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Sheehan N, Bannai D, Silverstein SM, Lizano P. Neuroretinal Alterations in Schizophrenia and Bipolar Disorder: An Updated Meta-analysis. Schizophr Bull 2024:sbae102. [PMID: 38954839 DOI: 10.1093/schbul/sbae102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Schizophrenia (SZ) and bipolar disorder (BD) are characterized by major symptomatic, cognitive, and neuroanatomical changes. Recent studies have used optical coherence tomography (OCT) to investigate retinal changes in SZ and BD, but their unique and shared changes require further evaluation. Articles were identified using PubMed and Google Scholar. 39 studies met the inclusion criteria. Diagnostic groups were proband (SZ/BD combined), SZ, BD, and healthy control (HC) eyes. Meta-analyses utilized fixed and random effects models when appropriate, and publication bias was corrected using trim-and-fill analysis ("meta" package in R). Results are reported as standardized mean differences with 95% CIs. Data from 3145 patient eyes (1956 SZ, 1189 BD) and 3135 HC eyes were included. Studies identified thinning of the peripapillary retinal nerve fiber layer (pRNFL, overall and in 2 subregions), m-Retina (overall and all subregions), mGCL-IPL, mIPL, and mRPE in SZ patients. BD showed thinning of the pRNFL (overall and in each subregion), pGCC, and macular Retina (in 5 subregions), but no changes in thickness or volume for the total retina. Neither SZ nor BD patients demonstrated significant changes in the fovea, mRNFL, mGCL, mGCC, mINL, mOPL, mONL, or choroid thicknesses. Moderating effects of age, illness duration, and smoking on retinal structures were identified. This meta-analysis builds upon previous literature in this field by incorporating recent OCT studies and examining both peripapillary and macular retinal regions with respect to psychotic disorders. Overall, this meta-analysis demonstrated both peripapillary and macular structural retinal abnormalities in people with SZ or BD compared with HCs.
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Affiliation(s)
- Nora Sheehan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Translational Neuroscience, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Deepthi Bannai
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Translational Neuroscience, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
| | - Paulo Lizano
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Translational Neuroscience, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Boudriot E, Gabriel V, Popovic D, Pingen P, Yakimov V, Papiol S, Roell L, Hasanaj G, Xu S, Moussiopoulou J, Priglinger S, Kern C, Schulte EC, Hasan A, Pogarell O, Falkai P, Schmitt A, Schworm B, Wagner E, Keeser D, Raabe FJ. Signature of Altered Retinal Microstructures and Electrophysiology in Schizophrenia Spectrum Disorders Is Associated With Disease Severity and Polygenic Risk. Biol Psychiatry 2024:S0006-3223(24)01262-9. [PMID: 38679358 DOI: 10.1016/j.biopsych.2024.04.014] [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: 08/03/2023] [Revised: 03/30/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Optical coherence tomography and electroretinography studies have revealed structural and functional retinal alterations in individuals with schizophrenia spectrum disorders (SSDs). However, it remains unclear which specific retinal layers are affected; how the retina, brain, and clinical symptomatology are connected; and how alterations of the visual system are related to genetic disease risk. METHODS Optical coherence tomography, electroretinography, and brain magnetic resonance imaging were applied to comprehensively investigate the visual system in a cohort of 103 patients with SSDs and 130 healthy control individuals. The sparse partial least squares algorithm was used to identify multivariate associations between clinical disease phenotype and biological alterations of the visual system. The association of the revealed patterns with individual polygenic disease risk for schizophrenia was explored in a post hoc analysis. In addition, covariate-adjusted case-control comparisons were performed for each individual optical coherence tomography and electroretinography parameter. RESULTS The sparse partial least squares analysis yielded a phenotype-eye-brain signature of SSDs in which greater disease severity, longer duration of illness, and impaired cognition were associated with electrophysiological alterations and microstructural thinning of most retinal layers. Higher individual loading onto this disease-relevant signature of the visual system was significantly associated with elevated polygenic risk for schizophrenia. In case-control comparisons, patients with SSDs had lower macular thickness, thinner retinal nerve fiber and inner plexiform layers, less negative a-wave amplitude, and lower b-wave amplitude. CONCLUSIONS This study demonstrates multimodal microstructural and electrophysiological retinal alterations in individuals with SSDs that are associated with disease severity and individual polygenic burden.
