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Guo Q, Liu S, Wang L, Feng K, Yang S. Analysis of microstate features for Parkinson's disease based on reliability validation. J Neurosci Methods 2024; 406:110115. [PMID: 38531478 DOI: 10.1016/j.jneumeth.2024.110115] [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: 11/29/2023] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Parkinson's disease (PD) is a disorder with abnormal changes in brain activity. The lack of objective indicators makes the assessment of PD progression difficult. Assessment of brain activity changes in PD may offer a potential solution. NEW METHOD Electroencephalogram (EEG) microstates reflect global dynamic changes in the brain. Therefore, we utilized microstates to assess changes in PD brain activity. However, the effect of epoch duration on the reliability of microstate analyses in PD is unclear. Thus, we first assessed the effect of data duration on the reliability of microstate topography and temporal features in PD and older healthy individuals. According to the reliability assessment, EEG epochs with high reliability were selected for microstate analysis in PD. Finally, we investigated the correlation between microstate features and clinical scales to determine whether these features could serve as objective indicators to evaluate PD progression. RESULTS Microstate analysis features that show high reliability for 3 min and above epoch durations. The topology of microstate D was significantly changed in PD compared to healthy controls, as well as the temporal features of microstates C and D. Additionally, the occurrence of C was negatively correlated with MoCA, and the duration of D was positively correlated with UPDRS. COMPARISON WITH EXISTING METHOD(S) High reliability of PD microstate features obtained by our approach. CONCLUSION EEG for PD microstate analysis should be at least 3 min. Microstate analysis is expected to provide new ideas and objective indicators for assessing Parkinson's disease progression in the clinical setting.
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Affiliation(s)
- Qingfang Guo
- Hebei Key Laboratory of Bioelectromagnetics and Neural Engineering, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin 300131, China; State Key Laboratory of Reliable and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, China
| | - Shuo Liu
- Hebei Key Laboratory of Bioelectromagnetics and Neural Engineering, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin 300131, China; State Key Laboratory of Reliable and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, China
| | - Lei Wang
- Hebei Key Laboratory of Bioelectromagnetics and Neural Engineering, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin 300131, China; State Key Laboratory of Reliable and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, China
| | - Keke Feng
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China.
| | - Shuo Yang
- Hebei Key Laboratory of Bioelectromagnetics and Neural Engineering, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin 300131, China; State Key Laboratory of Reliable and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, China.
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Li H, Wang C, Ma L, Xu C, Li H. EEG analysis in patients with schizophrenia based on microstate semantic modeling method. Front Hum Neurosci 2024; 18:1372985. [PMID: 38638803 PMCID: PMC11024310 DOI: 10.3389/fnhum.2024.1372985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Microstate analysis enables the characterization of quasi-stable scalp potential fields on a sub-second timescale, preserving the temporal dynamics of EEG and spatial information of scalp potential distributions. Owing to its capacity to provide comprehensive pathological insights, it has been widely applied in the investigation of schizophrenia (SCZ). Nevertheless, previous research has primarily concentrated on differences in individual microstate temporal characteristics, neglecting potential distinctions in microstate semantic sequences and not fully considering the issue of the universality of microstate templates between SCZ patients and healthy individuals. Methods This study introduced a microstate semantic modeling analysis method aimed at schizophrenia recognition. Firstly, microstate templates corresponding to both SCZ patients and healthy individuals were extracted from resting-state EEG data. The introduction of a dual-template strategy makes a difference in the quality of microstate sequences. Quality features of microstate sequences were then extracted from four dimensions: Correlation, Explanation, Residual, and Dispersion. Subsequently, the concept of microstate semantic features was proposed, decomposing the microstate sequence into continuous sub-sequences. Specific semantic sub-sequences were identified by comparing the time parameters of sub-sequences. Results The SCZ recognition test was performed on the public dataset for both the quality features and semantic features of microstate sequences, yielding an impressive accuracy of 97.2%. Furthermore, cross-subject experimental validation was conducted, demonstrating that the method proposed in this paper achieves a recognition rate of 96.4% between different subjects. Discussion This research offers valuable insights for the clinical diagnosis of schizophrenia. In the future, further studies will seek to augment the sample size to enhance the effectiveness and reliability of this method.
