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Tucci AA, Schroeder A, Noël C, Shvetz C, Yee J, Howard AL, Keshavan MS, Guimond S. Social cognition in youth with a first-degree relative with schizophrenia: A systematic scoping review. Psychiatry Res 2023; 323:115173. [PMID: 36989908 DOI: 10.1016/j.psychres.2023.115173] [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] [Received: 10/17/2022] [Revised: 03/14/2023] [Accepted: 03/18/2023] [Indexed: 03/31/2023]
Abstract
Social-cognitive deficits are present in individuals at familial high-risk (FHR) for schizophrenia and may play a role in the onset of the illness. No literature review has examined the social-cognitive profiles of youth at FHR who are within the peak window of risk for developing schizophrenia, which could provide insight on the endophenotypic role of social cognition. This systematic scoping review (1) summarizes the evidence on social-cognitive deficits in youth at FHR, (2) explores brain correlates, and (3) describes social-cognitive deficits and prodromal symptom associations. We searched PsycInfo and PubMed for studies investigating social cognition in FHR youth aged 35 or younger and included 19 studies (FHR=639; controls=689). Studies report that youth at FHR have difficulty recognizing negative emotions, particularly fear. Youth at FHR also have difficulty performing complex theory of mind tasks. Abnormality in corticolimbic and temporoparietal regions are observed in youth at FHR during social-cognitive tasks, but results are inconsistent. Finally, there is evidence for negative associations between prodromal symptoms and performance on emotion regulation and theory of mind tasks, but the research is scarce. This review highlights the need for studies on youth at FHR using longitudinal designs and extensive social-cognitive, brain imaging and clinical measures.
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Affiliation(s)
- Alexandra A Tucci
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada; Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Alexandra Schroeder
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Chelsea Noël
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Cecelia Shvetz
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Jasmin Yee
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Andrea L Howard
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Synthia Guimond
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada; Department of Psychology, Carleton University, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa, ON, Canada; Department of Psychoeducation and Psychology, University of Quebec in Outaouais, Gatineau, QC, Canada; Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
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Fiorito AM, Aleman A, Blasi G, Bourque J, Cao H, Chan RCK, Chowdury A, Conrod P, Diwadkar VA, Goghari VM, Guinjoan S, Gur RE, Gur RC, Kwon JS, Lieslehto J, Lukow PB, Meyer-Lindenberg A, Modinos G, Quarto T, Spilka MJ, Shivakumar V, Venkatasubramanian G, Villarreal M, Wang Y, Wolf DH, Yun JY, Fakra E, Sescousse G. Are Brain Responses to Emotion a Reliable Endophenotype of Schizophrenia? An Image-Based Functional Magnetic Resonance Imaging Meta-analysis. Biol Psychiatry 2023; 93:167-177. [PMID: 36085080 DOI: 10.1016/j.biopsych.2022.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Impaired emotion processing constitutes a key dimension of schizophrenia and a possible endophenotype of this illness. Empirical studies consistently report poorer emotion recognition performance in patients with schizophrenia as well as in individuals at enhanced risk of schizophrenia. Functional magnetic resonance imaging studies also report consistent patterns of abnormal brain activation in response to emotional stimuli in patients, in particular, decreased amygdala activation. In contrast, brain-level abnormalities in at-risk individuals are more elusive. We address this gap using an image-based meta-analysis of the functional magnetic resonance imaging literature. METHODS Functional magnetic resonance imaging studies investigating brain responses to negative emotional stimuli and reporting a comparison between at-risk individuals and healthy control subjects were identified. Frequentist and Bayesian voxelwise meta-analyses were performed separately, by implementing a random-effect model with unthresholded group-level T-maps from individual studies as input. RESULTS In total, 17 studies with a cumulative total of 677 at-risk individuals and 805 healthy control subjects were included. Frequentist analyses did not reveal significant differences between at-risk individuals and healthy control subjects. Similar results were observed with Bayesian analyses, which provided strong evidence for the absence of meaningful brain activation differences across the entire brain. Region of interest analyses specifically focusing on the amygdala confirmed the lack of group differences in this region. CONCLUSIONS These results suggest that brain activation patterns in response to emotional stimuli are unlikely to constitute a reliable endophenotype of schizophrenia. We suggest that future studies instead focus on impaired functional connectivity as an alternative and promising endophenotype.
