance. STUDY DESIGN In this cross-sectional multicenter study, we included 177 patients with schizophrenia, characterized by treatment response or resistance, with 3D T1-weighted magnetic resonance imaging. Cortical thickness and subcortical volumes calculated by FreeSurfer were converted into z scores using 73 healthy controls data. The Subtype and Stage Inference (SuStaIn) algorithm was used for unsupervised machine-learning analysis. STUDY RESULTS SuStaIn identified 3 different subtypes: (1) subcortical volume reduction (SC) type (73 patients), in which volume reduction of subcortical structures occurs first and moderate cortical thinning follows, (2) globus pallidus hypertrophy and cortical thinning (GP-CX) type (42 patients), in which globus pallidus hypertrophy initially occurs followed by progressive cortical thinning, and (3) cortical thinning (pure CX) type (39 patients), in which thinning of the insular and lateral temporal lobe cortices primarily happens. The remaining 23 patients were assigned to baseline stage of progression (no change). SuStaIn also found 84 stages of progression, and treatment-resistant schizophrenia showed significantly more progressed stages than treatment-responsive cases (P = .001). The GP-CX type presented earlier stages than the pure CX type (P = .009). CONCLUSIONS The brain morphological progressions in schizophrenia can be classified into 3 subtypes, and treatment resistance was associated with more progressed stages, which may suggest a novel biomarker.
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Affiliation(s)
- Daichi Sone
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, UK
| | - Alexandra Young
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Sakiko Tsugawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Iwata
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Ryosuke Tarumi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kamiyu Ogyu
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shiori Honda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Ochi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Karin Matsushita
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Fumihiko Ueno
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Nobuaki Hondo
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Akihiro Koreki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | | | - Wanna Mar
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Nathan Chan
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Teruki Koizumi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hideo Kato
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Keisuke Kusudo
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Vincenzo de Luca
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Philip Gerretsen
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Mitsumoto Onaya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Shigeta
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
| | | | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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5
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Kumar M, Goyal P, Sagar R, Kumaran SS. Gray matter biomarkers for major depressive disorder and manic disorder using logistic regression. J Psychiatr Res 2024; 171:177-184. [PMID: 38295451 DOI: 10.1016/j.jpsychires.2024.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/02/2024]
Abstract
The study investigates morphometric changes using surface-based measures and logistic regression in Major depressive-disorder (MDD) and Manic-disorder patients as compared to controls. MDD (n = 21) and manic (n = 20) subjects were recruited from psychiatric clinics, along with 19 healthy-controls from local population, after structured and semi-structured clinical interview (DSM-IV, brief Psychotic-Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Hamilton depression rating scale (HDRS), cognitive function by postgraduate Institute Battery of Brain Dysfunction (PGIBBD)). Using 3D T1-weighted images, gray matter (GM) cortical thickness and GM-based morphometric signatures (using logistic regression) were compared among MDD, manic disorder and controls using analysis of covariance (ANCOVA). No significant difference was found between the MDD and manic disorder patients. When compared to controls, cortical thinning was observed in bilateral rostral middle frontal gyrus and parsopercularis, right lateral occipital cortex, right lingual gyrus in MDD; and bilateral rostral middle frontal and superior frontal gyrus, right middle temporal gyrus, left supramarginal and left precentral gyrus in Manic disorders. Logistic regression analysis exhibited GM cortical thinning in the bilateral parsopercularis, right lateral occipital cortex and lingual gyrus in MDD; and bilateral rostral middle, superior frontal gyri, right middle temporal gyrus in Manic with a sensitivity and specificity of 85.7 % and 94.7 % and 90.0 % and 94.7 %, respectively in comparison with controls. Both groups exhibited GM loss in bilateral rostral middle frontal gyrus brain regions compared to controls. Multivariate analysis revealed common changes in GM in MDD and manic disorders associated with mood temperament, but differences when compared to controls.
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Affiliation(s)
- Mukesh Kumar
- Department of NMR, All India Institute of Medical Sciences, New Delhi, India.
| | - Prashant Goyal
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - S Senthil Kumaran
- Department of NMR, All India Institute of Medical Sciences, New Delhi, India.
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6
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Prohens L, Rodríguez N, Segura ÀG, Martínez-Pinteño A, Olivares-Berjaga D, Martínez I, González A, Mezquida G, Parellada M, Cuesta MJ, Bernardo M, Gassó P, Mas S. Gene expression imputation provides clinical and biological insights into treatment-resistant schizophrenia polygenic risk. Psychiatry Res 2024; 332:115722. [PMID: 38198858 DOI: 10.1016/j.psychres.2024.115722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
Genome-wide association studies (GWAS) have revealed the polygenic nature of treatment-resistant schizophrenia TRS. Gene expression imputation allowed the translation of GWAS results into regulatory mechanisms and the construction of gene expression (GReX) risk scores (GReX-RS). In the present study we computed GReX-RS from the largest GWAS of TRS to assess its association with clinical features. We perform transcriptome imputation in the largest GWAS of TRS to find GReX associated with TRS using brain tissues. Then, for each tissue, we constructed a GReX-RS of the identified genes in a sample of 254 genotyped first episode of psychosis (FEP) patients to test its association with clinical phenotypes, including clinical symptomatology, global functioning and cognitive performance. Our analysis provides evidence that the polygenic basis of TRS includes genetic variants that modulate the expression of certain genes in certain brain areas (substantia nigra, hippocampus, amygdala and frontal cortex), which at the same time are related to clinical features in FEP patients, mainly persistence of negative symptoms and cognitive alterations in sustained attention, which have also been suggested as clinical predictors of TRS. Our results provide a clinical explanation of the polygenic architecture of TRS and give more insight into the biological mechanisms underlying TRS.
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Affiliation(s)
- Llucia Prohens
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Natalia Rodríguez
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Àlex-Gonzàlez Segura
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Albert Martínez-Pinteño
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - David Olivares-Berjaga
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Irene Martínez
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Aitor González
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gisela Mezquida
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), ISCIII, Spain; Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Mara Parellada
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), ISCIII, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain; School of Medicine, Universidad Complutense, Madrid, Spain
| | - Manuel J Cuesta
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), ISCIII, Spain; Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Miquel Bernardo
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), ISCIII, Spain; Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Patricia Gassó
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), ISCIII, Spain
| | - Sergi Mas
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), ISCIII, Spain.
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7
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Liang L, Heinrichs RW, Liddle PF, Jeon P, Théberge J, Palaniyappan L. Cortical impoverishment in a stable subgroup of schizophrenia: Validation across various stages of psychosis. Schizophr Res 2024; 264:567-577. [PMID: 35644706 DOI: 10.1016/j.schres.2022.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cortical thinning is a well-known feature in schizophrenia. The considerable variation in the spatial distribution of thickness changes has been used to parse heterogeneity. A 'cortical impoverishment' subgroup with a generalized reduction in thickness has been reported. However, it is unclear if this subgroup is recoverable irrespective of illness stage, and if it relates to the glutamate hypothesis of schizophrenia. METHODS We applied hierarchical cluster analysis to cortical thickness data from magnetic resonance imaging scans of three datasets in different stages of psychosis (n = 288; 160 patients; 128 healthy controls) and studied the cognitive and symptom profiles of the observed subgroups. In one of the samples, we also studied the subgroup differences in 7-Tesla magnetic resonance spectroscopy glutamate concentration in the dorsal anterior cingulate cortex. RESULTS Our consensus-based clustering procedure consistently produced 2 subgroups of participants. Patients accounted for 75%-100% of participants in one subgroup that was characterized by significantly lower cortical thickness. Both subgroups were equally symptomatic in clinically unstable stages, but cortical impoverishment indicated a higher symptom burden in a clinically stable sample and higher glutamate levels in the first-episode sample. There were no subgroup differences in cognitive and functional outcome profiles or antipsychotic exposure across all stages. CONCLUSIONS Cortical thinning does not vary with functioning or cognitive impairment, but it is more prevalent among patients, especially those with glutamate excess in early stages and higher residual symptom burden at later stages, providing an important mechanistic clue to one of the several possible pathways to the illness.
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Affiliation(s)
- Liangbing Liang
- Graduate Program in Neuroscience, Western University, London, Ontario, Canada; Robarts Research Institute, Western University, London, Ontario, Canada
| | | | - Peter F Liddle
- Institute of Mental Health, Division of Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Peter Jeon
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Jean Théberge
- Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Psychiatry, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Lena Palaniyappan
- Robarts Research Institute, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Psychiatry, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
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8
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Sun J, Cong Q, Sun T, Xi S, Liu Y, Zeng R, Wang J, Zhang W, Gao J, Qian J, Qin S. Prefrontal cortex-specific Dcc deletion induces schizophrenia-related behavioral phenotypes and fail to be rescued by olanzapine treatment. Eur J Pharmacol 2023; 956:175940. [PMID: 37541362 DOI: 10.1016/j.ejphar.2023.175940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 07/09/2023] [Accepted: 07/31/2023] [Indexed: 08/06/2023]
Abstract
Multiple genome studies have discovered that variation in deleted in colorectal carcinoma (Dcc) at transcription and translation level were associated with the occurrences of psychiatric disorders. Yet, little is known about the function of Dcc in schizophrenia (SCZ)-related behavioral abnormalities and the efficacy of antipsychotic drugs in vivo. Here, we used an animal model of prefrontal cortex-specific knockdown (KD) of Dcc in adult C57BL/6 mice to study the attention deficits and impaired locomotor activity. Our results supported a critical role of Dcc deletion in SCZ-related behaviors. Notably, olanzapine rescued the SCZ-related behaviors in the MK801-treated mice but not in the cortex-specific Dcc KD mice, indicating that Dcc play a critical in the mechanism of antipsychotic effects of olanzapine. Knockdown of Dcc in prefrontal cortex results in glutamatergic dysfunction, including defects in glutamine synthetase and postsynaptic maturation. As one of the major risk factors of the degree of antipsychotic response, Dcc deletion-induced glutamatergic dysfunction may be involved in the underlying mechanism of treatment resistance of olanzapine. Our findings identified Dcc deletion-mediated SCZ-related behavioral defects, which serve as a valuable animal model for study of SCZ and amenable to targeted investigations in mechanistic hypotheses of the mechanism underlying glutamatergic dysfunction-induced antipsychotic treatment resistance.
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Affiliation(s)
- Jing Sun
- Neurobiology & Mitochondrial Key Laboratory, Effective & Toxicity Monitoring Innovative Practice Center for Food Pharmaceutical Specialty, School of Pharmacy, Jiangsu University, Zhenjiang, 212013, PR China.
| | - Qijie Cong
- Neurobiology & Mitochondrial Key Laboratory, Effective & Toxicity Monitoring Innovative Practice Center for Food Pharmaceutical Specialty, School of Pharmacy, Jiangsu University, Zhenjiang, 212013, PR China
| | - Tingkai Sun
- Neurobiology & Mitochondrial Key Laboratory, Effective & Toxicity Monitoring Innovative Practice Center for Food Pharmaceutical Specialty, School of Pharmacy, Jiangsu University, Zhenjiang, 212013, PR China
| | - Siyu Xi
- Neurobiology & Mitochondrial Key Laboratory, Effective & Toxicity Monitoring Innovative Practice Center for Food Pharmaceutical Specialty, School of Pharmacy, Jiangsu University, Zhenjiang, 212013, PR China
| | - Yunxi Liu
- Neurobiology & Mitochondrial Key Laboratory, Effective & Toxicity Monitoring Innovative Practice Center for Food Pharmaceutical Specialty, School of Pharmacy, Jiangsu University, Zhenjiang, 212013, PR China
| | - Rongsen Zeng
- Neurobiology & Mitochondrial Key Laboratory, Effective & Toxicity Monitoring Innovative Practice Center for Food Pharmaceutical Specialty, School of Pharmacy, Jiangsu University, Zhenjiang, 212013, PR China
| | - Jia Wang
- School of Medicine, Jiangsu University, Zhenjiang, 212013, PR China
| | - Weining Zhang
- School of Medicine, Jiangsu University, Zhenjiang, 212013, PR China
| | - Jing Gao
- Neurobiology & Mitochondrial Key Laboratory, Effective & Toxicity Monitoring Innovative Practice Center for Food Pharmaceutical Specialty, School of Pharmacy, Jiangsu University, Zhenjiang, 212013, PR China
| | - Jinjun Qian
- Department of Neurology, The Fourth People's Hospital of Zhenjiang, Zhenjiang, 212013, PR China.
| | - Shengying Qin
- Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Bio-X Institutes, Shanghai Jiao Tong University, Shanghai, 200030, PR China.