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Affiliation(s)
- Emanuel Boudriot
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany
| | - Vanessa Gabriel
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - David Popovic
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany
| | - Pauline Pingen
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Vladislav Yakimov
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Munich, Germany
| | - Sergi Papiol
- Max Planck Institute of Psychiatry, Munich, Germany; Institute of Psychiatric Phenomics and Genomics, LMU Munich, Munich, Germany
| | - Lukas Roell
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; NeuroImaging Core Unit Munich, LMU University Hospital, LMU Munich, Munich, Germany
| | - Genc Hasanaj
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Evidence-Based Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Simiao Xu
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Joanna Moussiopoulou
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christoph Kern
- Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Eva C Schulte
- Institute of Psychiatric Phenomics and Genomics, LMU Munich, Munich, Germany; Institute of Human Genetics, University Hospital, Faculty of Medicine, University of Bonn, Bonn, Germany; Department of Psychiatry and Psychotherapy, University Hospital, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany; German Center for Mental Health, partner site Munich-Augsburg, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany; German Center for Mental Health, partner site Munich-Augsburg, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany; German Center for Mental Health, partner site Munich-Augsburg, Germany; Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Benedikt Schworm
- Department of Ophthalmology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Elias Wagner
- Evidence-Based Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Augsburg, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; NeuroImaging Core Unit Munich, LMU University Hospital, LMU Munich, Munich, Germany; Munich Center for Neurosciences, LMU Munich, Planegg-Martinsried, Germany
| | - Florian J Raabe
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany.
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Komatsu H, Onoguchi G, Silverstein SM, Jerotic S, Sakuma A, Kanahara N, Kakuto Y, Ono T, Yabana T, Nakazawa T, Tomita H. Retina as a potential biomarker in schizophrenia spectrum disorders: a systematic review and meta-analysis of optical coherence tomography and electroretinography. Mol Psychiatry 2024; 29:464-482. [PMID: 38081943 PMCID: PMC11116118 DOI: 10.1038/s41380-023-02340-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Abnormal findings on optical coherence tomography (OCT) and electroretinography (ERG) have been reported in participants with schizophrenia spectrum disorders (SSDs). This study aims to reveal the pooled standard mean difference (SMD) in retinal parameters on OCT and ERG among participants with SSDs and healthy controls and their association with demographic characteristics, clinical symptoms, smoking, diabetes mellitus, and hypertension. METHODS Using PubMed, Scopus, Web of Science, and PSYNDEX, we searched the literature from inception to March 31, 2023, using specific search terms. This study was registered with PROSPERO (CRD4202235795) and conducted according to PRISMA 2020. RESULTS We included 65 studies in the systematic review and 44 in the meta-analysis. Participants with SSDs showed thinning of the peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell layer- inner plexiform cell layer, and retinal thickness in all other segments of the macula. A meta-analysis of studies that excluded SSD participants with diabetes and hypertension showed no change in results, except for pRNFL inferior and nasal thickness. Furthermore, a significant difference was found in the pooled SMD of pRNFL temporal thickness between the left and right eyes. Meta-regression analysis revealed an association between retinal thinning and duration of illness, positive and negative symptoms. In OCT angiography, no differences were found in the foveal avascular zone and superficial layer foveal vessel density between SSD participants and controls. In flash ERG, the meta-analysis showed reduced amplitude of both a- and b-waves under photopic and scotopic conditions in SSD participants. Furthermore, the latency of photopic a-wave was significantly shorter in SSD participants in comparison with HCs. DISCUSSION Considering the prior report of retinal thinning in unaffected first-degree relatives and the results of the meta-analysis, the findings suggest that retinal changes in SSDs have both trait and state aspects. Future longitudinal multimodal retinal imaging studies are needed to clarify the pathophysiological mechanisms of these changes and to clarify their utility in individual patient monitoring efforts.