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Affiliation(s)
- Anna M Fiorito
- Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, PSYR2 Team, University of Lyon, Lyon, France; Department of Psychiatry, University Hospital of Saint-Etienne, Saint-Etienne, France.
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells & Systems, Groningen, The Netherlands
| | - Giuseppe Blasi
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Josiane Bourque
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hengyi Cao
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Chinese Academy of Sciences Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Asadur Chowdury
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, Detroit, Michigan
| | - Patricia Conrod
- CHU Sainte-Justine Research Center, Department of Psychiatry and Addiction, University of Montréal, Montreal, Quebec, Canada
| | - Vaibhav A Diwadkar
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, Detroit, Michigan
| | - Vina M Goghari
- Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
| | | | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Johannes Lieslehto
- University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
| | - Paulina B Lukow
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Andreas Meyer-Lindenberg
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Gemma Modinos
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | | | - Michael J Spilka
- Department of Psychology, University of Georgia, Athens, Georgia
| | - Venkataram Shivakumar
- Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | | | - Mirta Villarreal
- Instituto de Neurociencias FLENI-CONICET, Facultad de Ciencias Exactas y Naturales, UBA, Buenos Aires, Argentina
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Chinese Academy of Sciences Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Daniel H Wolf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Je-Yeon Yun
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eric Fakra
- Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, PSYR2 Team, University of Lyon, Lyon, France; Department of Psychiatry, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Guillaume Sescousse
- Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, PSYR2 Team, University of Lyon, Lyon, France; Centre Hospitalier Le Vinatier, Bron, France
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Liu W, Li H, Lin X, Li P, Zhu X, Su S, Shi J, Lu L, Deng J, Sun X. Blunted superior temporal gyrus activity to negative emotional expression after mindfulness-based cognitive therapy for late-life depression. Front Aging Neurosci 2022; 14:1001447. [PMID: 36329872 PMCID: PMC9623567 DOI: 10.3389/fnagi.2022.1001447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Facial emotion recognition plays an important role in social functioning. Patients with late-life depression (LLD) often have abnormal facial emotion recognition. Mindfulness-based cognitive therapy (MBCT) is beneficial in treating depression. This study examined whether MBCT can act as an effective augmentation of antidepressants and improve facial emotion recognition in patients with LLD and its underlying neural mechanism. Patients with LLD were randomized into two groups (n = 30 per group). The MBCT group received an eight-week MBCT in conjunction with stable medication treatment. The other group was treated as usual (TAU group) with stable medication treatment. The positive affect (PA) scale, negative affect (NA) scale, and facial emotion recognition task with an fMRI scan were performed before and after the trial. After eight weeks of treatment, the repeated ANOVA showed that the PA score in the MBCT group significantly increased [F(1,54) = 13.31, p = 0.001], but did not change significantly [F(1,54) = 0.58, p = 0.449] in the TAU group. The NA scores decreased significantly in both the MBCT group [F(1,54) = 19.01, p < 0.001] and the TAU group [F(1,54) = 16.16, p < 0.001]. Patients showed an increase in recognition accuracy and speed of angry and sad faces after 8 weeks of MBCT. No improvement was detected in the TAU group after treatment. A significant interaction effect was found in the change of activation of the left superior temporal gyrus (L-STG) to negative emotional expression between time and groups. Furthermore, a decrease in activation of L-STG to negative emotional expression was positively correlated with the increase in PA score. The MBCT is beneficial for improving affect status and facial emotion recognition in patients with LLD, and the L-STG is involved in this process.