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9
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Pang TSW, Chun JSW, Wong TY, Chu ST, Ma CF, Honer WG, Chan SKW. A systematic review of neuroimaging studies of clozapine-resistant schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:65. [PMID: 37752161 PMCID: PMC10522657 DOI: 10.1038/s41537-023-00392-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023]
Abstract
This systematic review aimed to review neuroimaging studies comparing clozapine-resistant schizophrenia patients with clozapine-responding patients, and with first-line antipsychotic responding (FLR) patients. A total of 19 studies including 6 longitudinal studies were identified. Imaging techniques comprised computerized tomography (CT, n = 3), structural magnetic resonance imaging (MRI, n = 7), magnetic resonance spectroscopy (MRS, n = 5), functional MRI (n = 1), single-photon emission computerized tomography (SPECT, n = 3) and diffusion tensor imaging (DTI, n = 1). The most consistent finding was hypo-frontality in the clozapine-resistant group compared with the clozapine-responding group with possible differences in frontal-striatal-basal ganglia circuitry as well as the GABA level between the two treatment-resistant groups. Additional statistically significant findings were reported when comparing clozapine-resistant patients with the FLR group, including lower cortical thickness and brain volume of multiple brain regions as well as lower Glx/Cr level in the dorsolateral prefrontal cortex. Both treatment-resistant groups were found to have extensive differences in neurobiological features in comparison with the FLR group. Overall results suggested treatment-resistant schizophrenia is likely to be a neurobiological distinct type of the illness. Clozapine-resistant and clozapine-responding schizophrenia are likely to have both shared and distinct neurobiological features. However, conclusions from existing studies are limited, and future multi-center collaborative studies are required with a consensus clinical definition of patient samples, multimodal imaging tools, and longitudinal study designs.
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Affiliation(s)
- Tiffanie Sze Wing Pang
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Johnny Siu Wah Chun
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ting Yat Wong
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Sin Ting Chu
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chak Fai Ma
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - William G Honer
- Department of Psychiatry, The University of British Columbia, Vancouver, Canada
| | - Sherry Kit Wa Chan
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, HKSAR, Hong Kong SAR, China.
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10
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Tuovinen N, Hofer A. Resting-state functional MRI in treatment-resistant schizophrenia. FRONTIERS IN NEUROIMAGING 2023; 2:1127508. [PMID: 37554635 PMCID: PMC10406237 DOI: 10.3389/fnimg.2023.1127508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/17/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Abnormalities in brain regions involved in the pathophysiology of schizophrenia (SCZ) may present insight into individual clinical symptoms. Specifically, functional connectivity irregularities may provide potential biomarkers for treatment response or treatment resistance, as such changes can occur before any structural changes are visible. We reviewed resting-state functional magnetic resonance imaging (rs-fMRI) findings from the last decade to provide an overview of the current knowledge on brain functional connectivity abnormalities and their associations to symptoms in treatment-resistant schizophrenia (TRS) and ultra-treatment-resistant schizophrenia (UTRS) and to look for support for the dysconnection hypothesis. METHODS PubMed database was searched for articles published in the last 10 years applying rs-fMRI in TRS patients, i.e., who had not responded to at least two adequate treatment trials with different antipsychotic drugs. RESULTS Eighteen articles were selected for this review involving 648 participants (TRS and control cohorts). The studies showed frontal hypoconnectivity before the initiation of treatment with CLZ or riluzole, an increase in frontal connectivity after riluzole treatment, fronto-temporal hypoconnectivity that may be specific for non-responders, widespread abnormal connectivity during mixed treatments, and ECT-induced effects on the limbic system. CONCLUSION Probably due to the heterogeneity in the patient cohorts concerning antipsychotic treatment and other clinical variables (e.g., treatment response, lifetime antipsychotic drug exposure, duration of illness, treatment adherence), widespread abnormalities in connectivity were noted. However, irregularities in frontal brain regions, especially in the prefrontal cortex, were noted which are consistent with previous SCZ literature and the dysconnectivity hypothesis. There were major limitations, as most studies did not differentiate between TRS and UTRS (i.e., CLZ-resistant schizophrenia) and investigated heterogeneous cohorts treated with mixed treatments (with or without CLZ). This is critical as in different subtypes of the disorder an interplay between dopaminergic and glutamatergic pathways involving frontal, striatal, and hippocampal brain regions in separate ways is likely. Better definitions of TRS and UTRS are necessary in future longitudinal studies to correctly differentiate brain regions underlying the pathophysiology of SCZ, which could serve as potential functional biomarkers for treatment resistance.
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Affiliation(s)
- Noora Tuovinen
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
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11
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Morphological Abnormalities in Early-Onset Schizophrenia Revealed by Structural Magnetic Resonance Imaging. BIOLOGY 2023; 12:biology12030353. [PMID: 36979045 PMCID: PMC10045839 DOI: 10.3390/biology12030353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
Schizophrenia is a pathological condition characterized by delusions, hallucinations, and a lack of motivation. In this study, we performed a morphological analysis of regional biomarkers in early-onset schizophrenia, including cortical thicknesses, surface areas, surface curvature, and volumes extracted from T1-weighted structural magnetic resonance imaging (MRI) and compared these findings with a large cohort of neurotypical controls. Results demonstrate statistically significant abnormal presentation of the curvature of select brain regions in early-onset schizophrenia with large effect sizes, inclusive of the pars orbitalis, pars triangularis, posterior cingulate cortex, frontal pole, orbital gyrus, lateral orbitofrontal gyrus, inferior occipital gyrus, as well as in medial occipito-temporal, lingual, and insular sulci. We also observed reduced regional volumes, surface areas, and variability of cortical thicknesses in early-onset schizophrenia relative to neurotypical controls in the lingual, transverse temporal, cuneus, and parahippocampal cortices that did not reach our stringent standard for statistical significance and should be confirmed in future studies with higher statistical power. These results imply that abnormal neurodevelopment associated with early-onset schizophrenia can be characterized with structural MRI and may reflect abnormal and possibly accelerated pruning of the cortex in schizophrenia.
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12
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Kitajima K, Tamura S, Sasabayashi D, Nakajima S, Iwata Y, Ueno F, Takai Y, Takahashi J, Caravaggio F, Mar W, Torres-Carmona E, Noda Y, Gerretsen P, Luca VD, Mimura M, Hirano S, Nakao T, Onitsuka T, Remington G, Graff-Guerrero A, Hirano Y. Decreased cortical gyrification and surface area in the left medial parietal cortex in patients with treatment-resistant and ultratreatment-resistant schizophrenia. Psychiatry Clin Neurosci 2023; 77:2-11. [PMID: 36165228 PMCID: PMC10092309 DOI: 10.1111/pcn.13482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 01/06/2023]
Abstract
AIM Validating the vulnerabilities and pathologies underlying treatment-resistant schizophrenia (TRS) is an important challenge in optimizing treatment. Gyrification and surface area (SA), reflecting neurodevelopmental features, have been linked to genetic vulnerability to schizophrenia. The aim of this study was to identify gyrification and SA abnormalities specific to TRS. METHODS We analyzed 3T magnetic resonance imaging findings of 24 healthy controls (HCs), 20 responders to first-line antipsychotics (FL-Resp), and 41 patients with TRS, including 19 clozapine responders (CLZ-Resp) and 22 FL- and clozapine-resistant patients (patients with ultratreatment-resistant schizophrenia [URS]). The local gyrification index (LGI) and associated SA were analyzed across groups. Diagnostic accuracy was verified by receiver operating characteristic curve analysis. RESULTS Both CLZ-Resp and URS had lower LGI values than HCs (P = 0.041, Hedges g [gH ] = 0.75; P = 0.013, gH = 0.96) and FL-Resp (P = 0.007, gH = 1.00; P = 0.002, gH = 1.31) in the left medial parietal cortex (Lt-MPC). In addition, both CLZ-Resp and URS had lower SA in the Lt-MPC than FL-Resp (P < 0.001, gH = 1.22; P < 0.001, gH = 1.75). LGI and SA were positively correlated in non-TRS (FL-Resp) (ρ = 0.64, P = 0.008) and TRS (CLZ-Resp + URS) (ρ = 0.60, P < 0.001). The areas under the receiver operating characteristic curve for non-TRS versus TRS with LGI and SA in the Lt-MPC were 0.79 and 0.85, respectively. SA in the Lt-MPC was inversely correlated with negative symptoms (ρ = -0.40, P = 0.018) and clozapine plasma levels (ρ = -0.35, P = 0.042) in TRS. CONCLUSION LGI and SA in the Lt-MPC, a functional hub in the default-mode network, were abnormally reduced in TRS compared with non-TRS. Thus, altered LGI and SA in the Lt-MPC might be structural features associated with genetic vulnerability to TRS.
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Affiliation(s)
- Kazutoshi Kitajima
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Tamura
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.,Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Yusuke Iwata
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Fumihiko Ueno
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Yoshifumi Takai
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junichi Takahashi
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Neuropsychiatry, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Fernando Caravaggio
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Wanna Mar
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Edgardo Torres-Carmona
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yoshihiro Noda
- Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Philip Gerretsen
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Vincenzo de Luca
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Masaru Mimura
- Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Shogo Hirano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Onitsuka
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Gary Remington
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yoji Hirano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
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13
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Fan F, Huang J, Tan S, Wang Z, Li Y, Chen S, Li H, Hare S, Du X, Yang F, Tian B, Kochunov P, Tan Y, Hong LE. Association of cortical thickness and cognition with schizophrenia treatment resistance. Psychiatry Clin Neurosci 2023; 77:12-19. [PMID: 36184782 PMCID: PMC9812867 DOI: 10.1111/pcn.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 06/24/2022] [Accepted: 09/28/2022] [Indexed: 01/07/2023]
Abstract
AIM Approximately a third of patients with schizophrenia fail to adequately respond to antipsychotic medications, a condition known as treatment resistance (TR). We aimed to assess cognitive and cortical thickness deficits and their relationship to TR in schizophrenia. METHOD We recruited patients with schizophrenia (n = 127), including patients at treatment initiation (n = 45), treatment-responsive patients (n = 40) and TR patients (n = 42), and healthy controls (n = 83). Clinical symptoms, neurocognitive function, and structural images were assessed. We performed group comparisons, and explored association of cortical thickness and cognition with TR. RESULTS The TR patients showed significantly more severe clinical symptoms and cognitive impairment relative to the treatment-responsive group. Compared to healthy controls, 56 of 68 brain regions showed significantly reduced cortical thickness in patients with schizophrenia. Reductions in five regions were significantly associated with TR (reduction in TR relative to treatment-responsive patients), i.e. in the right caudal middle frontal gyrus, superior frontal cortex, fusiform gyrus, pars opercularis of the inferior frontal cortex, and supramarginal cortex. Cognition deficits were also significantly correlated with cortical thickness in these five regions in patients with schizophrenia. Cortical thickness of the right caudal middle frontal gyrus, superior frontal cortex and pars opercularis of the inferior frontal cortex also significantly mediated effects of cognitive deficits on TR. CONCLUSION Treatment resistance in schizophrenia was associated with reduced thickness in the right caudal middle frontal gyrus, superior frontal cortex, fusiform gyrus, pars opercularis of the inferior frontal cortex, and supramarginal cortex. Cortical abnormalities further mediate cognitive deficits known to be associated with TR.