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Affiliation(s)
- Hongwei Li
- Faculty of Computing, Harbin Institute of Technology, Harbin, China
| | - Changming Wang
- Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Lin Ma
- Faculty of Computing, Harbin Institute of Technology, Harbin, China
| | - Cong Xu
- Faculty of Computing, Harbin Institute of Technology, Harbin, China
| | - Haifeng Li
- Faculty of Computing, Harbin Institute of Technology, Harbin, China
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Chen M, Xia X, Kang Z, Li Z, Dai J, Wu J, Chen C, Qiu Y, Liu T, Liu Y, Zhang Z, Shen Q, Tao S, Deng Z, Lin Y, Wei Q. Distinguishing schizophrenia and bipolar disorder through a Multiclass Classification model based on multimodal neuroimaging data. J Psychiatr Res 2024; 172:119-128. [PMID: 38377667 DOI: 10.1016/j.jpsychires.2024.02.024] [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: 11/15/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/22/2024]
Abstract
This study aimed to identify neural biomarkers for schizophrenia (SZ) and bipolar disorder (BP) by analyzing multimodal neuroimaging. Utilizing data from structural magnetic resonance imaging (sMRI), diffusion tensor imaging (DTI), and resting-state functional magnetic resonance imaging (rs-fMRI), multiclass classification models were created for SZ, BP, and healthy controls (HC). A total of 113 participants (BP: 31, SZ: 39, and HC: 43) were recruited under strict enrollment control, from which 272, 200, and 1875 features were extracted from sMRI, DTI, and rs-fMRI data, respectively. A support vector machine (SVM) with recursive feature elimination (RFE) was employed to build the models using a one-against-one approach and leave-one-out cross-validation, achieving a classification accuracy of 70.8%. The most discriminative features were primarily from rs-fMRI, along with significant findings in sMRI and DTI. Key biomarkers identified included the increased thickness of the left cuneus cortex and decreased regional functional connectivity strength (rFCS) in the left supramarginal gyrus as shared indicators for BP and SZ. Additionally, decreased fractional anisotropy in the left superior fronto-occipital fasciculus was suggested as specific to BP, while decreased rFCS in the left inferior parietal area might serve as a specific biomarker for SZ. These findings underscore the potential of multimodal neuroimaging in distinguishing between BP and SZ and contribute to the understanding of their neural underpinnings.
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Affiliation(s)
- Ming Chen
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Mental Health Institute, Guangdong ProvincialPeople's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xiaowei Xia
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhuang Kang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhinan Li
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiamin Dai
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Junyan Wu
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Cai Chen
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yong Qiu
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Psychiatry, Mindfront Caring Medical, Guangzhou, China
| | - Tong Liu
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China
| | - Yanxi Liu
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ziyi Zhang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Medical Division, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qingni Shen
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sichu Tao
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zixin Deng
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ying Lin
- Department of Psychology, Sun Yat-sen University, Guangzhou, China.
| | - Qinling Wei
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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4
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Ling Y, Wen X, Tang J, Tao Z, Sun L, Xin H, Luo B. Effect of topographic comparison of electroencephalographic microstates on the diagnosis and prognosis prediction of patients with prolonged disorders of consciousness. CNS Neurosci Ther 2024; 30:e14421. [PMID: 37679900 PMCID: PMC10915977 DOI: 10.1111/cns.14421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/19/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
AIMS The electroencephalography (EEG) microstates are indicative of fundamental information processing mechanisms, which are severely damaged in patients with prolonged disorders of consciousness (pDoC). We aimed to improve the topographic analysis of EEG microstates and explore indicators available for diagnosis and prognosis prediction of patients with pDoC, which were still lacking. METHODS We conducted EEG recordings on 59 patients with pDoC and 32 healthy controls. We refined the microstate method to accurately estimate topographical differences, and then classify and forecast the prognosis of patients with pDoC. An independent dataset was used to validate the conclusion. RESULTS Through optimized topographic analysis, the global explained variance (GEV) of microstate E increased significantly in groups with reduced levels of consciousness. However, its ability to classify the VS/UWS group was poor. In addition, the optimized GEV of microstate E exhibited a statistically significant decrease in the good prognosis group as opposed to the group with a poor prognosis. Furthermore, the optimized GEV of microstate E strongly predicted a patient's prognosis. CONCLUSION This technique harmonizes with the existing microstate analysis and exhibits precise and comprehensive differences in microstate topography between groups. Furthermore, this method has significant potential for evaluating the clinical prognosis of pDoC patients.