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Affiliation(s)
- Weijian Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Hui Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xiao Lin
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Peng Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Ximei Zhu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Sizhen Su
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
- *Correspondence: Lin Lu,
| | - Jiahui Deng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Jiahui Deng,
| | - Xinyu Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- Xinyu Sun,
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Saarinen AIL, Huhtaniska S, Pudas J, Björnholm L, Jukuri T, Tohka J, Granö N, Barnett JH, Kiviniemi V, Veijola J, Hintsanen M, Lieslehto J. Structural and functional alterations in the brain gray matter among first-degree relatives of schizophrenia patients: A multimodal meta-analysis of fMRI and VBM studies. Schizophr Res 2020; 216:14-23. [PMID: 31924374 DOI: 10.1016/j.schres.2019.12.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We conducted a multimodal coordinate-based meta-analysis (CBMA) to investigate structural and functional brain alterations in first-degree relatives of schizophrenia patients (FRs). METHODS We conducted a systematic literature search from electronic databases to find studies that examined differences between FRs and healthy controls using whole-brain functional magnetic resonance imaging (fMRI) or voxel-based morphometry (VBM). A CBMA of 30 fMRI (754 FRs; 959 controls) and 11 VBM (885 FRs; 775 controls) datasets were conducted using the anisotropic effect-size version of signed differential mapping. Further, we conducted separate meta-analyses about functional alterations in different cognitive tasks: social cognition, executive functioning, working memory, and inhibitory control. RESULTS FRs showed higher fMRI activation in the right frontal gyrus during cognitive tasks than healthy controls. In VBM studies, there were no differences in gray matter density between FRs and healthy controls. Furthermore, multi-modal meta-analysis obtained no differences between FRs and healthy controls. By utilizing the BrainMap database, we showed that the brain region which showed functional alterations in FRs (i) overlapped only slightly with the brain regions that were affected in the meta-analysis of schizophrenia patients and (ii) correlated positively with the brain regions that exhibited increased activity during cognitive tasks in healthy individuals. CONCLUSIONS Based on this meta-analysis, FRs may exhibit only minor functional alterations in the brain during cognitive tasks, and the alterations are much more restricted and only slightly overlapping with the regions that are affected in schizophrenia patients. The familial risk did not relate to structural alterations in the gray matter.
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Affiliation(s)
- Aino I L Saarinen
- Research Unit of Psychology, University of Oulu, Finland; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland; Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, Finland.
| | - Sanna Huhtaniska
- Center for Life Course Health Research, University of Oulu, Finland
| | - Juho Pudas
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, Finland
| | - Lassi Björnholm
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, Finland
| | - Tuomas Jukuri
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, Finland
| | - Jussi Tohka
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Niklas Granö
- Helsinki University Hospital, Department of Adolescent Psychiatry, Finland
| | - Jennifer H Barnett
- Cambridge Cognition, Cambridge, UK; Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Vesa Kiviniemi
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Juha Veijola
- Research Unit of Clinical Neuroscience, Department of Psychiatry, University of Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | | | - Johannes Lieslehto
- Center for Life Course Health Research, University of Oulu, Finland; Section for Neurodiagnostic Applications, Department of Psychiatry, Ludwig Maximilian University, Nussbaumstrasse 7, 80336 Munich, Bavaria, Germany
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Kozhuharova P, Saviola F, Ettinger U, Allen P. Neural correlates of social cognition in populations at risk of psychosis: A systematic review. Neurosci Biobehav Rev 2020; 108:94-111. [DOI: 10.1016/j.neubiorev.2019.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/23/2019] [Accepted: 10/17/2019] [Indexed: 12/29/2022]
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Lindholm P, Lieslehto J, Nikkinen J, Moilanen I, Hurtig T, Veijola J, Miettunen J, Kiviniemi V, Ebeling H. Brain response to facial expressions in adults with adolescent ADHD. Psychiatry Res Neuroimaging 2019; 292:54-61. [PMID: 31536947 DOI: 10.1016/j.pscychresns.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 09/01/2019] [Accepted: 09/05/2019] [Indexed: 12/29/2022]
Abstract
The symptoms of ADHD tend to have continuity to adulthood even though the diagnostic criteria were no longer fulfilled. The aim of our study was to find out possible differences in BOLD signal in the face-processing network between adults with previous ADHD (pADHD, n = 23) and controls (n = 29) from the same birth cohort when viewing dynamic facial expressions. The brain imaging was performed using a General Electric Signa 1.5 Tesla HDX. Dynamic facial expression stimuli included happy and fearful expressions. The pADHD group demonstrated elevated activity in the left parietal area during fearful facial expression. The Network Based Statistics including multiple areas demonstrated higher functional connectivity in attention related network during visual exposure to happy faces in the pADHD group. Conclusions: We found differences in brain responses to facial emotional expressions in individuals with previous ADHD compared to control group in a number of brain regions including areas linked to processing of facial emotional expressions and attention. This might indicate that although these individuals no longer fulfill the ADHD diagnosis, they exhibit overactive network properties affecting facial processing.