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Affiliation(s)
- Fengmei Fan
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, P. R. China
| | - Junchao Huang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, P. R. China
| | - Shuping Tan
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, P. R. China
| | - Zhiren Wang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, P. R. China
| | - Yanli Li
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, P. R. China
| | - Song Chen
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, P. R. China
| | - Hui Li
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, P. R. China
| | - Stephanie Hare
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Xiaoming Du
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Fude Yang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, P. R. China
| | - Baopeng Tian
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, P. R. China
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yunlong Tan
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, P. R. China
| | - L. Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
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14
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Ghosh A, Kaur S, Shah R, Oomer F, Avasthi A, Ahuja CK, Basu D, Nehra R, Khandelwal N. Surface-based brain morphometry in schizophrenia vs. cannabis-induced psychosis: A controlled comparison. J Psychiatr Res 2022; 155:286-294. [PMID: 36170756 DOI: 10.1016/j.jpsychires.2022.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/19/2022] [Accepted: 09/16/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND & AIM We examined group differences in cortical thickness and surface-parameters among age and handedness--matched persons with cannabis-induced psychosis (CIP), schizophrenia with heavy cannabis use (SZC), and healthy controls (HC). METHODS We recruited 31 men with SZC, 28 with CIP, and 30 with HC. We used the Psychiatric Research Interview for Substance and Mental Disorders to differentiate between CIP and SZC. We processed and analyzed T1 MR images using the Surface-based Brain Morphometry (SBM) pipeline of the CAT-12 toolbox within the statistical parametric mapping. After pre-processing, volumes were segmented using surface and thickness estimation for the analysis of the region of interest. We used the projection-based thickness method to assess the cortical thickness and Desikan-Killiany atlas for cortical parcellation. RESULTS We observed the lowest cortical thickness, depth, and gyrification in the SZC, followed by CIP and the control groups. The differences were predominantly seen in frontal cortices, with limited parietal and temporal regions involvement. After False Discovery Rate (FDR) corrections and post-hoc analysis, SZC had reduced cortical thickness than HC in the middle and inferior frontal, right entorhinal, and left postcentral regions. Cortical thickness of SZC was also significantly lower than CIP in bilateral postcentral and right middle frontal regions. We found negative correlations (after FDR corrections) between the duration of cannabis use and cortical thickness in loci of parietal and occipital cortices. CONCLUSION Our study suggested cortical structural abnormalities in schizophrenia, in reference to healthy controls and cannabis-induced psychosis, indicating different pathophysiology of SZC and CIP.
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Affiliation(s)
- Abhishek Ghosh
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Simranjit Kaur
- Thapar Institute of Engineering and Technology, Punjab, India
| | - Raghav Shah
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Fareed Oomer
- Chasefarm Hospital, Barnet, Enfield & Haringey Mental Health Trust, Enfield, UK
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Chirag K Ahuja
- Department of Radio-diagnosis and Imaging, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Debasish Basu
- Chasefarm Hospital, Barnet, Enfield & Haringey Mental Health Trust, Enfield, UK
| | - Ritu Nehra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radio-diagnosis and Imaging, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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15
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Zhou H, Wang D, Cao B, Zhang X. Association of reduced cortical thickness and psychopathological symptoms in patients with first-episode drug-naïve schizophrenia. Int J Psychiatry Clin Pract 2022; 27:42-50. [PMID: 36193901 DOI: 10.1080/13651501.2022.2129067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
OBJECTIVE There is growing evidence that reduced cortical thickness has been considered to be a central abnormality in schizophrenia. Brain imaging studies have demonstrated that the cerebral cortex becomes thinner in patients with first-episode schizophrenia. This study aimed to examine whether cortical thickness is altered in drug-naïve schizophrenia in a Chinese Han population and the relationship between cortical thickness and clinical symptoms. METHODS We compared cortical thickness in 41 schizophrenia patients and 30 healthy controls. Psychopathology of patients with schizophrenia was assessed using the Positive and Negative Syndrome Scale (PANSS). RESULTS The cortical thickness of left banks of superior temporal sulcus, left lateral occipital gyrus, left rostral middle frontal gyrus, right inferior parietal lobule and right lateral occipital gyrus in schizophrenia patients was generally thinner compared with healthy controls. Correlation analysis revealed a negative correlation between cortical thickness of the left banks of superior temporal sulcus and general psychopathology of PANSS. CONCLUSIONS Our results suggest that cortical thickness abnormalities are already present early in the onset of schizophrenia and are associated with psychopathological symptoms, suggesting that it plays an important role in the pathogenesis and symptomatology of schizophrenia.Key points(1) The first-episode drug-naïve schizophrenia had reduced cortical thickness than the controls.(2) Cortical thickness was associated with psychopathological symptoms in patients with schizophrenia.
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Affiliation(s)
- Huixia Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Bo Cao
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
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16
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Wada M, Noda Y, Iwata Y, Tsugawa S, Yoshida K, Tani H, Hirano Y, Koike S, Sasabayashi D, Katayama H, Plitman E, Ohi K, Ueno F, Caravaggio F, Koizumi T, Gerretsen P, Suzuki T, Uchida H, Müller DJ, Mimura M, Remington G, Grace AA, Graff-Guerrero A, Nakajima S. Dopaminergic dysfunction and excitatory/inhibitory imbalance in treatment-resistant schizophrenia and novel neuromodulatory treatment. Mol Psychiatry 2022; 27:2950-2967. [PMID: 35444257 DOI: 10.1038/s41380-022-01572-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/31/2022] [Accepted: 04/07/2022] [Indexed: 12/13/2022]
Abstract
Antipsychotic drugs are the mainstay in the treatment of schizophrenia. However, one-third of patients do not show adequate improvement in positive symptoms with non-clozapine antipsychotics. Additionally, approximately half of them show poor response to clozapine, electroconvulsive therapy, or other augmentation strategies. However, the development of novel treatment for these conditions is difficult due to the complex and heterogenous pathophysiology of treatment-resistant schizophrenia (TRS). Therefore, this review provides key findings, potential treatments, and a roadmap for future research in this area. First, we review the neurobiological pathophysiology of TRS, particularly the dopaminergic, glutamatergic, and GABAergic pathways. Next, the limitations of existing and promising treatments are presented. Specifically, this article focuses on the therapeutic potential of neuromodulation, including electroconvulsive therapy, repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and deep brain stimulation. Finally, we propose multivariate analyses that integrate various perspectives of the pathogenesis, such as dopaminergic dysfunction and excitatory/inhibitory imbalance, thereby elucidating the heterogeneity of TRS that could not be obtained by conventional statistics. These analyses can in turn lead to a precision medicine approach with closed-loop neuromodulation targeting the detected pathophysiology of TRS.
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Affiliation(s)
- Masataka Wada
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Yusuke Iwata
- Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Sakiko Tsugawa
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan.,Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Hideaki Tani
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Yoji Hirano
- Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan.,Neural Dynamics Laboratory, Research Service, VA Boston Healthcare System, and Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Shinsuke Koike
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Haruyuki Katayama
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Eric Plitman
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Fumihiko Ueno
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Fernando Caravaggio
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Teruki Koizumi
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan.,Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Philip Gerretsen
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Takefumi Suzuki
- Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Daniel J Müller
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Gary Remington
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anthony A Grace
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ariel Graff-Guerrero
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan. .,Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
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17
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Zhao Y, Zhang Q, Shah C, Li Q, Sweeney JA, Li F, Gong Q. Cortical Thickness Abnormalities at Different Stages of the Illness Course in Schizophrenia: A Systematic Review and Meta-analysis. JAMA Psychiatry 2022; 79:560-570. [PMID: 35476125 PMCID: PMC9047772 DOI: 10.1001/jamapsychiatry.2022.0799] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
IMPORTANCE Questions of whether and how cortical thickness (CTh) alterations differ over the course of schizophrenia (SCZ) have yet to be resolved. OBJECTIVE To characterize CTh alterations across illness stages in SCZ. DATA SOURCES PubMed, Embase, Web of Science, and Science Direct were screened for CTh studies published before June 15, 2021. STUDY SELECTION Original studies comparing whole-brain CTh alterations from healthy controls in individuals at clinical high-risk (CHR), first episode of psychosis (FEP), and long-term illness stages of SCZ were included. DATA EXTRACTION AND SYNTHESIS This preregistered systematic review and meta-analysis followed PRISMA reporting guidelines. Separate and pooled meta-analyses were performed using seed-based d mapping. Meta-regression analyses were conducted. MAIN OUTCOMES AND MEASURES Cortical thickness differences from healthy control individuals across illness stages. RESULTS Ten studies comprising 859 individuals with CHR (mean [SD] age, 21.02 [2.66] years; male, 573 [66.7%]), 12 studies including 671 individuals with FEP (mean [SD] age, 22.87 [3.99] years; male, 439 [65.4%]), and 10 studies comprising 579 individuals with long-term SCZ (mean [SD] age, 41.58 [6.95] years; male, 396 [68.4%]) were included. Compared with healthy control individuals, individuals with CHR showed cortical thinning in bilateral medial prefrontal cortex (z = -1.01; P < .001). Individuals with FEP showed cortical thinning in right lateral superior temporal cortex (z = -1.34; P < .001), right anterior cingulate cortex (z = -1.44; P < .001), and right insula (z = -1.14; P = .002). Individuals with long-term SCZ demonstrated CTh reductions in right insula (z = -3.25; P < .001), right inferior frontal cortex (z = -2.19; P < .001), and left (z = -2.37; P < .001) and right (z = -1.94; P = .002) temporal pole. There were no significant CTh differences between CHR and FEP. Individuals with long-term SCZ showed greater cortical thinning in right insula (z = -2.58; P < .001), right inferior frontal cortex (z = -2.32; P < .001), left lateral temporal cortex (z = -1.91; P = .002), and right temporal pole (z = -1.82; P = .002) than individuals with FEP. Combining all studies on SCZ, accelerated age-related CTh reductions were found in bilateral lateral middle temporal cortex and right pars orbitalis in inferior frontal cortex. CONCLUSIONS AND RELEVANCE The absence of significant differences between FEP and CHR noted in this systematic review and meta-analysis suggests that the onset of psychosis was not associated with robust CTh reduction. The greater cortical thinning in long-term SCZ compared with FEP with accelerated age-related reduction in CTh suggests progressive neuroanatomic alterations following illness onset. Caution in interpretation is needed because heterogeneity in samples and antipsychotic treatment may confound these results.
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Affiliation(s)
- Youjin Zhao
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qian Zhang
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Chandan Shah
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Qian Li
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - John A. Sweeney
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio
| | - Fei Li
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qiyong Gong
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China,Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, Fujian, China
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18
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Talarico F, Costa GO, Ota VK, Santoro ML, Noto C, Gadelha A, Bressan R, Azevedo H, Belangero SI. Systems-Level Analysis of Genetic Variants Reveals Functional and Spatiotemporal Context in Treatment-resistant Schizophrenia. Mol Neurobiol 2022; 59:3170-3182. [DOI: 10.1007/s12035-022-02794-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/06/2022] [Indexed: 10/18/2022]
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19
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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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20
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Wang M, Hu K, Fan L, Yan H, Li P, Jiang T, Liu B. Predicting Treatment Response in Schizophrenia With Magnetic Resonance Imaging and Polygenic Risk Score. Front Genet 2022; 13:848205. [PMID: 35186051 PMCID: PMC8847599 DOI: 10.3389/fgene.2022.848205] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/12/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Prior studies have separately demonstrated that magnetic resonance imaging (MRI) and schizophrenia polygenic risk score (PRS) are predictive of antipsychotic medication treatment outcomes in schizophrenia. However, it remains unclear whether MRI combined with PRS can provide superior prognostic performance. Besides, the relative importance of these measures in predictions is not investigated. Methods: We collected 57 patients with schizophrenia, all of which had baseline MRI and genotype data. All these patients received approximately 6 weeks of antipsychotic medication treatment. Psychotic symptom severity was assessed using the Positive and Negative Syndrome Scale (PANSS) at baseline and follow-up. We divided these patients into responders (N = 20) or non-responders (N = 37) based on whether their percentages of PANSS total reduction were above or below 50%. Nine categories of MRI measures and PRSs with 145 different p-value thresholding ranges were calculated. We trained machine learning classifiers with these baseline predictors to identify whether a patient was a responder or non-responder. Results: The extreme gradient boosting (XGBoost) technique was applied to build binary classifiers. Using a leave-one-out cross-validation scheme, we achieved an accuracy of 86% with all MRI and PRS features. Other metrics were also estimated, including sensitivity (85%), specificity (86%), F1-score (81%), and area under the receiver operating characteristic curve (0.86). We found excluding a single feature category of gray matter volume (GMV), amplitude of low-frequency fluctuation (ALFF), and surface curvature could lead to a maximum accuracy drop of 10.5%. These three categories contributed more than half of the top 10 important features. Besides, removing PRS features caused a modest accuracy drop (8.8%), which was not the least decrease (1.8%) among all feature categories. Conclusions: Our classifier using both MRI and PRS features was stable and not biased to predicting either responder or non-responder. Combining with MRI measures, PRS could provide certain extra predictive power of antipsychotic medication treatment outcomes in schizophrenia. PRS exhibited medium importance in predictions, lower than GMV, ALFF, and surface curvature, but higher than measures of cortical thickness, cortical volume, and surface sulcal depth. Our findings inform the contributions of PRS in predictions of treatment outcomes in schizophrenia.