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Affiliation(s)
- Yi Ling
- Department of Neurology, First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Xinrui Wen
- Department of Neurology, First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Jianghui Tang
- Zhejiang Provincial Key Laboratory of Pancreatic DiseaseZhejiang University School of Medicine First Affiliated HospitalHangzhouChina
| | - Zhengde Tao
- Department of NeurologyFirst People's Hospital of WenlingZhejiangChina
| | - Liping Sun
- Department of Neurology, First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Hailiang Xin
- Department of RehabilitationHangzhou Mingzhou Brain Rehabilitation HospitalHangzhouChina
| | - Benyan Luo
- Department of Neurology, First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
- The MOE Frontier Science Center for Brain Science and Brain‐Machine IntegrationZhejiang UniversityHangzhouChina
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5
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Yan T, Wang G, Liu T, Li G, Wang C, Funahashi S, Suo D, Pei G. Effects of Microstate Dynamic Brain Network Disruption in Different Stages of Schizophrenia. IEEE Trans Neural Syst Rehabil Eng 2023; 31:2688-2697. [PMID: 37285242 DOI: 10.1109/tnsre.2023.3283708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Schizophrenia is a heterogeneous mental disorder with unknown etiology or pathological characteristics. Microstate analysis of the electroencephalogram (EEG) signal has shown significant potential value for clinical research. Importantly, significant changes in microstate-specific parameters have been extensively reported; however, these studies have ignored the information interactions within the microstate network in different stages of schizophrenia. Based on recent findings, since rich information about the functional organization of the brain can be revealed by functional connectivity dynamics, we use the first-order autoregressive model to construct the functional connectivity of intra- and intermicrostate networks to identify information interactions among microstate networks. We demonstrate that, beyond abnormal parameters, disrupted organization of the microstate networks plays a crucial role in different stages of the disease by 128-channel EEG data collected from individuals with first-episode schizophrenia, ultrahigh-risk, familial high-risk, and healthy controls. According to the characteristics of the microstates of patients at different stages, the parameters of microstate class A are reduced, those of class C are increased, and the transitions from intra- to intermicrostate functional connectivity are gradually disrupted. Furthermore, decreased integration of intermicrostate information might lead to cognitive deficits in individuals with schizophrenia and those in high-risk states. Taken together, these findings illustrate that the dynamic functional connectivity of intra- and intermicrostate networks captures more components of disease pathophysiology. Our work sheds new light on the characterization of dynamic functional brain networks based on EEG signals and provides a new interpretation of aberrant brain function in different stages of schizophrenia from the perspective of microstates.
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Zhang G, Ye X, Wang X, Lin Y, Zhu C, Pan J, Yin X, Ye M, Lv W, Tang W, Liu J, Yang X, Hui L, Zheng K. Serum total cholesterol levels associated with immediate memory performance in patients with chronic schizophrenia. Schizophr Res 2023; 255:256-260. [PMID: 37060796 DOI: 10.1016/j.schres.2023.03.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/13/2023] [Accepted: 03/26/2023] [Indexed: 04/17/2023]
Abstract
Cognitive impairments are common in patients with schizophrenia. Changes in total cholesterol (TC) may be involved in the development of schizophrenia and associated with cognitive function. This study aimed to investigate differences in serum TC level and cognitive function between schizophrenia patients and healthy controls and explore the relationship between serum TC level and cognitive function in patients with schizophrenia. A total of 105 schizophrenia patients and 105 healthy controls were recruited. Results showed that patients with schizophrenia had significantly lower scores on the overall RBANS scale and subscales (i.e., immediate memory, language, attention, and delayed memory) than those of healthy controls. Pearson's correlation analyses showed that in patients with schizophrenia, serum TC levels were positively associated with RBANS subscale scores of immediate memory and language. Furthermore, multivariate regression analyses showed that serum TC level was positively associated with the immediate memory index in patients with schizophrenia. However, no significant association was found between serum TC level and RBANS score in the healthy control group. Our results suggest that elevated serum TC level may be related to improved cognitive function in patients with schizophrenia, especially that of immediate memory.
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Affiliation(s)
- Guohua Zhang
- School of Mental Health, Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325035, PR China.
| | - Xiaodan Ye
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China
| | - Xin Wang
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Yixuan Lin
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, PR China
| | - Cheng Zhu
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China
| | - Jianshe Pan
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China
| | - Xiaoli Yin
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China
| | - Minjie Ye
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China
| | - Wei Lv
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China
| | - Wei Tang
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China
| | - Jiahong Liu
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China
| | - Xue Yang
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Li Hui
- Institute of Mental Health, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China.
| | - Ke Zheng
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China.