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Affiliation(s)
- Päivi Lindholm
- PEDEGO Research Unit, Child Psychiatry, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland; Clinic of Child Psychiatry, Oulu University Hospital, P.O. Box 26, FI-90029 Oulu, Finland.
| | - Johannes Lieslehto
- Research Unit of Clinical Neuroscience, Psychiatry, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland; Section for Neurodiagnostic Applications, Department of Psychiatry, Ludwig Maximilian University, Nussbaumstrasse 7, 80336, Munich, Bavaria, Germany
| | - Juha Nikkinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, P.O. Box 50, FI-90029 Oulu, Finland; Department of Oncology and Radiotherapy, Oulu University Hospital, P.O. Box 20, FI-90029 Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.
| | - Irma Moilanen
- PEDEGO Research Unit, Child Psychiatry, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland; Clinic of Child Psychiatry, Oulu University Hospital, P.O. Box 26, FI-90029 Oulu, Finland.
| | - Tuula Hurtig
- PEDEGO Research Unit, Child Psychiatry, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland; Clinic of Child Psychiatry, Oulu University Hospital, P.O. Box 26, FI-90029 Oulu, Finland; Research Unit of Clinical Neuroscience, Psychiatry, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland.
| | - Juha Veijola
- Research Unit of Clinical Neuroscience, Psychiatry, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland; Clinic of Psychiatry, University Hospital of Oulu, P.O.Box 26, FI-90029 Oulu, Finland.
| | - Jouko Miettunen
- Research Unit of Clinical Neuroscience, Psychiatry, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland.
| | - Vesa Kiviniemi
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, P.O. Box 50, FI-90029 Oulu, Finland.
| | - Hanna Ebeling
- PEDEGO Research Unit, Child Psychiatry, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland; Clinic of Child Psychiatry, Oulu University Hospital, P.O. Box 26, FI-90029 Oulu, Finland.
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7
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Lieslehto J, Kiviniemi VJ, Nordström T, Barnett JH, Murray GK, Jones PB, Paus T, Veijola J. Polygenic Risk Score for Schizophrenia and Face-Processing Network in Young Adulthood. Schizophr Bull 2019; 45:835-845. [PMID: 30281090 PMCID: PMC6581147 DOI: 10.1093/schbul/sby139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Development of schizophrenia relates to both genetic and environmental factors. Functional deficits in many cognitive domains, including the ability to communicate in social interactions and impaired recognition of facial expressions, are common for patients with schizophrenia and might also be present in individuals at risk of developing schizophrenia. Here we explore whether an individual's polygenic risk score (PRS) for schizophrenia is associated with the degree of interregional similarities in blood oxygen level-dependent (BOLD) signal and gray matter volume of the face-processing network and whether the exposure to early adversity moderates this association. A total of 90 individuals (mean age 22 years, both functional and structural data available) were used for discovery analyses, and 211 individuals (mean age 26 years, structural data available) were used for replication of the structural findings. Both samples were drawn from the Northern Finland Birth Cohort 1986. We found that the degree of interregional similarities in BOLD signal and gray matter volume vary as a function of PRS; lowest interregional correlation (both measures) was observed in individuals with high PRS. We also replicated the gray matter volume finding. We did not find evidence for an interaction between early adversity and PRS on the interregional correlation of BOLD signal and gray matter volume. We speculate that the observed group differences in PRS-related correlations in both modalities may result from differences in the concurrent functional engagement of the face-processing regions over time, eg, via differences in exposure to social interaction with other people.