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Affiliation(s)
- Meng Wang
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Ke Hu
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Lingzhong Fan
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.,Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Hao Yan
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Peng Li
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Tianzi Jiang
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.,Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.,Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.,Innovation Academy for Artificial Intelligence, Chinese Academy of Sciences, Beijing, China
| | - Bing Liu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
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21
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Sasabayashi D, Takayanagi Y, Takahashi T, Furuichi A, Kobayashi H, Noguchi K, Suzuki M. Increased brain gyrification and subsequent relapse in patients with first-episode schizophrenia. Front Psychiatry 2022; 13:937605. [PMID: 36032231 PMCID: PMC9406142 DOI: 10.3389/fpsyt.2022.937605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Most schizophrenia patients experience psychotic relapses, which may compromise long-term outcome. However, it is difficult to objectively assess the actual risk of relapse for each patient as the biological changes underlying relapse remain unknown. The present study used magnetic resonance imaging (MRI) to investigate the relationship between brain gyrification pattern and subsequent relapse in patients with first-episode schizophrenia. The subjects consisted of 19 patients with and 33 patients without relapse during a 3-year clinical follow-up after baseline MRI scanning. Using FreeSurfer software, we compared the local gyrification index (LGI) between the relapsed and non-relapsed groups. In the relapsed group, we also explored the relationship among LGI and the number of relapses and time to first relapse after MRI scanning. Relapsed patients exhibited a significantly higher LGI in the bilateral parietal and left occipital areas than non-relapsed patients. In addition, the time to first relapse was negatively correlated with LGI in the right inferior temporal cortex. These findings suggest that increased LGI in the temporo-parieto-occipital regions in first-episode schizophrenia patients may be a potential prognostic biomarker that reflects relapse susceptibility in the early course of the illness.
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Affiliation(s)
- Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Yoichiro Takayanagi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Arisawabashi Hospital, Toyama, Japan
| | - Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Atsushi Furuichi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Haruko Kobayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Kyo Noguchi
- Department of Radiology, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
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22
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Liu C, Kim WS, Shen J, Tsogt U, Kang NI, Lee KH, Chung YC. Altered Neuroanatomical Signatures of Patients With Treatment-Resistant Schizophrenia Compared to Patients With Early-Stage Schizophrenia and Healthy Controls. Front Psychiatry 2022; 13:802025. [PMID: 35664476 PMCID: PMC9158464 DOI: 10.3389/fpsyt.2022.802025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/12/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The relationship between brain structural changes and cognitive dysfunction in schizophrenia is strong. However, few studies have investigated both neuroanatomical abnormalities and cognitive dysfunction in treatment-resistant schizophrenia (TRS). We examined neuroanatomical markers and cognitive function between patients with TRS or early-stage schizophrenia (ES-S) and healthy controls (HCs). Relationships between neuroanatomical markers and cognitive function in the patient groups were also investigated. METHODS A total of 46 and 45 patients with TRS and ES-S and 61 HCs underwent structural magnetic resonance imaging (MRI) brain scanning and comprehensive cognitive tests. MRI scans were analyzed using the FreeSurfer to investigate differences in cortical surface area (CSA), cortical thickness (CT), cortical volume (CV), and subcortical volume (SCV) among the groups. Four cognitive domains (attention, verbal memory, executive function, and language) were assessed. Comparisons of neuroanatomical and cognitive function results among the three groups were performed. RESULTS A widespread reduction in CT was observed in patients with TRS compared to HCs, but differences in cortical thinning between TRS and ES-S patients were mainly limited to the inferior frontal gyrus and insula. Several subcortical structures (accumbens, amygdala, hippocampus, putamen, thalamus and ventricles) were significantly altered in TRS patients compared to both ES-S patients and HCs. Performance in the verbal memory domain was significantly worse in TRS patients compared to ES-S patients. A positive relationship between the thickness of the left middle temporal gyrus and the composite score for language was identified in patients with ES-S. CONCLUSIONS Our findings suggest significant cognitive impairment and reductions in CT and SCV in individuals with TRS compared to those with ES-S and HCs. These abnormalities could act as biomarkers for earlier identification of TRS.
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Affiliation(s)
- Congcong Liu
- Department of Psychiatry, Medical School, Jeonbuk National University, Jeonju, South Korea
| | - Woo-Sung Kim
- Department of Psychiatry, Medical School, Jeonbuk National University, Jeonju, South Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Jie Shen
- Department of Psychiatry, Medical School, Jeonbuk National University, Jeonju, South Korea
| | - Uyanga Tsogt
- Department of Psychiatry, Medical School, Jeonbuk National University, Jeonju, South Korea
| | - Nam-In Kang
- Department of Psychiatry, Maeumsarang Hospital, Wanju, South Korea
| | - Keon-Hak Lee
- Department of Psychiatry, Maeumsarang Hospital, Wanju, South Korea
| | - Young-Chul Chung
- Department of Psychiatry, Medical School, Jeonbuk National University, Jeonju, South Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.,Department of Psychiatry, Jeonbuk National University Hospital, Jeonju, South Korea
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23
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Itahashi T, Noda Y, Iwata Y, Tarumi R, Tsugawa S, Plitman E, Honda S, Caravaggio F, Kim J, Matsushita K, Gerretsen P, Uchida H, Remington G, Mimura M, Aoki YY, Graff-Guerrero A, Nakajima S. Dimensional distribution of cortical abnormality across antipsychotics treatment-resistant and responsive schizophrenia. NEUROIMAGE-CLINICAL 2021; 32:102852. [PMID: 34638035 PMCID: PMC8527893 DOI: 10.1016/j.nicl.2021.102852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/13/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022]
Abstract
Different etiology is assumed in treatment-resistant
and responsive schizophrenia. Patients with treatment-resistant schizophrenia were
classified from controls. Patients with non-treatment-resistant schizophrenia
were classified from controls. Two classifications reached area under the curve as
high as 0.69 and 0.85. Area under the curve remained as high as 0.69 when
two classifiers were swapped.
Background One-third of patients with schizophrenia are
treatment-resistant to non-clozapine antipsychotics (TRS), while the rest
respond (NTRS). Examining whether TRS and NTRS represent different
pathophysiologies is an important step toward precision
medicine. Methods Focusing on cortical thickness (CT), we analyzed
international multi-site cross-sectional datasets of magnetic resonance imaging
comprising 110 patients with schizophrenia (NTRS = 46, TRS = 64) and 52 healthy
controls (HCs). We utilized a logistic regression with L1-norm regularization to
find brain regions related to either NTRS or TRS. We conducted nested 10-fold
cross-validation and computed the accuracy and area under the curve (AUC). Then,
we applied the NTRS classifier to patients with TRS, and vice
versa. Results Patients with NTRS and TRS were classified from HCs with
65% and 78% accuracies and with the AUC of 0.69 and 0.85
(p = 0.014 and < 0.001, corrected), respectively.
The left planum temporale (PT) and left anterior insula/inferior frontal gyrus
(IFG) contributed to both NTRS and TRS classifiers. The left supramarginal gyrus
only contributed to NTRS and right superior temporal sulcus and right lateral
orbitofrontal cortex only to the TRS. The NTRS classifiers successfully
distinguished those with TRS from HCs with the AUC of 0.78
(p < 0.001), while the TRS classifiers classified
those with NTRS from HCs with the AUC of 0.69
(p = 0.015). Conclusion Both NTRS and TRS could be distinguished from HCs on the
basis of CT. The CT pathological basis of NTRS and TRS has commonalities, and
TRS presents unique CT features.
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Affiliation(s)
- Takashi Itahashi
- Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Iwata
- Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Ryosuke Tarumi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Sakiko Tsugawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Eric Plitman
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Shiori Honda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Fernando Caravaggio
- Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Julia Kim
- Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Karin Matsushita
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Philip Gerretsen
- Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Gary Remington
- Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yuta Y Aoki
- Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan.
| | - Ariel Graff-Guerrero
- Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.
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24
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Cortical surface abnormalities are different depending on the stage of schizophrenia: A cross-sectional vertexwise mega-analysis of thickness, area and gyrification. Schizophr Res 2021; 236:104-114. [PMID: 34481405 DOI: 10.1016/j.schres.2021.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 05/28/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Brain magnetic resonance imaging studies have not investigated the cortical surface comprehensively in schizophrenia subjects by assessing thickness, surface area and gyrification separately during the first-episode of psychosis (FEP) or chronic schizophrenia (ChSch). METHODS We investigated cortical surface abnormalities in 137 FEP patients and 240 ChSch subjects compared to 297 Healthy Controls (HC) contributed by five cohorts. Maps showing results of vertexwise between-group comparisons of cortical thickness, area, and gyrification were produced using T1-weighted datasets processed using FreeSurfer 5.3, followed by validated quality control protocols. RESULTS FEP subjects showed large clusters of increased area and gyrification relative to HC in prefrontal and insuli cortices (Cohen's d: 0.049 to 0.28). These between-group differences occurred partially beyond the effect of sample. ChSch subjects displayed reduced cortical thickness relative to HC in smaller fronto-temporal foci (d: -0.73 to -0.35), but not beyond the effect of sample. Differences between FEP and HC subjects were associated with male gender, younger age, and earlier illness onset, while differences between ChSch and HC were associated with treatment-resistance and first-generation antipsychotic (FGA) intake independently of sample effect. CONCLUSIONS Separate assessments of FEP and ChSch revealed abnormalities that differed in regional distribution, phenotypes affected and effect size. In FEP, associations of greater cortical area and gyrification abnormalities with earlier age of onset suggest an origin on anomalous neurodevelopment, while thickness reductions in ChSch are at least partially explained by treatment-resistance and FGA intake. Associations of between-group differences with clinical variables retained statistical significance beyond the effect of sample.
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25
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Jiang Y, Wang Y, Huang H, He H, Tang Y, Su W, Xu L, Wei Y, Zhang T, Hu H, Wang J, Yao D, Wang J, Luo C. Antipsychotics Effects on Network-Level Reconfiguration of Cortical Morphometry in First-Episode Schizophrenia. Schizophr Bull 2021; 48:231-240. [PMID: 34313782 PMCID: PMC8781340 DOI: 10.1093/schbul/sbab082] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Cortical thickness reductions are evident in schizophrenia (SZ). Associations between antipsychotic medications (APMs) and cortical morphometry have been explored in SZ patients. This raises the question of whether the reconfiguration of morphological architecture by APM plays potential compensatory roles for abnormalities in the cerebral cortex. Structural magnetic resonance imaging was obtained from 127 medication-naive first-episode SZ patients and 133 matched healthy controls. Patients received 12 weeks of APM and were categorized as responders (n = 75) or nonresponders (NRs, n = 52) at follow-up. Using surface-based morphometry and structural covariance (SC) analysis, this study investigated the short-term effects of antipsychotics on cortical thickness and cortico-cortical covariance. Global efficiency was computed to characterize network integration of the large-scale structural connectome. The relationship between covariance and cortical thinning was examined by SC analysis among the top-n regions with thickness reduction. Widespread cortical thickness reductions were observed in pre-APM patients. Post-APM patients showed more reductions in cortical thickness, even in the frontotemporal regions without baseline reductions. Covariance analysis revealed strong cortico-cortical covariance and higher network integration in responders than in NRs. For the NRs, some of the prefrontal and temporal nodes were not covariant between the top-n regions with cortical thickness reduction. Antipsychotic effects are not restricted to a single brain region but rather exhibit a network-level covariance pattern. Neuroimaging connectomics highlights the positive effects of antipsychotics on the reconfiguration of brain architecture, suggesting that abnormalities in regional morphology may be compensated by increasing interregional covariance when symptoms are controlled by antipsychotics.