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Event-related microstate dynamics represents working memory performance. Neuroimage 2022; 263:119669. [PMID: 36206941 DOI: 10.1016/j.neuroimage.2022.119669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/21/2022] Open
Abstract
In recent years, EEG microstate analysis has attracted much attention as a tool for characterizing the spatial and temporal dynamics of large-scale electrophysiological activities in the human brain. Canonical 4 states (classes A, B, C, and D) have been widely reported, and they have been pointed out for their relationships with cognitive functions and several psychiatric disorders such as schizophrenia, in particular, through their static parameters such as average duration, occurrence, coverage, and transition probability. However, the relationships between event-related microstate changes and their related cognitive functions, as is often analyzed in event-related potentials under time-locked frameworks, is still not well understood. Furthermore, not enough attention has been paid to the relationship between microstate dynamics and static characteristics. To clarify the relationships between the static microstate parameters and dynamic microstate changes, and between the dynamics and working memory (WM) function, we first examined the temporal profiles of the microstates during the N-back task. We found significant event-related microstate dynamics that differed predominantly with WM loads, which were not clearly observed in the static parameters. Furthermore, in the 2-back condition, patterns of state transitions from class A to C in the high- and low-performance groups showed prominent differences at 50-300 ms after stimulus onset. We also confirmed that the transition patterns of the specific time periods were able to predict the performance level (low or high) in the 2-back condition at a significant level, where a specific transition between microstates, namely from class A to C with specific polarity, contributed to the prediction robustly. Taken together, our findings indicate that event-related microstate dynamics at 50-300 ms after onset may be essential for WM function. This suggests that event-related microstate dynamics can reflect more highly-refined brain functions.
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Soni S, Muthukrishnan SP, Sood M, Kaur S, Sharma R. Spectral perturbations of cortical dipoles during a dynamic visuo-spatial working memory task in schizophrenia. Psychiatry Res Neuroimaging 2022; 326:111530. [PMID: 36067547 DOI: 10.1016/j.pscychresns.2022.111530] [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: 03/08/2022] [Revised: 06/29/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
Abstract
Altered neural oscillations during prestimulus-task conditions have been reported to be associated with aberrant information processing in schizophrenia. Spectral perturbations induced by visuo-spatial working memory (VSWM) task were investigated in patients and their first-degree relatives in order to study the biomarkers in schizophrenia. EEG was recorded using 128-channel during VSWM task in 28 patients, 27 first-degree relatives and 25 controls. After pre-processing and ICA, current dipole was estimated for each IC. Total of 1609 independent and localizable EEG components across all groups were used to compute ERSP during different events of task. Patients deactivated DMN, RSN, auditory cortex more compared to controls during search period to perform VSWM task. Relatives showed altered activation of right medial and inferior frontal gyri during different events and loads of task in lower frequencies compared to controls. Relatives also showed hyperactivity in right cingulate and parahippocampal gyri compared to controls. This is suggestive of genetic predisposition in schizophrenia and could act as vulnerability markers, further strengthened by no significant differences between patients and relatives. Altered processing of simultaneous ongoing events in patients and relatives can serve as state and trait-specific features of schizophrenia.
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Affiliation(s)
- Sunaina Soni
- Stress and Cognitive Electroimaging Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Suriya Prakash Muthukrishnan
- Stress and Cognitive Electroimaging Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Simran Kaur
- Stress and Cognitive Electroimaging Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ratna Sharma
- Stress and Cognitive Electroimaging Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.
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Wang B, Zhang S, Yu X, Niu Y, Niu J, Li D, Zhang S, Xiang J, Yan T, Yang J, Wu J, Liu M. Alterations in white matter network dynamics in patients with schizophrenia and bipolar disorder. Hum Brain Mapp 2022; 43:3909-3922. [PMID: 35567336 PMCID: PMC9374889 DOI: 10.1002/hbm.25892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/17/2022] [Accepted: 04/08/2022] [Indexed: 11/12/2022] Open
Abstract
Emerging evidence suggests white matter network abnormalities in patients with schizophrenia (SZ) and bipolar disorder (BD), but the alterations in dynamics of the white matter network in patients with SZ and BD are largely unknown. The white matter network of patients with SZ (n = 45) and BD (n = 47) and that of healthy controls (HC, n = 105) were constructed. We used dynamics network control theory to quantify the dynamics metrics of the network, including controllability and synchronizability, to measure the ability to transfer between different states. Experiments show that the patients with SZ and BD showed decreasing modal controllability and synchronizability and increasing average controllability. The correlations between the average controllability and synchronizability of patients were broken, especially for those with SZ. The patients also showed alterations in brain regions with supercontroller roles and their distribution in the cognitive system. Finally, we were able to accurately discriminate and predict patients with SZ and BD. Our findings provide novel dynamic metrics evidence that patients with SZ and BD are characterized by a selective disruption of brain network controllability, potentially leading to reduced brain state transfer capacity, and offer new guidance for the clinical diagnosis of mental illness.