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Affiliation(s)
- Johannes Lieslehto
- Department of Psychiatry, Research Unit of Clinical Neuroscience, Faculty of Medicine, University of Oulu, Oulu, Finland,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland,To whom correspondence should be addressed; PO Box 5000, Oulu 90014, Finland; tel: +358-40-125-3267, e-mail: johannes.lieslehto@.gmail.com
| | - Vesa J Kiviniemi
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Tanja Nordström
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland,Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jennifer H Barnett
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK,Cambridge Cognition Ltd, Cambridge, UK
| | - Graham K Murray
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Peter B Jones
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Tomáš Paus
- Child Mind Institute, New York, NY,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada,Department of Psychology, University of Toronto, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Juha Veijola
- Department of Psychiatry, Research Unit of Clinical Neuroscience, Faculty of Medicine, University of Oulu, Oulu, Finland,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland,Department of Psychiatry, Oulu University Hospital, Oulu, Finland
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Miettunen J, Haapea M, Björnholm L, Huhtaniska S, Juola T, Kinnunen L, Lehtiniemi H, Lieslehto J, Rautio N, Nordström T. Psychiatric research in the Northern Finland Birth Cohort 1986 - a systematic review. Int J Circumpolar Health 2019; 78:1571382. [PMID: 30744507 PMCID: PMC6374936 DOI: 10.1080/22423982.2019.1571382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The Northern Finland Birth Cohort 1986 is a large population-based birth cohort, which aims to promote health and wellbeing of the population. In this paper, we systematically review the psychiatric research performed in the cohort until today, i.e. at the age of 32 years of the cohort (2018). We conducted a systematic literature search using the databases of PubMed and Scopus and complemented it with a manual search. We found a total of 94 articles, which were classified as examining ADHD, emotional and behavioural problems, psychosis risk or other studies relating to psychiatric subjects. The articles are mainly based on two large comprehensive follow-up studies of the cohort and several substudies. The studies have often used also nationwide register data. The studies have found several early predictors for the aforementioned psychiatric outcomes, such as problems at pregnancy and birth, family factors in childhood, physical inactivity and substance use in adolescence. There are also novel findings relating to brain imaging and cognition, for instance regarding familial risk of psychosis in relation to resting state functional MRI. The Northern Finland Birth Cohort 1986 has been utilised frequently in psychiatric research and future data collections are likely to lead to new scientifically important findings. Abbreviations: attention deficit hyperactivity disorder (ADHD); magnetic resonance imaging (MRI)
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Affiliation(s)
- Jouko Miettunen
- a Center for Life Course Health Research , University of Oulu , Oulu , Finland.,b Medical Research Center Oulu , Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Marianne Haapea
- a Center for Life Course Health Research , University of Oulu , Oulu , Finland.,b Medical Research Center Oulu , Oulu University Hospital and University of Oulu , Oulu , Finland.,c Department of Psychiatry , Oulu University Hospital , Oulu , Finland
| | - Lassi Björnholm
- c Department of Psychiatry , Oulu University Hospital , Oulu , Finland.,d Department of Psychiatry , Research Unit of Clinical Neuroscience, University of Oulu , Oulu , Finland
| | - Sanna Huhtaniska
- a Center for Life Course Health Research , University of Oulu , Oulu , Finland
| | - Teija Juola
- a Center for Life Course Health Research , University of Oulu , Oulu , Finland
| | - Lotta Kinnunen
- a Center for Life Course Health Research , University of Oulu , Oulu , Finland.,b Medical Research Center Oulu , Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Heli Lehtiniemi
- a Center for Life Course Health Research , University of Oulu , Oulu , Finland.,b Medical Research Center Oulu , Oulu University Hospital and University of Oulu , Oulu , Finland.,e Northern Finland Birth Cohorts, Faculty of Medicine , University of Oulu , Oulu , Finland
| | - Johannes Lieslehto
- a Center for Life Course Health Research , University of Oulu , Oulu , Finland.,b Medical Research Center Oulu , Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Nina Rautio
- a Center for Life Course Health Research , University of Oulu , Oulu , Finland.,b Medical Research Center Oulu , Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Tanja Nordström
- a Center for Life Course Health Research , University of Oulu , Oulu , Finland.,b Medical Research Center Oulu , Oulu University Hospital and University of Oulu , Oulu , Finland.,e Northern Finland Birth Cohorts, Faculty of Medicine , University of Oulu , Oulu , Finland