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Affiliation(s)
- Yuchao Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, PR China,High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Yingchan Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Huan Huang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, PR China,High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Hui He
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Wenjun Su
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Lihua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yanyan Wei
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Tianhong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Hao Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jinhong Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, PR China,Research Unit of NeuroInformation (2019RU035), Chinese Academy of Medical Sciences, Chengdu, PR China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, PR China,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, PR China,High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, PR China,Research Unit of NeuroInformation (2019RU035), Chinese Academy of Medical Sciences, Chengdu, PR China,To whom correspondence should be addressed; University of Electronic Science and Technology of China, Second North Jianshe Road, Chengdu 610054, PR China; tel: 86-28-83201018, fax: 86-28-83208238, e-mail:
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26
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Yao C, Hu N, Cao H, Tang B, Zhang W, Xiao Y, Zhao Y, Gong Q, Lui S. A Multimodal Fusion Analysis of Pretreatment Anatomical and Functional Cortical Abnormalities in Responsive and Non-responsive Schizophrenia. Front Psychiatry 2021; 12:737179. [PMID: 34925087 PMCID: PMC8671303 DOI: 10.3389/fpsyt.2021.737179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/29/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Antipsychotic medications provide limited long-term benefit to ~30% of schizophrenia patients. Multimodal magnetic resonance imaging (MRI) data have been used to investigate brain features between responders and nonresponders to antipsychotic treatment; however, these analytical techniques are unable to weigh the interrelationships between modalities. Here, we used multiset canonical correlation and joint independent component analysis (mCCA + jICA) to fuse MRI data to examine the shared and specific multimodal features between the patients and healthy controls (HCs) and between the responders and non-responders. Method: Resting-state functional and structural MRI data were collected from 55 patients with drug-naïve first-episode schizophrenia (FES) and demographically matched HCs. Based on the decrease in Positive and Negative Syndrome Scale scores from baseline to the 1-year follow-up, FES patients were divided into a responder group (RG) and a non-responder group (NRG). Gray matter volume (GMV), fractional amplitude of low-frequency fluctuation (fALFF), and regional homogeneity (ReHo) maps were used as features in mCCA + jICA. Results: Between FES patients and HCs, there were three modality-specific discriminative independent components (ICs) showing the difference in mixing coefficients (GMV-IC7, GMV-IC8, and fALFF-IC5). The fusion analysis indicated one modality-shared IC (GMV-IC2 and ReHo-IC2) and three modality-specific ICs (GMV-IC1, GMV-IC3, and GMV-IC6) between the RG and NRG. The right postcentral gyrus showed a significant difference in GMV features between FES patients and HCs and modality-shared features (GMV and ReHo) between responders and nonresponders. The modality-shared component findings were highlighted by GMV, mainly in the bilateral temporal gyrus and the right cerebellum associated with ReHo in the right postcentral gyrus. Conclusions: This study suggests that joint anatomical and functional features of the cortices may reflect an early pathophysiological mechanism that is related to a 1-year treatment response.
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Affiliation(s)
- Chenyang Yao
- Department of Radiology, Huaxi Magnetic Resonance Research Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Imaging Medicine, Inner Mongolia Autonomous Region People's Hospital, Hohhot, China
| | - Na Hu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hengyi Cao
- Department of Radiology, Huaxi Magnetic Resonance Research Center, West China Hospital, Sichuan University, Chengdu, China.,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, United States.,Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - Biqiu Tang
- Department of Radiology, Huaxi Magnetic Resonance Research Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjing Zhang
- Department of Radiology, Huaxi Magnetic Resonance Research Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Xiao
- Department of Radiology, Huaxi Magnetic Resonance Research Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Youjin Zhao
- Department of Radiology, Huaxi Magnetic Resonance Research Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiyong Gong
- Department of Radiology, Huaxi Magnetic Resonance Research Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Su Lui
- Department of Radiology, Huaxi Magnetic Resonance Research Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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27
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Brain structural correlates of functional capacity in first-episode psychosis. Sci Rep 2020; 10:17229. [PMID: 33056996 PMCID: PMC7560620 DOI: 10.1038/s41598-020-73553-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023] Open
Abstract
Impaired functional capacity is a core feature of schizophrenia and presents even in first-episode psychosis (FEP) patients. Impairments in daily functioning tend to persist despite antipsychotic therapy but their neural basis is less clear. Previous studies suggest that volume loss in frontal cortex might be an important contributor, but findings are inconsistent. We aimed to comprehensively investigate the brain structural correlates of functional capacity in FEP using MRI and a reliable objective measure of functioning [University of California, San Diego Performance-Based Skills Assessment (UPSA)]. In a sample of FEP (n = 39) and a well-matched control group (n = 21), we measured cortical thickness, gray matter volume, and white matter tract integrity (fractional anisotropy, FA) within brain regions implicated by previous work. The FEP group had thinner cortex in various frontal regions and fusiform, and reduced FA in inferior longitudinal fasciculus (ILF). In FEP, poorer functional capacity correlated with reduced superior frontal volume and lower FA in left ILF. Importantly, frontal brain volumes and integrity of the ILF were identified as the structural correlates of functional capacity in FEP, controlling for other relevant factors. These findings enhance mechanistic understanding of functional capacity deficits in schizophrenia by specifying the underlying neural correlates. In future, this could help inform intervention strategies.
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28
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Tronchin G, Akudjedu TN, Ahmed M, Holleran L, Hallahan B, Cannon DM, McDonald C. Progressive subcortical volume loss in treatment-resistant schizophrenia patients after commencing clozapine treatment. Neuropsychopharmacology 2020; 45:1353-1361. [PMID: 32268345 PMCID: PMC7298040 DOI: 10.1038/s41386-020-0665-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 02/07/2023]
Abstract
The association of antipsychotic medication with abnormal brain morphometry in schizophrenia remains uncertain. This study investigated subcortical morphometric changes 6 months after switching treatment to clozapine in patients with treatment-resistant schizophrenia compared with healthy volunteers, and the relationships between longitudinal volume changes and clinical variables. In total, 1.5T MRI images were acquired at baseline before commencing clozapine and again after 6 months of treatment for 33 patients with treatment-resistant schizophrenia and 31 controls, and processed using the longitudinal pipeline of Freesurfer v.5.3.0. Two-way repeated MANCOVA was used to assess group differences in subcortical volumes over time and partial correlations to determine association with clinical variables. Whereas no significant subcortical volume differences were found between patients and controls at baseline (F(8,52) = 1.79; p = 0.101), there was a significant interaction between time, group and structure (F(7,143) = 52.54; p < 0.001). Corrected post-hoc analyses demonstrated that patients had significant enlargement of lateral ventricles (F(1,59) = 48.89; p < 0.001) and reduction of thalamus (F(1,59) = 34.85; p < 0.001), caudate (F(1,59) = 59.35; p < 0.001), putamen (F(1,59) = 87.20; p < 0.001) and hippocampus (F(1,59) = 14.49; p < 0.001) volumes. Thalamus and putamen volume reduction was associated with improvement in PANSS (r = 0.42; p = 0.021, r = 0.39; p = 0.033), SANS (r = 0.36; p = 0.049, r = 0.40; p = 0.027) and GAF (r = -0.39; p = 0.038, r = -0.42; p = 0.024) scores. Reduced thalamic volume over time was associated with increased serum clozapine level at follow-up (r = -0.44; p = 0.010). Patients with treatment-resistant schizophrenia display progressive subcortical volume deficits after switching to clozapine despite experiencing symptomatic improvement. Thalamo-striatal progressive volumetric deficit associated with symptomatic improvement after clozapine exposure may reflect an adaptive response related to improved outcome rather than a harmful process.
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Affiliation(s)
- Giulia Tronchin
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland.
| | - Theophilus N Akudjedu
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
- Institute of Medical Imaging & Visualisation, Faculty of Health & Social Science, Department of Medical Science & Public Science, Bournemouth University, Bournemouth, UK
| | - Mohamed Ahmed
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Laurena Holleran
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Brian Hallahan
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Dara M Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
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29
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Shah P, Plitman E, Iwata Y, Kim J, Nakajima S, Chan N, Brown EE, Caravaggio F, Torres E, Hahn M, Chakravarty MM, Remington G, Gerretsen P, Graff-Guerrero A. Glutamatergic neurometabolites and cortical thickness in treatment-resistant schizophrenia: Implications for glutamate-mediated excitotoxicity. J Psychiatr Res 2020; 124:151-158. [PMID: 32169688 DOI: 10.1016/j.jpsychires.2020.02.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 12/21/2022]
Abstract
Treatment-resistant schizophrenia may be related to structural brain alterations. However, the mechanisms underlying these changes remain unclear. The present study had two main aims: (1) to explore differences in cortical thickness between patients with treatment-resistant schizophrenia non-responsive to clozapine (ultra-treatment-resistant schizophrenia, UTRS), patients with treatment-resistant schizophrenia responsive to clozapine (Cloz-Resp), patients responsive to first-line non-clozapine antipsychotics (FL-Resp), and healthy controls (HCs); and (2) to test our hypothesis of structural compromise as a manifestation of neurotoxic effects from elevated glutamate (Glu) (i.e. glutamate-mediated excitotoxicity) by examining the relationships between glutamatergic neurometabolite levels (Glu and glutamate + glutamine (Glx)) in the dorsal anterior cingulate cortex (dACC) and cortical thickness. T1-weighted images and 1H-MRS data were obtained from UTRS (n = 24), Cloz-Resp (n = 25), FL-Resp (n = 19), and HCs (n = 26). Vertex-wise analyses showed that patients with UTRS had widespread cortical thinning in the bilateral frontal, temporal, parietal, and occipital gyri compared to HCs and FL-Resp patients. In the patient group, negative associations were found between dACC Glx levels and cortical thickness in the right dorsolateral prefrontal cortex after correcting for multiple comparisons and controlling for age, sex, antipsychotic dose, and illness severity. In conclusion, glutamate-mediated excitotoxicity may be one of the mechanisms underlying structural compromise seen in treatment-resistant schizophrenia. Future studies should longitudinally examine the associations between glutamatergic neurometabolite levels and cortical thickness in the context of treatment and illness progression.
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Affiliation(s)
- Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Eric Plitman
- Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Shinichiro Nakajima
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Nathan Chan
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Eric E Brown
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Edgardo Torres
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Margaret Hahn
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - M Mallar Chakravarty
- Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Gary Remington
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada.
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30
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Sardari S, Pourrahimi AM, Talebi H, Mazhari S. Symmetrical electrophysiological brain responses to unilateral and bilateral auditory stimuli suggest disrupted spatial processing in schizophrenia. Sci Rep 2019; 9:16454. [PMID: 31712599 PMCID: PMC6848080 DOI: 10.1038/s41598-019-52931-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/26/2019] [Indexed: 11/08/2022] Open
Abstract
Research has found auditory spatial processing deficits in patients with schizophrenia (SCZ), but no study has examined SCZ patients' auditory spatial processing at both pre-attentional and attentional stages. To address this gap, we investigated schizophrenics' brain responses to sounds originating from different locations (right, left, and bilateral sources). The event-related potentials (ERPs) of 25 chronic schizophrenic patients and 25 healthy subjects were compared. Mismatch negativity (MMN) in response to frequency and duration deviants was assessed. Two P3 components (P3a and P3b) were elicited via a frequency discrimination task, and MMN and P3 were recorded through separate monaural and dichotic stimulation paradigms. Our results corroborated the previously published finding that MMN, P3a, and P3b amplitudes are reduced in SCZ patients, but they showed no significant effect of stimulus location on either MMN or P3. These results indicated similarity between the SCZ patients and healthy individuals as regards patterns of ERP responses to stimuli that come from different directions. No evidence of auditory hemispatial bias in the SCZ patients was found, supporting the existence of non-lateralized spatial processing deficits in such patients and suggesting compensatory changes in the hemispheric laterality of patients' brains.
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Affiliation(s)
- Sara Sardari
- Neuroscience Research center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Mohammad Pourrahimi
- Neuroscience Research center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Hossein Talebi
- Audiology department, Rehabilitation faculty, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahrzad Mazhari
- Neuroscience Research center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.
- Department of Psychiatry, Medical School, Kerman University of Medical Sciences, Kerman, Iran.
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31
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Leung CCY, Gadelrab R, Ntephe CU, McGuire PK, Demjaha A. Clinical Course, Neurobiology and Therapeutic Approaches to Treatment Resistant Schizophrenia. Toward an Integrated View. Front Psychiatry 2019; 10:601. [PMID: 31551822 PMCID: PMC6735262 DOI: 10.3389/fpsyt.2019.00601] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 07/29/2019] [Indexed: 12/19/2022] Open
Abstract
Despite considerable psychotherapeutic advancement since the discovery of chlorpromazine, almost one third of patients with schizophrenia remain resistant to dopamine-blocking antipsychotics, and continue to be exposed to unwanted and often disabling side effects, but little if any clinical benefit. Even clozapine, the superior antipsychotic treatment, is ineffective in approximately half of these patients. Thus treatment resistant schizophrenia (TRS), continues to present a major therapeutic challenge to psychiatry. The main impediment to finding novel treatments is the lack of understanding of precise molecular mechanisms leading to TRS. Not only has the neurobiology been enigmatic for decades, but accurate and early detection of patients who are at risk of not responding to dopaminergic blockade remains elusive. Fortunately, recent work has started to unravel some of the neurobiological mechanisms underlying treatment resistance, providing long awaited answers, at least to some extent. Here we focus on the scientific advances in the field, from the clinical course of TRS to neurobiology and available treatment options. We specifically emphasize emerging evidence from TRS imaging and genetic literature that implicates dysregulation in several neurotransmitters, particularly dopamine and glutamate, and in addition genetic and neural alterations that concertedly may lead to the formation of TRS. Finally, we integrate available findings into a putative model of TRS, which may provide a platform for future studies in a bid to open the avenues for subsequent development of effective therapeutics.