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Affiliation(s)
- Bin Wang
- Department of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Shanshan Zhang
- Department of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Xuexue Yu
- Department of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Yan Niu
- Department of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Jinliang Niu
- Department of Medical Imaging, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Dandan Li
- Department of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Shan Zhang
- Department of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Jie Xiang
- Department of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Ting Yan
- Teranslational Medicine Research Center, Shanxi Medical University, Taiyuan, China
| | - Jiajia Yang
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama, Japan
| | - Jinglong Wu
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama, Japan
| | - Miaomiao Liu
- School of Psychology, Shenzhen University, Shenzhen, China
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Sun Q, Zhao L, Tan L. Abnormalities of Electroencephalography Microstates in Drug-Naïve, First-Episode Schizophrenia. Front Psychiatry 2022; 13:853602. [PMID: 35360139 PMCID: PMC8964053 DOI: 10.3389/fpsyt.2022.853602] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/22/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Microstate analysis is a powerful tool to probe the brain functions, and changes in microstates under electroencephalography (EEG) have been repeatedly reported in patients with schizophrenia. This study aimed to investigate the dynamics of EEG microstates in drug-naïve, first-episode schizophrenia (FE-SCH) and to test the relationship between EEG microstates and clinical symptoms. METHODS Resting-state EEG were recorded for 23 patients with FE-SCH and 23 healthy controls using a 64-channel cap. Three parameters, i.e., contribution, duration, and occurrence, of the four microstate classes were calculated. Group differences in EEG microstates and their clinical symptoms [assessed using the Positive and Negative Syndrome Scale (PANSS)] were analyzed. RESULTS Compared with healthy controls, patients with FE-SCH showed increased duration, occurrence and contribution of microstate class C and decreased contribution and occurrence of microstate class D. In addition, the score of positive symptoms in PANSS was negatively correlated with the occurrence of microstate D. CONCLUSION Our findings showed abnormal patterns of EEG microstates in drug-naïve, first-episode schizophrenia, which might help distinguish individuals with schizophrenia in the early stage and develop early intervention strategies.
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Affiliation(s)
- Qiaoling Sun
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Linlin Zhao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Liwen Tan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
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11
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Dai Z, Zhang S, Wang X, Wang H, Zhou H, Tian S, Chen Z, Lu Q, Yao Z. Sub-second transient activated patterns to sad expressions in major depressive disorders discovered via hidden Markov model. J Neurosci Res 2021; 99:3250-3260. [PMID: 34585763 DOI: 10.1002/jnr.24942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/04/2021] [Accepted: 07/24/2021] [Indexed: 01/15/2023]
Abstract
The pathological mechanisms of major depressive disorders (MDDs) is associated with the overexpression of negative emotions, and the fast transient-activated patterns underlying overrepresentation in depression still remain to be revealed to date. We hypothesized that the aberrant spatiotemporal attributes of the process of sad expressions are related to the neuropathology of MDD and help to detect the depression severity. We enrolled a total of 96 subjects including 47 patients with MDD and 49 healthy controls (HCs), and recorded their magnetoencephalography data under a sad expression recognition task. A hidden Markov model (HMM) was applied to separate the whole neural activity into several brain states, then to characterize the dynamics. To find the disrupted temporal-spatial characteristics, power estimations and fractional occupancy (FO) of each state were estimated and contrasted between MDDs and HCs. Three states were found over the period of emotional stimuli processing procedure. The early visual stage (0-270 ms) was mainly manifested by state 1, and the emotional information processing stage (270-600 ms) was manifested by state 2, while the state 3 remained a steady proportion across the whole period. MDDs activated statistically more in limbic system during state 2 (p = 0.0045) and less in frontoparietal control network during state 3 (p = 5.38 × 10-5 ) relative to HCs. Hamilton Depression Rating Scale scores were significantly correlated with the predicted disorder severity using FO values (p = 0.0062, r = 0.3933). Relative to HCs, MDDs perceived the sad contents quickly and spent more time overexpressing the negative emotions. These phenomena indicated MDD patients might easily indulge in negative emotion and neglect other things. Furthermore, temporal descriptors built by HMM could be potential biomarkers for identifying the severity of depression disorders.