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Quarto T, Paparella I, De Tullio D, Viscanti G, Fazio L, Taurisano P, Romano R, Rampino A, Masellis R, Popolizio T, Selvaggi P, Pergola G, Bertolino A, Blasi G. Familial Risk and a Genome-Wide Supported DRD2 Variant for Schizophrenia Predict Lateral Prefrontal-Amygdala Effective Connectivity During Emotion Processing. Schizophr Bull 2018; 44:834-843. [PMID: 28981847 PMCID: PMC6007415 DOI: 10.1093/schbul/sbx128] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The brain functional mechanisms translating genetic risk into emotional symptoms in schizophrenia (SCZ) may include abnormal functional integration between areas key for emotion processing, such as the amygdala and the lateral prefrontal cortex (LPFC). Indeed, investigation of these mechanisms is also complicated by emotion processing comprising different subcomponents and by disease-associated state variables. Here, our aim was to investigate the relationship between risk for SCZ and effective connectivity between the amygdala and the LPFC during different subcomponents of emotion processing. Thus, we first characterized with dynamic causal modeling (DCM) physiological patterns of LPFC-amygdala effective connectivity in healthy controls (HC) during implicit and explicit emotion processing. Then, we compared DCM patterns in a subsample of HC, in patients with SCZ and in healthy siblings of patients (SIB), matched for demographics. Finally, we investigated in HC association of LPFC-amygdala effective connectivity with a genome-wide supported variant increasing genetic risk for SCZ and possibly relevant to emotion processing (DRD2 rs2514218). In HC, we found that a "bottom-up" amygdala-to-LPFC pattern during implicit processing and a "top-down" LPFC-to-amygdala pattern during explicit processing were the most likely directional models of effective connectivity. Differently, implicit emotion processing in SIB, SCZ, and HC homozygous for the SCZ risk rs2514218 C allele was associated with decreased probability for the "bottom-up" as well as with increased probability for the "top-down" model. These findings suggest that task-specific anomaly in the directional flow of information or disconnection between the amygdala and the LPFC is a good candidate endophenotype of SCZ.
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Affiliation(s)
- Tiziana Quarto
- Psychiatric Neuroscience Group, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy,Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Isabella Paparella
- Psychiatric Neuroscience Group, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Davide De Tullio
- Psychiatric Neuroscience Group, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Giovanna Viscanti
- Psychiatric Neuroscience Group, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Leonardo Fazio
- Psychiatric Neuroscience Group, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Paolo Taurisano
- Psychiatric Neuroscience Group, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Raffaella Romano
- Psychiatric Neuroscience Group, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Antonio Rampino
- Psychiatric Neuroscience Group, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Rita Masellis
- Psychiatric Neuroscience Group, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Teresa Popolizio
- IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy
| | - Pierluigi Selvaggi
- Psychiatric Neuroscience Group, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Giulio Pergola
- Psychiatric Neuroscience Group, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Alessandro Bertolino
- Psychiatric Neuroscience Group, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Giuseppe Blasi
- Psychiatric Neuroscience Group, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy,To whom correspondence should be addressed; tel: +390 8055 93629; fax: +390 8055 93204; e-mail:
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10
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Goghari VM, Sanford N, Spilka MJ, Woodward TS. Task-Related Functional Connectivity Analysis of Emotion Discrimination in a Family Study of Schizophrenia. Schizophr Bull 2017; 43:1348-1362. [PMID: 28338738 PMCID: PMC5737224 DOI: 10.1093/schbul/sbx004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Poor emotion recognition is a core deficit in schizophrenia and is associated with poor functional outcome. Functional magnetic resonance imaging (fMRI) multivariate analysis methods were used to elucidate the neural underpinnings of face and emotion processing associated with both genetic liability and disease-specific effects. Schizophrenia patients, relatives, and controls completed a task that included 4 facial emotion discrimination conditions and an age discrimination condition during fMRI. Three functional networks were derived from the data: the first involved in visual attention and response generation, the second a default mode network (DMN), and a third involved in face and emotion processing. No differences in activation were found between groups for the visual attention and response generation network, suggesting that basic processes were intact. Both schizophrenia patients and relatives showed evidence for hyperdeactivation in the DMN compared to controls, with relatives being intermediate, suggesting a genetic liability effect. Both disease-specific and genetic liability effects were found for the face processing network, which included the amygdala. Patients exhibited lower coordinated network activity compared to controls and relatives across all facial discrimination conditions. Additionally, in relation to the other emotion discrimination conditions, a heightened coordinated response during fear and anger discrimination was observed in schizophrenia compared to other conditions, whereas relatives demonstrated heightened coordinated activity for anger discrimination only relative to other emotion conditions. With regards to brain functioning, this study found that schizophrenia is associated with abnormal processing of threat-related information, and that in part may be associated with the genetic risk for the disorder, suggesting that the facial and emotion processing network could be targeted for intervention.