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Affiliation(s)
- Cheryl Cheuk-Yan Leung
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Romayne Gadelrab
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | - Philip K. McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Arsime Demjaha
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, London, United Kingdom
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32
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Wannan CMJ, Cropley VL, Chakravarty MM, Bousman C, Ganella EP, Bruggemann JM, Weickert TW, Weickert CS, Everall I, McGorry P, Velakoulis D, Wood SJ, Bartholomeusz CF, Pantelis C, Zalesky A. Evidence for Network-Based Cortical Thickness Reductions in Schizophrenia. Am J Psychiatry 2019; 176:552-563. [PMID: 31164006 DOI: 10.1176/appi.ajp.2019.18040380] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Cortical thickness reductions in schizophrenia are irregularly distributed across multiple loci. The authors hypothesized that cortical connectivity networks would explain the distribution of cortical thickness reductions across the cortex, and, specifically, that cortico-cortical connectivity between loci with these reductions would be exceptionally strong and form an interconnected network. This hypothesis was tested in three cross-sectional schizophrenia cohorts: first-episode psychosis, chronic schizophrenia, and treatment-resistant schizophrenia. METHODS Structural brain images were acquired for 70 patients with first-episode psychosis, 153 patients with chronic schizophrenia, and 47 patients with treatment-resistant schizophrenia and in matching healthy control groups (N=57, N=168, and N=54, respectively). Cortical thickness was compared between the patient and respective control groups at 148 regions spanning the cortex. Structural connectivity strength between pairs of cortical regions was quantified with structural covariance analysis. Connectivity strength between regions with cortical thickness reductions was compared with connectivity strength between 5,000 sets of randomly chosen regions to establish whether regions with reductions were interconnected more strongly than would be expected by chance. RESULTS Significant (false discovery rate corrected) and widespread cortical thickness reductions were found in the chronic schizophrenia (79 regions) and treatment-resistant schizophrenia (106 regions) groups, with more circumscribed reductions in the first-episode psychosis group (34 regions). Cortical thickness reductions with the largest effect sizes were found in frontal, temporal, cingulate, and insular regions. In all cohorts, both the patient and healthy control groups showed significantly increased structural covariance between regions with cortical thickness reductions compared with randomly selected regions. CONCLUSIONS Brain network architecture can explain the irregular topographic distribution of cortical thickness reductions in schizophrenia. This finding, replicated in three distinct schizophrenia cohorts, suggests that the effect is robust and independent of illness stage.
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Affiliation(s)
- Cassandra M J Wannan
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Vanessa L Cropley
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - M Mallar Chakravarty
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Chad Bousman
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Eleni P Ganella
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Jason M Bruggemann
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Thomas W Weickert
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Cynthia Shannon Weickert
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Ian Everall
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Patrick McGorry
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Dennis Velakoulis
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Stephen J Wood
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Cali F Bartholomeusz
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Christos Pantelis
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Andrew Zalesky
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
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Vita A, Minelli A, Barlati S, Deste G, Giacopuzzi E, Valsecchi P, Turrina C, Gennarelli M. Treatment-Resistant Schizophrenia: Genetic and Neuroimaging Correlates. Front Pharmacol 2019; 10:402. [PMID: 31040787 PMCID: PMC6476957 DOI: 10.3389/fphar.2019.00402] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/01/2019] [Indexed: 12/11/2022] Open
Abstract
Schizophrenia is a severe neuropsychiatric disorder that affects approximately 0.5–1% of the population. Response to antipsychotic therapy is highly variable, and it is not currently possible to predict those patients who will or will not respond to antipsychotic medication. Furthermore, a high percentage of patients, approximately 30%, are classified as treatment-resistant (treatment-resistant schizophrenia; TRS). TRS is defined as a non-response to at least two trials of antipsychotic medication of adequate dose and duration. These patients are usually treated with clozapine, the only evidence-based pharmacotherapy for TRS. However, clozapine is associated with severe adverse events. For these reasons, there is an increasing interest to identify better targets for drug development of new compounds and to establish better biomarkers for existing medications. The ability of antipsychotics to improve psychotic symptoms is dependent on their antagonist and reverse agonist activities at different neuroreceptors, and some genetic association studies of TRS have focused on different pharmacodynamic factors. Some genetic studies have shown an association between antipsychotic response or TRS and neurodevelopment candidate genes, antipsychotic mechanisms of action (such as dopaminergic, serotonergic, GABAergic, and glutamatergic) or pharmacokinetic factors (i.e., differences in the cytochrome families). Moreover, there is a growing body of literature on the structural and functional neuroimaging research into TRS. Neuroimaging studies can help to uncover the underlying neurobiological reasons for such resistance and identify resistant patients earlier. Studies examining the neuropharmacological mechanisms of antipsychotics, including clozapine, can help to improve our knowledge of their action on the central nervous system, with further implications for the discovery of biomarkers and the development of new treatments. The identification of the underlying mechanisms of TRS is a major challenge for developing personalized medicine in the psychiatric field for schizophrenia treatment. The main goal of precision medicine is to use genetic and brain-imaging information to improve the safety, effectiveness, and health outcomes of patients via more efficiently targeted risk stratification, prevention, and tailored medication and treatment management approaches. The aim of this review is to summarize the state of art of pharmacogenetic, pharmacogenomic and neuroimaging studies in TRS.
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Affiliation(s)
- Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alessandra Minelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy
| | - Edoardo Giacopuzzi
- Genetic Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Paolo Valsecchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cesare Turrina
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Massimo Gennarelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Genetic Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Barry EF, Vanes LD, Andrews DS, Patel K, Horne CM, Mouchlianitis E, Hellyer PJ, Shergill SS. Mapping cortical surface features in treatment resistant schizophrenia with in vivo structural MRI. Psychiatry Res 2019; 274:335-344. [PMID: 30851596 DOI: 10.1016/j.psychres.2019.02.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 12/16/2022]
Abstract
Decreases in cortical volume (CV), thickness (CT) and surface area (SA) have been reported in individuals with schizophrenia by in vivo MRI studies. However, there are few studies that examine these cortical measures as potential biomarkers of treatment resistance (TR) and treatment response (NTR) in schizophrenia. This study used structural MRI to examine differences in CV, CT, and SA in 42 adults with schizophrenia (TR = 21, NTR = 21) and 23 healthy controls (HC) to test the hypothesis that individuals with TR schizophrenia have significantly greater reductions in these cortical measures compared to individuals with NTR schizophrenia. We found that individuals with TR schizophrenia showed significant reductions in CV and CT compared to individuals with NTR schizophrenia in right frontal and precentral regions, right parietal and occipital cortex, left temporal cortex and bilateral cingulate cortex. In line with previous literature, the temporal lobe and cingulate gyrus in both patient groups showed significant reductions of all three measures when compared to healthy controls. Taken together these results suggest that regional changes in CV and CT may index mechanisms specific to TR schizophrenia and potentially identify patients with TR schizophrenia for earlier treatment.
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Affiliation(s)
- Erica F Barry
- Cognition Schizophrenia and Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | - Lucy D Vanes
- Cognition Schizophrenia and Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Derek S Andrews
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Krisna Patel
- Cognition Schizophrenia and Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Charlotte M Horne
- Cognition Schizophrenia and Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Elias Mouchlianitis
- Cognition Schizophrenia and Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Peter J Hellyer
- Cognition Schizophrenia and Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sukhi S Shergill
- Cognition Schizophrenia and Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Tarcijonas G, Sarpal DK. Neuroimaging markers of antipsychotic treatment response in schizophrenia: An overview of magnetic resonance imaging studies. Neurobiol Dis 2018; 131:104209. [PMID: 29953933 DOI: 10.1016/j.nbd.2018.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/16/2018] [Accepted: 06/23/2018] [Indexed: 12/18/2022] Open
Abstract
Antipsychotic drugs are the primary treatment for psychosis, yet individual response to their administration remains variable. At present, no biological predictors of response exist to guide clinicians as they select treatments for patients, and our understanding of the neurobiology underlying the heterogeneity of outcomes remains limited. Magnetic Resonance Imaging (MRI) has been applied by numerous studies to examine the response to antipsychotic treatment, though a large gap remains between their results and our clinical practice. To advance patient care with precision medicine approaches, prior work must be accounted for and built upon with future studies. This review provides an overview of studies that relate treatment outcome to various MRI-related measures, including structural, spectroscopic, diffusion tensor, and functional imaging. Knowledge derived from these studies will be discussed along with future directions for the field.
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Affiliation(s)
- Goda Tarcijonas
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Deepak K Sarpal
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
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Khokhar JY, Henricks AM, Sullivan EDK, Green AI. Unique Effects of Clozapine: A Pharmacological Perspective. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2018; 82:137-162. [PMID: 29413518 DOI: 10.1016/bs.apha.2017.09.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Schizophrenia is a heterogenous and severe neuropsychiatric disorder that affects nearly 1% of the population worldwide. Antipsychotic drugs are the mainstay of treatment, but not all patients with schizophrenia respond to treatment with these agents. Clozapine, the first atypical antipsychotic, is a highly effective medication for patients with schizophrenia who do not respond to other antipsychotics. Although clozapine tends not to produce extrapyramidal symptoms, other side effects of the drug (e.g., agranulocytosis, myocarditis, seizures) limit its widespread use. This chapter reviews clozapine's unique clinical effects and unusual pharmacological profile. In addition to its effects in treatment-resistant schizophrenia, clozapine has been shown to decrease suicidality, which occurs at an increased rate in patients with schizophrenia. Still preliminary, but consistent data, also suggest that clozapine limits substance use in these patients, an important effect since substance use disorders are common in patients with schizophrenia and are associated with a poor outcome, including an increased risk for suicide and poor response to treatment. We have suggested, from animal studies, that clozapine's apparent ability to limit substance use may occur through its actions as a weak dopamine D2 receptor antagonist, a potent norepinephrine α-2 receptor antagonist and a norepinephrine reuptake inhibitor. Using animal models, we have built combinations of agents toward creation of safer clozapine-like drugs to reduce substance use in these patients. Future research into the mechanisms of action of clozapine toward the development of safe clozapine-like agents is of great public health importance.
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Affiliation(s)
- Jibran Y Khokhar
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States
| | - Angela M Henricks
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States
| | - Emily D K Sullivan
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States
| | - Alan I Green
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States.
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MacKay MAB, Paylor JW, Wong JTF, Winship IR, Baker GB, Dursun SM. Multidimensional Connectomics and Treatment-Resistant Schizophrenia: Linking Phenotypic Circuits to Targeted Therapeutics. Front Psychiatry 2018; 9:537. [PMID: 30425662 PMCID: PMC6218602 DOI: 10.3389/fpsyt.2018.00537] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
Schizophrenia is a very complex syndrome that involves widespread brain multi-dysconnectivity. Neural circuits within specific brain regions and their links to corresponding regions are abnormal in the illness. Theoretical models of dysconnectivity and the investigation of connectomics and brain network organization have been examined in schizophrenia since the early nineteenth century. In more recent years, advancements have been achieved with the development of neuroimaging tools that have provided further clues to the structural and functional organization of the brain and global neural networks in the illness. Neural circuitry that extends across prefrontal, temporal and parietal areas of the cortex as well as limbic and other subcortical brain regions is disrupted in schizophrenia. As a result, many patients have a poor response to antipsychotic treatment and treatment failure is common. Treatment resistance that is specific to positive, negative, and cognitive domains of the illness may be related to distinct circuit phenotypes unique to treatment-refractory disease. Currently, there are no customized neural circuit-specific and targeted therapies that address this neural dysconnectivity. Investigation of targeted therapeutics that addresses particular areas of substantial regional dysconnectivity is an intriguing approach to precision medicine in schizophrenia. This review examines current findings of system and circuit-level brain dysconnectivity in treatment-resistant schizophrenia based on neuroimaging studies. Within a connectome context, on-off circuit connectivity synonymous with excitatory and inhibitory neuronal pathways is discussed. Mechanistic cellular, neurochemical and molecular studies are included with specific emphasis given to cell pathology and synaptic communication in glutamatergic and GABAergic systems. In this review we attempt to deconstruct how augmenting treatments may be applied within a circuit context to improve circuit integration and treatment response. Clinical studies that have used a variety of glutamate receptor and GABA interneuron modulators, nitric oxide-based therapies and a variety of other strategies as augmenting treatments with antipsychotic drugs are included. This review supports the idea that the methodical mapping of system-level networks to both on (excitatory) and off (inhibitory) cellular circuits specific to treatment-resistant disease may be a logical and productive approach in directing future research toward the advancement of targeted pharmacotherapeutics in schizophrenia.