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Affiliation(s)
- Zhongpeng Dai
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
| | - Siqi Zhang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
| | - Xinyi Wang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
| | - Huan Wang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
| | - Hongliang Zhou
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.,Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shui Tian
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
| | - Zhilu Chen
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.,Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qing Lu
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
| | - Zhijian Yao
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.,Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China
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12
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Chen J, Li H, Ma L, Bo H, Soong F, Shi Y. Dual-Threshold-Based Microstate Analysis on Characterizing Temporal Dynamics of Affective Process and Emotion Recognition From EEG Signals. Front Neurosci 2021; 15:689791. [PMID: 34335165 PMCID: PMC8318040 DOI: 10.3389/fnins.2021.689791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
Recently, emotion classification from electroencephalogram (EEG) data has attracted much attention. As EEG is an unsteady and rapidly changing voltage signal, the features extracted from EEG usually change dramatically, whereas emotion states change gradually. Most existing feature extraction approaches do not consider these differences between EEG and emotion. Microstate analysis could capture important spatio-temporal properties of EEG signals. At the same time, it could reduce the fast-changing EEG signals to a sequence of prototypical topographical maps. While microstate analysis has been widely used to study brain function, few studies have used this method to analyze how brain responds to emotional auditory stimuli. In this study, the authors proposed a novel feature extraction method based on EEG microstates for emotion recognition. Determining the optimal number of microstates automatically is a challenge for applying microstate analysis to emotion. This research proposed dual-threshold-based atomize and agglomerate hierarchical clustering (DTAAHC) to determine the optimal number of microstate classes automatically. By using the proposed method to model the temporal dynamics of auditory emotion process, we extracted microstate characteristics as novel temporospatial features to improve the performance of emotion recognition from EEG signals. We evaluated the proposed method on two datasets. For public music-evoked EEG Dataset for Emotion Analysis using Physiological signals, the microstate analysis identified 10 microstates which together explained around 86% of the data in global field power peaks. The accuracy of emotion recognition achieved 75.8% in valence and 77.1% in arousal using microstate sequence characteristics as features. Compared to previous studies, the proposed method outperformed the current feature sets. For the speech-evoked EEG dataset, the microstate analysis identified nine microstates which together explained around 85% of the data. The accuracy of emotion recognition achieved 74.2% in valence and 72.3% in arousal using microstate sequence characteristics as features. The experimental results indicated that microstate characteristics can effectively improve the performance of emotion recognition from EEG signals.
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Affiliation(s)
- Jing Chen
- School of Computer Science and Technology, Faculty of Computing, Harbin Institute of Technology, Harbin, China
| | - Haifeng Li
- School of Computer Science and Technology, Faculty of Computing, Harbin Institute of Technology, Harbin, China
| | - Lin Ma
- School of Computer Science and Technology, Faculty of Computing, Harbin Institute of Technology, Harbin, China
| | - Hongjian Bo
- Shenzhen Academy of Aerospace Technology, Shenzhen, China
| | - Frank Soong
- Speech Group, Microsoft Research Asia, Beijing, China
| | - Yaohui Shi
- Heilongjiang Provincial Hospital, Harbin, China
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13
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Resting-State EEG Microstates Parallel Age-Related Differences in Allocentric Spatial Working Memory Performance. Brain Topogr 2021; 34:442-460. [PMID: 33871737 PMCID: PMC8195770 DOI: 10.1007/s10548-021-00835-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 03/30/2021] [Indexed: 11/08/2022]
Abstract
Alterations of resting-state EEG microstates have been associated with various neurological disorders and behavioral states. Interestingly, age-related differences in EEG microstate organization have also been reported, and it has been suggested that resting-state EEG activity may predict cognitive capacities in healthy individuals across the lifespan. In this exploratory study, we performed a microstate analysis of resting-state brain activity and tested allocentric spatial working memory performance in healthy adult individuals: twenty 25–30-year-olds and twenty-five 64–75-year-olds. We found a lower spatial working memory performance in older adults, as well as age-related differences in the five EEG microstate maps A, B, C, C′ and D, but especially in microstate maps C and C′. These two maps have been linked to neuronal activity in the frontal and parietal brain regions which are associated with working memory and attention, cognitive functions that have been shown to be sensitive to aging. Older adults exhibited lower global explained variance and occurrence of maps C and C′. Moreover, although there was a higher probability to transition from any map towards maps C, C′ and D in young and older adults, this probability was lower in older adults. Finally, although age-related differences in resting-state EEG microstates paralleled differences in allocentric spatial working memory performance, we found no evidence that any individual or combination of resting-state EEG microstate parameter(s) could reliably predict individual spatial working memory performance. Whether the temporal dynamics of EEG microstates may be used to assess healthy cognitive aging from resting-state brain activity requires further investigation.