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Affiliation(s)
- Hiroshi Komatsu
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan.
- Miyagi Psychiatric Center, Natori, Japan.
| | - Goh Onoguchi
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Stefan Jerotic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Atsushi Sakuma
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuhisa Kanahara
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Yoshihisa Kakuto
- Miyagi Psychiatric Center, Natori, Japan
- Department of Community Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Takeshi Yabana
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Tomita
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
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Hall PA, Burhan AM, MacKillop JC, Duarte D. Next-generation cognitive assessment: Combining functional brain imaging, system perturbations and novel equipment interfaces. Brain Res Bull 2023; 204:110797. [PMID: 37875208 DOI: 10.1016/j.brainresbull.2023.110797] [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: 08/09/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023]
Abstract
Conventional cognitive assessment is widely used in clinical and research settings, in educational institutions, and in the corporate world for personnel selection. Such approaches involve having a client, a patient, or a research participant complete a series of standardized cognitive tasks in order to challenge specific and global cognitive abilities, and then quantify performance for the desired end purpose. The latter may include a diagnostic confirmation of a disease, description of a state or ability, or matching cognitive characteristics to a particular occupational role requirement. Metrics derived from cognitive assessments are putatively informative about important features of the brain and its function. For this reason, the research sector also makes use of cognitive assessments, most frequently as a stimulus for cognitive activity from which to extract functional neuroimaging data. Such "task-related activations" form the core of the most widely used neuroimaging technologies, such as fMRI. Much of what we know about the brain has been drawn from the interleaving of cognitive assessments of various types with functional brain imaging technologies. Despite innovation in neuroimaging (i.e., quantifying the neural response), relatively little innovation has occurred on task presentation and volitional response measurement; yet these together comprise the core of cognitive performance. Moreover, even when cognitive assessment is interleaved with functional neuroimaging, this is most often undertaken in the research domain, rather than the primary applications of cognitive assessment in diagnosis and monitoring, education and personnel selection. There are new ways in which brain imaging-and even more importantly, brain modulation-technologies can be combined with automation and artificial intelligence to deliver next-generation cognitive assessment methods. In this review paper, we describe some prototypes for how this can be done and identify important areas for progress (technological and otherwise) to enable it to happen. We will argue that the future of cognitive assessment will include semi- and fully-automated assessments involving neuroimaging, standardized perturbations via neuromodulation technologies, and artificial intelligence. Furthermore, the fact that cognitive assessments take place in a social/interpersonal context-normally between the patient and clinician-makes the human-machine interface consequential, and this will also be discussed.
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Affiliation(s)
- Peter A Hall
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada; Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, Ontario, Canada.