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Affiliation(s)
- Mary-Anne B MacKay
- Neurochemical Research Unit and Bebensee Schizophrenia Research Unit, Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - John W Paylor
- Neurochemical Research Unit and Bebensee Schizophrenia Research Unit, Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - James T F Wong
- Neurochemical Research Unit and Bebensee Schizophrenia Research Unit, Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Ian R Winship
- Neurochemical Research Unit and Bebensee Schizophrenia Research Unit, Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Glen B Baker
- Neurochemical Research Unit and Bebensee Schizophrenia Research Unit, Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Serdar M Dursun
- Neurochemical Research Unit and Bebensee Schizophrenia Research Unit, Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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Abstract
Although treatment-resistant schizophrenia (TRS) was described 50 years ago and has a gold standard treatment with clozapine based on well-defined criteria, there is still a matter of great interest and controversy. In terms of the underlying mechanisms of the development of TRS, progress has been made for the elucidation of the neurochemical mechanisms. Structural neuroimaging studies have shown that patients with TRS have significant reduction of the prefrontal cortex volume when compared with non- TRS. This article updates and enhances our previous review with new evidence mainly derived from new studies, clinical trials, systematic reviews, and meta-analyses.
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Affiliation(s)
- Helio Elkis
- Instituto de Psiquiatria HC- FMUSP, Rua Ovidio Pires de Campos 785-São Paulo, SP-05403-010, Brazil.
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Mouchlianitis E, McCutcheon R, Howes OD. Brain-imaging studies of treatment-resistant schizophrenia: a systematic review. Lancet Psychiatry 2016; 3:451-63. [PMID: 26948188 PMCID: PMC5796640 DOI: 10.1016/s2215-0366(15)00540-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 02/05/2023]
Abstract
Around 30% of patients with schizophrenia show an inadequate response to antipsychotics-ie, treatment resistance. Neuroimaging studies can help to uncover the underlying neurobiological reasons for such resistance and identify these patients earlier. Additionally, studies examining the effect of clozapine on the brain can help to identify aspects of clozapine that make it uniquely effective in patients with treatment resistance. We did a systematic search of PubMed between Jan 1, 1980, and April 13, 2015, to identify all neuroimaging studies that examined treatment-resistant patients or longitudinally assessed the effects of clozapine treatment. We identified 330 articles, of which 61 met the inclusion criteria. Replicated differences between treatment-resistant and treatment-responsive patients include reductions in grey matter and perfusion of frontotemporal regions, and increases in white matter and basal ganglia perfusion, with effect sizes ranging from 0·4 to greater than 1. Clozapine treatment led to reductions in caudate nucleus volume in three separate studies. The available evidence supports the hypothesis that some of the neurobiological changes seen in treatment-resistant schizophrenia lie along a continuum with treatment-responsive schizophrenia, whereas other differences are categorical in nature and have potential to be used as biomarkers. However, further replication is needed, and for neuroimaging findings to be clinically translatable, future studies need to focus on a-priori hypotheses and be adequately powered.
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Affiliation(s)
- Elias Mouchlianitis
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Robert McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; Psychiatric Imaging Group, Medical Research Council Clinical Sciences Centre, Institute of Clinical Science, Imperial College London, London, UK.
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; Psychiatric Imaging Group, Medical Research Council Clinical Sciences Centre, Institute of Clinical Science, Imperial College London, London, UK
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Frydecka D, Beszłej JA, Gościmski P, Kiejna A, Misiak B. Profiling cognitive impairment in treatment-resistant schizophrenia patients. Psychiatry Res 2016; 235:133-8. [PMID: 26706131 DOI: 10.1016/j.psychres.2015.11.028] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 10/08/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
The aim of this study was to compare cognitive performance between schizophrenia patients with and without treatment resistance (TRS and non-TRS patients) taking into account psychopathological symptoms and antipsychotic treatment. The following cognitive tests were administered to 53 TRS patients and 32 non-TRS subjects: Rey Auditory Verbal Learning Test (RAVLT), Trail Making Tests (TMT-A and TMT-B), verbal fluency tests (FAS test and Supermarket), as well as selected Wechsler Adults Intelligence Scale (WAIS-R-PI) subtests: Digit Symbol Coding Test, Digit Span Forward and Backward and Similarities. TRS patients performed significantly worse in comparison with non-TRS patients on the measures of processing speed (TMT-A, Stroop test, FAS test, Supermarket test, Digit Symbol Coding test), verbal fluency (FAS test, Supermarket test), cognitive flexibility and executive functions (Stroop test) after controlling for age, illness duration, clinical symptoms severity, the number of years of completed education and antipsychotics' dose. Cognitive performance was associated with negative and general symptomatology. Anticholinergic activity of antipsychotics had debilitating effect on cognitive functioning in non-TRS patients (FAS test) and in TRS patients (TMT-B test, Stroop test, RAVLT subtests, Digit Coding test and Similarities test), while low anticholinergic activity of antipsychotics was associated with better cognitive performance in non-TRS patients (Backward Digit Span test) and in TRS patients (Similarities test). Results of this study indicate that cognitive deficits are more robust in TRS patients than in non-TRS subjects, and are associated with clinical symptoms as well as the treatment with antipsychotics that exert high anticholinergic activity.
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Affiliation(s)
- Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland.
| | - Jan Aleksander Beszłej
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland
| | - Piotr Gościmski
- Lower Silesian Centre of Mental Health, 18 Conrad Korzeniowski Street, 50-226 Wroclaw, Poland
| | - Andrzej Kiejna
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland
| | - Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland; Department of Genetics, Wroclaw Medical University, 1 Marcinkowski Street, 50-368 Wroclaw, Poland
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Serum brain-derived neurotrophic factor and cortical thickness are differently related in patients with schizophrenia and controls. Psychiatry Res 2015; 234:84-9. [PMID: 26341949 DOI: 10.1016/j.pscychresns.2015.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 06/13/2015] [Accepted: 08/25/2015] [Indexed: 11/23/2022]
Abstract
Brain-derived neurotrophic factor (BDNF) has been implicated in neuronal plasticity, a key process related to the pathophysiology of schizophrenia. However, the relationship of peripheral levels of BDNF to cortical thickness and subcortical structures has not been extensively investigated. This study aims to investigate the relationship of peripheral serum BDNF levels to cortical thickness and volumes of the hippocampus and amygdala. Twenty-nine patients with schizophrenia and 32 healthy controls were included in this study. Structural magnetic resonance imaging (MRI) scans obtained in a 1.5 T scanner were performed in all subjects. Images were processed using Freesurfer software. Blood samples were collected on the same day of the MRI scan for BDNF peripheral levels. Vertex-wise analysis revealed significantly thinner cortex in patients compared with controls. BDNF levels and cortical thickness showed different patterns of correlation for patients and healthy controls in one cluster in the right hemisphere distributed across the supramarginal, postcentral, and inferior frontal cortices.
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Gomes JS, Shiozawa P, Dias ÁM, Valverde Ducos D, Akiba H, Trevizol AP, Bikson M, Aboseria M, Gadelha A, de Lacerda ALT, Cordeiro Q. Left Dorsolateral Prefrontal Cortex Anodal tDCS Effects on Negative Symptoms in Schizophrenia. Brain Stimul 2015; 8:989-91. [PMID: 26279407 DOI: 10.1016/j.brs.2015.07.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- July Silveira Gomes
- Clinical Neuroscience Interdisciplinary Laboratory, Federal University of Sao Paulo Medical School, Department of Psychiatry, Sao Paulo, Brazil.
| | - Pedro Shiozawa
- Clinical Neuromodulation Laboratory, Department of Psychiatry, Santa Casa School of Medicine, São Paulo, Brazil
| | - Álvaro Machado Dias
- Clinical Neuroscience Interdisciplinary Laboratory, Federal University of Sao Paulo Medical School, Department of Psychiatry, Sao Paulo, Brazil
| | - Daniella Valverde Ducos
- Clinical Neuroscience Interdisciplinary Laboratory, Federal University of Sao Paulo Medical School, Department of Psychiatry, Sao Paulo, Brazil
| | - Henrique Akiba
- Clinical Neuroscience Interdisciplinary Laboratory, Federal University of Sao Paulo Medical School, Department of Psychiatry, Sao Paulo, Brazil; Institute of Psychology, University of Sao Paulo, São Paulo, Brazil
| | - Alisson Paulino Trevizol
- Clinical Neuromodulation Laboratory, Department of Psychiatry, Santa Casa School of Medicine, São Paulo, Brazil
| | | | | | - Ary Gadelha
- Clinical Neuroscience Interdisciplinary Laboratory, Federal University of Sao Paulo Medical School, Department of Psychiatry, Sao Paulo, Brazil
| | - Aciolly Luiz Tavares de Lacerda
- Clinical Neuroscience Interdisciplinary Laboratory, Federal University of Sao Paulo Medical School, Department of Psychiatry, Sao Paulo, Brazil
| | - Quirino Cordeiro
- Clinical Neuromodulation Laboratory, Department of Psychiatry, Santa Casa School of Medicine, São Paulo, Brazil
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Lin AS, Chang SS, Lin SH, Peng YC, Hwu HG, Chen WJ. Minor physical anomalies and craniofacial measures in patients with treatment-resistant schizophrenia. Psychol Med 2015; 45:1839-1850. [PMID: 25515974 DOI: 10.1017/s0033291714002931] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Schizophrenia patients have higher rates of minor physical anomalies (MPAs) than controls, particularly in the craniofacial region; this difference lends support to the neurodevelopmental model of schizophrenia. Whether MPAs are associated with treatment response in schizophrenia remains unknown. The aim of this case-control study was to investigate whether more MPAs and specific quantitative craniofacial features in patients with schizophrenia are associated with operationally defined treatment resistance. METHOD A comprehensive scale, consisting of both qualitatively measured MPAs and quantitative measurements of the head and face, was applied in 108 patients with treatment-resistant schizophrenia (TRS) and in 104 non-TRS patients. Treatment resistance was determined according to the criteria proposed by Conley & Kelly (2001; Biological Psychiatry 50, 898-911). RESULTS Our results revealed that patients with TRS had higher MPA scores in the mouth region than non-TRS patients, and the two groups also differed in four quantitative measurements (facial width, lower facial height, facial height, and length of the philtrum), after controlling for multiple comparisons using the false discovery rate. Among these dysmorphological measurements, three MPA item types (mouth MPA score, facial width, and lower facial height) and earlier disease onset were further demonstrated to have good discriminant validity in distinguishing TRS from non-TRS patients in a multivariable logistic regression analysis, with an area under the curve of 0.84 and a generalized R 2 of 0.32. CONCLUSIONS These findings suggest that certain MPAs and craniofacial features may serve as useful markers for identifying TRS at early stages of the illness.