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14
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Sun Q, Zhou J, Guo H, Gou N, Lin R, Huang Y, Guo W, Wang X. EEG Microstates and Its Relationship With Clinical Symptoms in Patients With Schizophrenia. Front Psychiatry 2021; 12:761203. [PMID: 34777062 PMCID: PMC8581189 DOI: 10.3389/fpsyt.2021.761203] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022] Open
Abstract
Schizophrenia is a complex and devastating disorder with unclear pathogenesis. Electroencephalogram (EEG) microstates have been suggested as a potential endophenotype for this disorder. However, no clear dynamic pattern of microstates has been found. This study aims to identify the dynamics of EEG microstates in schizophrenia and to test whether schizophrenia patients with altered clinical symptoms severity showed different microstates abnormalities compared with healthy controls. Resting-state EEG data in 46 individuals who met the ICD-10 diagnostic criteria for schizophrenia and 39 healthy controls was recorded. The patients with schizophrenia were divided into subgroups based on the level of their negative or positive symptoms assessed using the Positive and Negative Syndrome Scale. Microstate parameters (contribution, occurrence, and duration) of four prototypical microstate classes (A-D) were investigated. Compared with healthy controls, individuals with schizophrenia showed increased duration and contribution of microstate class C, decreased contribution and occurrence of microstate class B. Different microstate patterns were found between subgroups and healthy controls. Results in this study support the consistent observation of abnormal EEG microstates patterns in patients with schizophrenia and highlight the necessity to divide subjects into subgroups according to their clinical symptoms.
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Affiliation(s)
- Qiaoling Sun
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiansong Zhou
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Huijuan Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ningzhi Gou
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ruoheng Lin
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ying Huang
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Weilong Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoping Wang
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
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15
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Pal A, Behari M, Goyal V, Sharma R. Study of EEG microstates in Parkinson's disease: a potential biomarker? Cogn Neurodyn 2020; 15:463-471. [PMID: 34040672 DOI: 10.1007/s11571-020-09643-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/23/2020] [Accepted: 10/06/2020] [Indexed: 11/30/2022] Open
Abstract
The spontaneous activity of the brain is dynamic even at rest and the deviation from this normal pattern of dynamics can lead to different pathological states. EEG microstate analysis of resting-state neuronal activity in Parkinson's disease (PD) could provide insight into altered brain dynamics of patients exhibiting dementia. Resting-state EEG microstate maps were derived from 128 channel EEG data in 20 PD without dementia (PDND), 18 PD with dementia (PDD) and 20 Healthy controls (CON) using Cartool and sLORETA softwares. Microstate map parameters including global explained variance, mean duration, frequency of occurrence (TF) and time coverage were compared statistically among the groups. Eight maps that explained 72% of the topographic variance were identified and only three maps differed significantly across the groups. TF of Map1 was lower in both PDND and PDD (p < 0.001) and that of Map3 (p = 0.02) in PDND compared to control. Cortical sources showed higher activation in precuneus, cuneus and superior parietal lobe (Threshold: Log-F = 1.74, p < 0.05) with maximum activity in the precuneus region (MNI co-ordinates: - 25, - 75, - 40; Log-F = 1.9) in PDND compared to control only for Map1. Lower TF of Map1 (prototypical microstate D) may potentially serve as a biomarker for PD with or without dementia whereas higher activation of precuneus, cuneus and superior parietal lobe at resting-state could favour signal processing, lack of which could be associated with dementia in Parkinson's disorder.