| | - Amer M Burhan
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James C MacKillop
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Dante Duarte
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Seniors Mental Health Program, St. Joseph's Healthcare, Hamilton, Ontario, Canada
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Blose BA, Lai A, Crosta C, Thompson JL, Silverstein SM. Retinal Neurodegeneration as a Potential Biomarker of Accelerated Aging in Schizophrenia Spectrum Disorders. Schizophr Bull 2023; 49:1316-1324. [PMID: 37459382 PMCID: PMC10483469 DOI: 10.1093/schbul/sbad102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND AND HYPOTHESES Several biological markers are believed to reflect accelerated aging in schizophrenia spectrum disorders; however, retinal neural changes have not yet been explored as potential CNS biomarkers of accelerated aging in this population. The aim of this study was to determine whether retinal neural layer thinning is more strongly related to age in schizophrenia and schizoaffective disorder patients (SZ) than in a psychiatrically healthy control group (CON). STUDY DESIGN Schizophrenia (n = 60) and CON participants (n = 69) underwent spectral domain optical coherence tomography (OCT) scans to examine the following variables in both eyes: retinal nerve fiber layer (RNFL) thickness, macula central subfield (CSF) thickness, macula volume, ganglion cell layer-inner plexiform layer (GCL-IPL) thickness, optic cup volume, and cup-to-disc ratio. Eleven participants in each group had diabetes or hypertension. STUDY RESULTS Significant negative relationships between age and RNFL thickness, macula volume, and GCL-IPL thickness were observed in the SZ group, while no significant relationships were observed in the CON group. However, many of the findings in the SZ group lost significance when participants with diabetes/hypertension were removed from analyses. A notable exception to this was that the age × SZ interaction accounted for a unique proportion of variance in GCL-IPL thinning over and above the effect of diabetes/hypertension. CONCLUSIONS The results suggest that retinal atrophy occurs at an increased rate in schizophrenia spectrum disorders, potentially reflecting accelerated aging inherent to these conditions, with considerable contributions from systemic medical diseases closely linked to this population.
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Affiliation(s)
- Brittany A Blose
- Department of Psychology, University of Rochester, Rochester, NY, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Adriann Lai
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- University Behavioral Health Care, Rutgers University, Piscataway, NJ, USA
| | - Christen Crosta
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, USA
| | - Judy L Thompson
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, NJ, USA
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- University Behavioral Health Care, Rutgers University, Piscataway, NJ, USA
- Department of Psychiatry, Rutgers University, Piscataway, NJ, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
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Constable PA, Lim JKH, Thompson DA. Retinal electrophysiology in central nervous system disorders. A review of human and mouse studies. Front Neurosci 2023; 17:1215097. [PMID: 37600004 PMCID: PMC10433210 DOI: 10.3389/fnins.2023.1215097] [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: 05/01/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
The retina and brain share similar neurochemistry and neurodevelopmental origins, with the retina, often viewed as a "window to the brain." With retinal measures of structure and function becoming easier to obtain in clinical populations there is a growing interest in using retinal findings as potential biomarkers for disorders affecting the central nervous system. Functional retinal biomarkers, such as the electroretinogram, show promise in neurological disorders, despite having limitations imposed by the existence of overlapping genetic markers, clinical traits or the effects of medications that may reduce their specificity in some conditions. This narrative review summarizes the principal functional retinal findings in central nervous system disorders and related mouse models and provides a background to the main excitatory and inhibitory retinal neurotransmitters that have been implicated to explain the visual electrophysiological findings. These changes in retinal neurochemistry may contribute to our understanding of these conditions based on the findings of retinal electrophysiological tests such as the flash, pattern, multifocal electroretinograms, and electro-oculogram. It is likely that future applications of signal analysis and machine learning algorithms will offer new insights into the pathophysiology, classification, and progression of these clinical disorders including autism, attention deficit/hyperactivity disorder, bipolar disorder, schizophrenia, depression, Parkinson's, and Alzheimer's disease. New clinical applications of visual electrophysiology to this field may lead to earlier, more accurate diagnoses and better targeted therapeutic interventions benefiting individual patients and clinicians managing these individuals and their families.