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Affiliation(s)
- Vina M Goghari
- Department of Psychology, University of Toronto, Toronto, ON, Canada,To whom correspondence should be addressed; Department of Psychology, University of Toronto, 1265 Military Trail, Toronto, ON M1C 1A4, Canada; tel: 416-208-8168, fax: 416-287-7642, e-mail:
| | - Nicole Sanford
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada,BC Mental Health and Addictions Research Institute, Vancouver, BC, Canada
| | - Michael J Spilka
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Todd S Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada,BC Mental Health and Addictions Research Institute, Vancouver, BC, Canada
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11
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Lieslehto J, Kiviniemi V, Mäki P, Koivukangas J, Nordström T, Miettunen J, Barnett JH, Jones PB, Murray GK, Moilanen I, Paus T, Veijola J. Early adversity and brain response to faces in young adulthood. Hum Brain Mapp 2017; 38:4470-4478. [PMID: 28612935 DOI: 10.1002/hbm.23674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/05/2017] [Accepted: 05/23/2017] [Indexed: 12/21/2022] Open
Abstract
Early stressors play a key role in shaping interindividual differences in vulnerability to various psychopathologies, which according to the diathesis-stress model might relate to the elevated glucocorticoid secretion and impaired responsiveness to stress. Furthermore, previous studies have shown that individuals exposed to early adversity have deficits in emotion processing from faces. This study aims to explore whether early adversities associate with brain response to faces and whether this association might associate with the regional variations in mRNA expression of the glucocorticoid receptor gene (NR3C1). A total of 104 individuals drawn from the Northern Finland Brith Cohort 1986 participated in a face-task functional magnetic resonance imaging (fMRI) study. A large independent dataset (IMAGEN, N = 1739) was utilized for reducing fMRI data-analytical space in the NFBC 1986 dataset. Early adversities were associated with deviant brain response to fearful faces (MANCOVA, P = 0.006) and with weaker performance in fearful facial expression recognition (P = 0.01). Glucocorticoid receptor gene expression (data from the Allen Human Brain Atlas) correlated with the degree of associations between early adversities and brain response to fearful faces (R2 = 0.25, P = 0.01) across different brain regions. Our results suggest that early adversities contribute to brain response to faces and that this association is mediated in part by the glucocorticoid system. Hum Brain Mapp 38:4470-4478, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Johannes Lieslehto
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.,Aurora Doctoral Program, Thule Institute, University of Oulu, Oulu, Finland
| | - Vesa Kiviniemi
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Pirjo Mäki
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.,Department of Psychiatry, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Psychiatry, Länsi-Pohja Healthcare District, Keropudas and the Middle Ostrobothnia Central Hospital, Kiuru, Kokkola, Mental Health Services in Raahe District and District of Kallio, Finland
| | - Jenni Koivukangas
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
| | - Tanja Nordström
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jouko Miettunen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jennifer H Barnett
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Irma Moilanen
- University of Oulu and Department of Child Psychiatry, Oulu University Hospital, PEDEGO Research Center, Child Psychiatry, Oulu, Finland
| | | | - Tomáš Paus
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada.,Departments of Psychology and Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Child Mind Institute, New York, New York
| | - Juha Veijola
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.,Department of Psychiatry, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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12
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Abnormal effective fronto-limbic connectivity during emotion processing in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2017; 72:1-8. [PMID: 27528110 DOI: 10.1016/j.pnpbp.2016.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Schizophrenia is associated with core emotional dysfunctions. At the neural level, functional neuro-imaging studies have highlighted fronto-limbic alterations during emotion processing in schizophrenia, as well as impaired connectivity between the amygdala and the prefrontal cortex. However, the direction of the impaired fronto-limbic connections remains largely unknown. To clarify this issue, we performed an effective connectivity study on emotion processing in schizophrenia. METHODS Forty-one healthy individuals and 39 schizophrenia patients (DSM-IV criteria) viewed negative, positive and neutral images during an fMRI session. Effective connectivity between significantly activated regions was examined using Granger causality and psychophysical interaction analyses. RESULTS Subjective ratings of emotionally neutral images were higher in schizophrenia patients than in controls. Across groups, significant activations were observed in the dorso-medial prefrontal cortex (dmPFC) and the bilateral amygdala. The Granger connectivity from the right amygdala to the dmPFC was significantly reduced in schizophrenia patients, relative to controls, during the negative and neutral conditions. The Granger connectivity from the left amygdala to the dmPFC was significantly reduced in schizophrenia patients, relative to controls, during the positive condition. DISCUSSION The finding of a reduced lagged connectivity from the bilateral amygdala to the dmPFC in schizophrenia suggests that the bottom-up mechanisms involved in the processing of highly arousing emotional stimuli are impaired in this disorder. The finding of an impaired lagged connectivity from the right amygdala to the dmPFC during the processing of emotionally neutral stimuli in schizophrenia is novel and may explain why these patients tend to confer emotional significance to irrelevant stimuli.