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Affiliation(s)
- Anita Pal
- Stress and Cognitive Electroimaging Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Madhuri Behari
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Ratna Sharma
- Stress and Cognitive Electroimaging Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, 110029 India
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16
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Soni S, Muthukrishnan SP, Sood M, Kaur S, Sharma R. Altered parahippocampal gyrus activation and its connectivity with resting-state network areas in schizophrenia: An EEG study. Schizophr Res 2020; 222:411-422. [PMID: 32534839 DOI: 10.1016/j.schres.2020.03.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 02/21/2020] [Accepted: 03/29/2020] [Indexed: 02/02/2023]
Abstract
Synchronized and coherent activity in resting-networks during normal brain functioning could be altered in disconnection syndrome like schizophrenia. Study of neural oscillations as assessed by EEG appears to be a promising proposition to understand the pathophysiology of schizophrenia in patients and their first-degree relatives, where disturbances in neural oscillations point towards genetic predisposition. Therefore, present study aims at establishing EEG based biomarkers for early detection and management strategies. Thirty-two patients with schizophrenia, 28 first-degree relatives and 31 healthy controls (HC) participated in the study. Resting brain activity was recorded using 128-channel electroencephalography. After pre-processing and independent component analysis (ICA), an equivalent current dipole was estimated for each IC. Total of 1551 independent and localizable EEG components across all groups were used in subsequent analysis. Power spectral density and source coherence between IC clusters were computed. Patients and first-degree relatives displayed significantly higher power spectral density (PSD) than HC for all frequency bands in left parahippocampal gyrus (PHG) (-7, -26, 8; BA 27). Another region within left deep PHG (-4, -28, 1), however, distinguished patients from first-degree relatives and HC in terms of significantly lower PSD in higher frequency bands. Functional connectivity (FC) was found to be lower in patients and higher in relatives compared to HC between different resting-state network areas. In patients, connectivity was lower compared to first-degree relatives. Altered activity within left PHG and FC of primarily this with other areas in resting-state network can serve as state and trait markers of schizophrenia.
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Affiliation(s)
- Sunaina Soni
- Stress and Cognitive Electroimaging Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Suriya Prakash Muthukrishnan
- Stress and Cognitive Electroimaging Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Simran Kaur
- Stress and Cognitive Electroimaging Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ratna Sharma
- Stress and Cognitive Electroimaging Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.
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17
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Mackintosh AJ, Borgwardt S, Studerus E, Riecher-Rössler A, de Bock R, Andreou C. EEG Microstate Differences in Medicated vs. Medication-Naïve First-Episode Psychosis Patients. Front Psychiatry 2020; 11:600606. [PMID: 33329154 PMCID: PMC7732503 DOI: 10.3389/fpsyt.2020.600606] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/30/2020] [Indexed: 12/21/2022] Open
Abstract
There has been considerable interest in the role of synchronous brain activity abnormalities in the pathophysiology of psychotic disorders and their relevance for treatment; one index of such activity are EEG resting-state microstates. These reflect electric field configurations of the brain that persist over 60-120 ms time periods. A set of quasi-stable microstates classes A, B, C, and D have been repeatedly identified across healthy participants. Changes in microstate parameters coverage, duration and occurrence have been found in medication-naïve as well as medicated patients with psychotic disorders compared to healthy controls. However, to date, only two studies have directly compared antipsychotic medication effects on EEG microstates either pre- vs. post-treatment or between medicated and unmedicated chronic schizophrenia patients. The aim of this study was therefore to directly compare EEG resting-state microstates between medicated and medication-naïve (untreated) first-episode (FEP) psychosis patients (mFEP vs. uFEP). We used 19-channel clinical EEG recordings to compare temporal parameters of four prototypical microstate classes (A-D) within an overall sample of 47 patients (mFEP n = 17; uFEP n = 30). The results demonstrated significant decreases of microstate class A and significant increases of microstate class B in mFEP compared to uFEP. No significant differences between groups were found for microstate classes C and D. Further studies are needed to replicate these results in longitudinal designs that assess antipsychotic medication effects on neural networks at the onset of the disorder and over time during illness progression. As treatment response and compliance in FEP patients are relatively low, such studies could contribute to better understand treatment outcomes and ultimately improve treatment strategies.
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Affiliation(s)
- Amatya J Mackintosh
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Erich Studerus
- Division of Personality and Developmental Psychology, Department of Psychology, University of Basel, Basel, Switzerland
| | | | - Renate de Bock
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.,University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland
| | - Christina Andreou
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
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