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Affiliation(s)
- A-S Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University,17 Xu-Zhou Road,Taipei 100,Taiwan
| | - S-S Chang
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, University of Hong Kong,Hong Kong Special Administrative Region,People's Republic of China
| | - S-H Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University,Tainan,Taiwan
| | - Y-C Peng
- Department of General Psychiatry,Bali Psychiatric Center, Ministry of Health and Welfare,New Taipei City,Taiwan
| | - H-G Hwu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University,17 Xu-Zhou Road,Taipei 100,Taiwan
| | - W J Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University,17 Xu-Zhou Road,Taipei 100,Taiwan
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Nakajima S, Takeuchi H, Plitman E, Fervaha G, Gerretsen P, Caravaggio F, Chung JK, Iwata Y, Remington G, Graff-Guerrero A. Neuroimaging findings in treatment-resistant schizophrenia: A systematic review: Lack of neuroimaging correlates of treatment-resistant schizophrenia. Schizophr Res 2015; 164:164-75. [PMID: 25684554 PMCID: PMC4409508 DOI: 10.1016/j.schres.2015.01.043] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/28/2015] [Accepted: 01/30/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recent developments in neuroimaging have advanced the understanding of biological mechanisms underlying schizophrenia. However, neuroimaging correlates of treatment-resistant schizophrenia (TRS) and superior effects of clozapine on TRS remain unclear. METHODS Systematic search was performed to identify neuroimaging characteristics unique to TRS and ultra-resistant schizophrenia (i.e. clozapine-resistant [URS]), and clozapine's efficacy in TRS using Embase, Medline, and PsychInfo. Search terms included (schizophreni*) and (resistan* OR refractory OR clozapine) and (ASL OR CT OR DTI OR FMRI OR MRI OR MRS OR NIRS OR PET OR SPECT). RESULTS 25 neuroimaging studies have investigated TRS and effects of clozapine. Only 5 studies have compared TRS and non-TRS, collectively providing no replicated neuroimaging finding specific to TRS. Studies comparing TRS and healthy controls suggest that hypometabolism in the prefrontal cortex, hypermetabolism in the basal ganglia, and structural anomalies in the corpus callosum contribute to TRS. Clozapine may increase prefrontal hypoactivation in TRS although this was not related to clinical improvement; in contrast, evidence has suggested a link between clozapine efficacy and decreased metabolism in the basal ganglia and thalamus. CONCLUSION Existing literature does not elucidate neuroimaging correlates specific to TRS or URS, which, if present, might also shed light on clozapine's efficacy in TRS. This said, leads from other lines of investigation, including the glutamatergic system can prove useful in guiding future neuroimaging studies focused on, in particular, the frontocortical-basal ganglia-thalamic circuits. Critical to the success of this work will be precise subtyping of study subjects based on treatment response/nonresponse and the use of multimodal neuroimaging.
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Affiliation(s)
- Shinichiro Nakajima
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.
| | - Hiroyoshi Takeuchi
- Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan; Schizophrenia Division, Complex Mental Illness Program, Centre for Addiction and Mental Health, Toronto, Canada.
| | - Eric Plitman
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Gagan Fervaha
- Schizophrenia Division, Complex Mental Illness Program, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Philip Gerretsen
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Fernando Caravaggio
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Jun Ku Chung
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Yusuke Iwata
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.
| | - Gary Remington
- Department of Psychiatry, University of Toronto, Toronto, Canada; Schizophrenia Division, Complex Mental Illness Program, Centre for Addiction and Mental Health, Toronto, Canada; Campbell Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group - Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Campbell Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
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45
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Tseng CEJ, Chien YL, Liu CM, Wang HLS, Hwu HG, Tseng WYI. Altered cortical structures and tract integrity of the mirror neuron system in association with symptoms of schizophrenia. Psychiatry Res 2015; 231:286-91. [PMID: 25659475 DOI: 10.1016/j.pscychresns.2015.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 10/17/2014] [Accepted: 01/11/2015] [Indexed: 11/26/2022]
Abstract
The mirror neuron system (MNS) may be implicated in schizophrenia. This study investigated MNS structures, including the pars opercularis (Pop), the supramarginal gyrus (SMg), the third branch of the superior longitudinal fasciculus, and callosal fibers interconnecting bilateral Pop (CC-Pop) and SMg (CC-SMg), and clarified their relationships with positive and negative symptoms of schizophrenia. Participants comprised 32 schizophrenia patients and 32 matched controls who received T1-weighted structural magnetic resonance imaging (MRI, T1WI) and diffusion spectrum imaging (DSI). The cortical measures were computed from the T1WI data. Tract integrity was assessed using a tractography-based analysis of the generalized fractional anisotropy (GFA) derived from the DSI data. Pearson׳s correlations and multiple linear regression analysis were used to investigate the associations between MNS structures and positive and negative symptom scores of schizophrenia. Cortical thickness in bilateral Pop and SMg were significantly thinner and mean GFA of CC-Pop was significantly decreased in patients. Negative symptoms were significantly correlated with left SMg volume, and positive symptoms were significantly correlated with right SMg thickness. Multiple linear regression analysis showed left SMg volume to be the strongest contributor to the negative symptoms. The association between left SMg volume and negative symptoms may reflect the degree of social cognition impairment in schizophrenia.
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Affiliation(s)
- Chieh-En Jane Tseng
- Center for Optoelectronic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiao-Lan Sharon Wang
- Center for Optoelectronic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hai-Gwo Hwu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Wen-Yih Isaac Tseng
- Center for Optoelectronic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan; Molecular Imaging Center, National Taiwan University, Taipei, Taiwan.
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46
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Anderson VM, Goldstein ME, Kydd RR, Russell BR. Extensive gray matter volume reduction in treatment-resistant schizophrenia. Int J Neuropsychopharmacol 2015; 18:pyv016. [PMID: 25716781 PMCID: PMC4540109 DOI: 10.1093/ijnp/pyv016] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Approximately one-third of people with schizophrenia are treatment-resistant and some do not achieve remission with clozapine, the gold-standard antipsychotic medication for treatment-resistant schizophrenia. This study compared global and regional brain volumes between treatment-respondent and treatment-resistant patients with schizophrenia, including a group of patients who were clozapine-resistant. METHODS T1-weighted brain MRIs were obtained on a 3T scanner in 20 controls and 52 people with schizophrenia who were selected based on their symptomatic responses to antipsychotic medication: 18 responded well to first-line atypical antipsychotics (FLR), 19 were treatment-resistant but responsive to clozapine monotherapy (TR), and 15 were ultra-treatment-resistant and did not respond to clozapine (UTR). Treatment groups were matched for disease duration and current psychopathology. SIENAX and FSL-VBM were used to investigate differences in the global brain, gray matter (GM), white matter, ventricular cerebrospinal fluid volumes, and regional GM volumes. RESULTS GM volume was significantly reduced in the TR and UTR groups compared with controls and the FLR group (p < 0.05). GM volume was significantly reduced in TR patients compared with FLRs in the superior, middle, and inferior temporal gyri, pre- and post-central gyri, middle and superior frontal gyri, right supramarginal gyrus, and right lateral occipital cortex. UTR patients showed reduced GM compared with FLRs in their right parietal operculum and left cerebellum. No significant volume differences were observed between TR and UTR groups. CONCLUSIONS These differences are unlikely to be solely due to medication effects, and reduced GM volume in treatment-resistant schizophrenia may represent an accelerated disease course or a different underlying pathology.
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Affiliation(s)
| | | | | | - Bruce R Russell
- School of Pharmacy, University of Auckland, Auckland, New Zealand (Drs Anderson, Goldstein, and Russell); Centre for Brain Research, University of Auckland, Auckland, New Zealand (Drs Anderson, Goldstein, Kydd, and Russell); Department of Psychological Medicine, University of Auckland, Auckland, New Zealand (Dr Kydd).
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47
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Song X, Quan M, Lv L, Li X, Pang L, Kennedy D, Hodge S, Harrington A, Ziedonis D, Fan X. Decreased cortical thickness in drug naïve first episode schizophrenia: in relation to serum levels of BDNF. J Psychiatr Res 2015; 60:22-8. [PMID: 25282282 DOI: 10.1016/j.jpsychires.2014.09.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/16/2014] [Accepted: 09/11/2014] [Indexed: 01/19/2023]
Abstract
This study was to examine cortical thickness in drug naïve, first episode schizophrenia patients, and to explore its relationship with serum levels of brain-derived neurotrophic factor (BDNF). Forty-five drug naive schizophrenia patients and 28 healthy controls were enrolled in the study. Freesurfer was used to parcellate cortical regions, and vertex-wise group analysis was used for whole brain cortical thickness. The clusters for the brain regions that demonstrated group differences were extracted, and the mean values of thickness were calculated. Serum levels of BDNF were measured using enzyme-linked immunosorbent assay (ELISA). After controlling for age and gender, significantly thinner cortical thickness was found in left insula and superior temporal gyrus in the patient group compared with the healthy control group (HC group) (p's < 0.001). Lower serum levels of BDNF were also found in the patient group compared with the HC group (p = 0.001). Correlation analysis showed a significant positive relationship between thickness of left insula and serum levels of BDNF within the HC group (r = 0.396, p = 0.037) but there was no such relationship within the patient group (r = 0.035, p = 0.819). Cortical thinning is present in drug naïve, first episode schizophrenia patients, indicating neurodevelopmental abnormalities at the onset of schizophrenia. Left insula might be an imaging biomarker in detecting the impaired protective role of neurotrophic factor for the brain development in schizophrenia.
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Affiliation(s)
- Xueqin Song
- The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China.
| | - Meina Quan
- UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Luxian Lv
- Henan Province Biological Psychiatry Key Laboratory, Xinxiang Medical University, Xinxiang, China; Henan Province Mental Hospital, The Second Affiliated Hospital, Xinxiang Medical University, Xinxiang, China
| | - Xue Li
- The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Lijuan Pang
- The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - David Kennedy
- UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Steven Hodge
- UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Amy Harrington
- UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Douglas Ziedonis
- UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| | - Xiaoduo Fan
- UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA.
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48
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Ota VK, Bellucco FT, Gadelha A, Santoro ML, Noto C, Christofolini DM, Assunção IB, Yamada KM, Ribeiro-dos-Santos ÂK, Santos S, Mari JJ, Smith MAC, Melaragno MI, Bressan RA, Sato JR, Jackowski AP, Belangero SI. PRODH polymorphisms, cortical volumes and thickness in schizophrenia. PLoS One 2014; 9:e87686. [PMID: 24498354 PMCID: PMC3912045 DOI: 10.1371/journal.pone.0087686] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 01/02/2014] [Indexed: 11/28/2022] Open
Abstract
Schizophrenia is a neurodevelopmental disorder with high heritability. Several lines of evidence indicate that the PRODH gene may be related to the disorder. Therefore, our study investigates the effects of 12 polymorphisms of PRODH on schizophrenia and its phenotypes. To further evaluate the roles of the associated variants in the disorder, we have conducted magnetic resonance imaging (MRI) scans to assess cortical volumes and thicknesses. A total of 192 patients were evaluated using the Structured Clinical Interview for DSM-IV (SCID), Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale, Global Assessment of Functioning (GAF) and Clinical Global Impression (CGI) instruments. The study included 179 controls paired by age and gender. The samples were genotyped using the real-time polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP)-PCR and Sanger sequencing methods. A sample of 138 patients and 34 healthy controls underwent MRI scans. One polymorphism was associated with schizophrenia (rs2904552), with the G-allele more frequent in patients than in controls. This polymorphism is likely functional, as predicted by PolyPhen and SIFT, but it was not associated with brain morphology in our study. In summary, we report a functional PRODH variant associated with schizophrenia that may have a neurochemical impact, altering brain function, but is not responsible for the cortical reductions found in the disorder.
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Affiliation(s)
- Vanessa K. Ota
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
- LiNC - Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
| | - Fernanda T. Bellucco
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
| | - Ary Gadelha
- LiNC - Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
- Departamento de Psiquiatria, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Marcos L. Santoro
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
- LiNC - Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
| | - Cristiano Noto
- LiNC - Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
- Departamento de Psiquiatria, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Denise M. Christofolini
- Disciplina de Genética e Reproducao Humana, Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina do ABC (FMABC), Santo Andre, Sao Paulo, Brazil
| | - Idaiane B. Assunção
- Departamento de Psiquiatria, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Karen M. Yamada
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
| | | | - Sidney Santos
- Laboratório de Genética Humana e Médica, Universidade Federal do Pará (UFPA), Belém, Pará, Brazil
| | - Jair J. Mari
- Departamento de Psiquiatria, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Marília A. C. Smith
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
| | - Maria I. Melaragno
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
| | - Rodrigo A. Bressan
- LiNC - Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
- Departamento de Psiquiatria, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - João R. Sato
- LiNC - Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
- Center of Mathematics, Computation and Cognition, Universidade Federal do ABC, Santo Andre, Brazil
| | - Andrea P. Jackowski
- LiNC - Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
| | - Sintia I. Belangero
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
- LiNC - Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
- Departamento de Psiquiatria, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil
- * E-mail:
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