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Affiliation(s)
- Paul A. Constable
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Jeremiah K. H. Lim
- Discipline of Optometry, School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Dorothy A. Thompson
- The Tony Kriss Visual Electrophysiology Unit, Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Tursini K, Remy I, Le Cam S, Louis-Dorr V, Malka-Mahieu H, Schwan R, Gross G, Laprévote V, Schwitzer T. Subsequent and simultaneous electrophysiological investigation of the retina and the visual cortex in neurodegenerative and psychiatric diseases: what are the forecasts for the medicine of tomorrow? Front Psychiatry 2023; 14:1167654. [PMID: 37333926 PMCID: PMC10272854 DOI: 10.3389/fpsyt.2023.1167654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
Visual electrophysiological deficits have been reported in neurodegenerative disorders as well as in mental disorders. Such alterations have been mentioned in both the retina and the cortex, notably affecting the photoreceptors, retinal ganglion cells (RGCs) and the primary visual cortex. Interestingly, such impairments emphasize the functional role of the visual system. For this purpose, the present study reviews the existing literature with the aim of identifying key alterations in electroretinograms (ERGs) and visual evoked potentials electroencephalograms (VEP-EEGs) of subjects with neurodegenerative and psychiatric disorders. We focused on psychiatric and neurodegenerative diseases due to similarities in their neuropathophysiological mechanisms. Our research focuses on decoupled and coupled ERG/VEP-EEG results obtained with black-and-white checkerboards or low-level visual stimuli. A decoupled approach means recording first the ERG, then the VEP-EEG in the same subject with the same visual stimuli. The second method means recording both ERG and VEP-EEG simultaneously in the same participant with the same visual stimuli. Both coupled and decoupled results were found, indicating deficits mainly in the N95 ERG wave and the P100 VEP-EEG wave in Parkinson’s, Alzheimer’s, and major depressive disorder. Such results reinforce the link between the retina and the visual cortex for the diagnosis of psychiatric and neurodegenerative diseases. With that in mind, medical devices using coupled ERG/VEP-EEG measurements are being developed in order to further investigate the relationship between the retina and the visual cortex. These new techniques outline future challenges in mental health and the use of machine learning for the diagnosis of mental disorders, which would be a crucial step toward precision psychiatry.
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Affiliation(s)
- Katelyne Tursini
- Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes et d’Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
- BioSerenity, Paris, France
- INSERM U1254, Université de Lorraine, IADI, Nancy, France
| | - Irving Remy
- Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes et d’Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
- BioSerenity, Paris, France
- INSERM U1114, Université de Strasbourg, Strasbourg, France
| | - Steven Le Cam
- CRAN, CNRS UMR 7039, Université de Lorraine, Nancy, France
| | | | | | - Raymund Schwan
- Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes et d’Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
- INSERM U1254, Université de Lorraine, IADI, Nancy, France
- Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Grégory Gross
- Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes et d’Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
- INSERM U1254, Université de Lorraine, IADI, Nancy, France
| | - Vincent Laprévote
- Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes et d’Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
- INSERM U1114, Université de Strasbourg, Strasbourg, France
- Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Thomas Schwitzer
- Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes et d’Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
- INSERM U1254, Université de Lorraine, IADI, Nancy, France
- Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France
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8
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Haigh SM, Berryhill ME, Kilgore-Gomez A, Dodd M. Working memory and sensory memory in subclinical high schizotypy: An avenue for understanding schizophrenia? Eur J Neurosci 2023; 57:1577-1596. [PMID: 36895099 PMCID: PMC10178355 DOI: 10.1111/ejn.15961] [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: 07/05/2022] [Accepted: 03/07/2023] [Indexed: 03/11/2023]
Abstract
The search for robust, reliable biomarkers of schizophrenia remains a high priority in psychiatry. Biomarkers are valuable because they can reveal the underlying mechanisms of symptoms and monitor treatment progress and may predict future risk of developing schizophrenia. Despite the existence of various promising biomarkers that relate to symptoms across the schizophrenia spectrum, and despite published recommendations encouraging multivariate metrics, they are rarely investigated simultaneously within the same individuals. In those with schizophrenia, the magnitude of purported biomarkers is complicated by comorbid diagnoses, medications and other treatments. Here, we argue three points. First, we reiterate the importance of assessing multiple biomarkers simultaneously. Second, we argue that investigating biomarkers in those with schizophrenia-related traits (schizotypy) in the general population can accelerate progress in understanding the mechanisms of schizophrenia. We focus on biomarkers of sensory and working memory in schizophrenia and their smaller effects in individuals with nonclinical schizotypy. Third, we note irregularities across research domains leading to the current situation in which there is a preponderance of data on auditory sensory memory and visual working memory, but markedly less in visual (iconic) memory and auditory working memory, particularly when focusing on schizotypy where data are either scarce or inconsistent. Together, this review highlights opportunities for researchers without access to clinical populations to address gaps in knowledge. We conclude by highlighting the theory that early sensory memory deficits contribute negatively to working memory and vice versa. This presents a mechanistic perspective where biomarkers may interact with one another and impact schizophrenia-related symptoms.