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13
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Abstract
Research into emotions has increased in recent decades, especially on the subject of recognition of emotions. However, studies of the facial expressions of emotion were compromised by technical problems with visible video analysis and electromyography in experimental settings. These have only recently been overcome. There have been new developments in the field of automated computerized facial recognition; allowing real-time identification of facial expression in social environments. This review addresses three approaches to measuring facial expression of emotion and describes their specific contributions to understanding emotion in the healthy population and in persons with mental illness. Despite recent progress, studies on human emotions have been hindered by the lack of consensus on an emotion theory suited to examining the dynamic aspects of emotion and its expression. Studying expression of emotion in patients with mental health conditions for diagnostic and therapeutic purposes will profit from theoretical and methodological progress.
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Affiliation(s)
- Karsten Wolf
- Clinical Director, Marienheide Mental Health Centre, Germany
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14
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Yan LR, Wu YB, Zeng XH, Gao LC. Dysfunctional putamen modulation during bimanual finger-to-thumb movement in patients with Parkinson's disease. Front Hum Neurosci 2015; 9:516. [PMID: 26483652 PMCID: PMC4588113 DOI: 10.3389/fnhum.2015.00516] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/04/2015] [Indexed: 11/14/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder affecting middle-aged and elderly people. PD can be viewed as “circuit disorder,” indicating that large scale cortico-subcortical pathways were involved in its pathophysiology. The brain network in an experimental context is emerging as an important biomarker in disease diagnosis and prognosis prediction. This context-dependent network for PD and the underling functional mechanism remains unclear. In this paper, the brain network profiles in 11 PD patients without dementia were studied and compared with 12 healthy controls. The functional magnetic resonance imaging (fMRI) data were acquired when the subjects were performing a pseudorandomized unimanual or bimanual finger-to-thumb movement task. The activation was detected and the network profiles were analyzed by psychophysiological interaction (PPI) toolbox. For the controls and PD patients, the motor areas including the primary motor and premotor areas, supplementary motor area, the cerebellum and parts of the frontal, temporal and parietal gyrus were activated. The right putamen exhibited significant control > PD activation and weaker activity during the bimanual movement relative to the unimanual movement in the control group. The decreased putamen modulation on some nucleus in basal ganglia, such as putamen, thalamus and caudate, and some cortical areas, such as cingulate, parietal, angular, frontal, temporal and occipital gyrus was detected in the bimanual movement condition relative to the unimanual movement condition. Between-group PPI difference was detected in cingulate gyrus, angular gyrus and precuneus (control > PD) and inferior frontal gyrus (PD > control). The deficient putamen activation and its enhanced connectivity with the frontal gyrus could be a correlate of impaired basal ganglia inhibition and frontal gyrus compensation to maintain the task performance during the motor programs of PD patients.
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Affiliation(s)
- Li-Rong Yan
- Department of Information, Wuhan General Hospital of Guangzhou Command Wuhan, China
| | - Yi-Bo Wu
- Department of Unmanned Aerial Vehicle, Wuhan Mechanical Technology College Wuhan, China
| | - Xiao-Hua Zeng
- Department of Radiology, Wuhan General Hospital of Guangzhou Command Wuhan, China
| | - Li-Chen Gao
- Department of Radiology, Wuhan General Hospital of Guangzhou Command Wuhan, China
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