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Affiliation(s)
- Sarah M. Haigh
- Department of Psychology, Center for Integrative Neuroscience, Programs in Cognitive and Brain Sciences, and Neuroscience, University of Nevada, Reno, Nevada, USA
| | - Marian E. Berryhill
- Department of Psychology, Center for Integrative Neuroscience, Programs in Cognitive and Brain Sciences, and Neuroscience, University of Nevada, Reno, Nevada, USA
| | - Alexandrea Kilgore-Gomez
- Department of Psychology, Center for Integrative Neuroscience, Programs in Cognitive and Brain Sciences, and Neuroscience, University of Nevada, Reno, Nevada, USA
| | - Michael Dodd
- Department of Psychology, University of Nebraska, Lincoln, Nebraska, USA
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Urenda JP, Del Dosso A, Birtele M, Quadrato G. Present and Future Modeling of Human Psychiatric Connectopathies With Brain Organoids. Biol Psychiatry 2023; 93:606-615. [PMID: 36759258 DOI: 10.1016/j.biopsych.2022.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/21/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
Brain organoids derived from human pluripotent stem cells are emerging as a powerful tool to model cellular aspects of neuropsychiatric disorders, including alterations in cell proliferation, differentiation, migration, and lineage trajectory. To date, most contributions in the field have focused on modeling cellular impairment of the cerebral cortex, with few studies probing dysfunction in local network connectivity. However, it is increasingly more apparent that these psychiatric disorders are connectopathies involving multiple brain structures and the connections between them. Therefore, the lack of reproducible anatomical features in these 3-dimensional cultures represents a major bottleneck for effectively modeling brain connectivity at the micro(cellular) level and at the macroscale level between brain regions. In this perspective, we review the use of current organoid protocols to model neuropsychiatric disorders with a specific emphasis on the potential and limitations of the current strategies to model impairments in functional connectivity. Finally, we discuss the importance of adopting interdisciplinary strategies to establish next-generation, multiregional organoids that can model, with higher fidelity, the dysfunction in the development and functionality of long-range connections within the brain of patients affected by psychiatric disorders.
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Affiliation(s)
- Jean-Paul Urenda
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ashley Del Dosso
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Marcella Birtele
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Giorgia Quadrato
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
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10
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Choroidal structural analysis in ultra-high risk and first-episode psychosis. Eur Neuropsychopharmacol 2023; 70:72-80. [PMID: 36931136 DOI: 10.1016/j.euroneuro.2023.02.016] [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: 01/03/2023] [Revised: 02/02/2023] [Accepted: 02/22/2023] [Indexed: 03/19/2023]
Abstract
Both structural and functional alterations in the retina and the choroid of the eye, as parts of the central nervous system, have been shown in psychotic disorders, especially in schizophrenia. In addition, genetic and imaging studies indicate vascular and angiogenesis anomalies in the psychosis spectrum disorders. In this ocular imaging study, choroidal structure and vascularity were investigated using enhanced depth imaging (EDI) optical coherence tomography (OCT) in first-episode psychosis (FEP), ultra-high risk for psychosis (UHR-P), and age- and gender- matched healthy controls (HCs). There were no significant differences between groups in central choroidal thickness, stromal choroidal area (SCA), luminal choroidal area (LCA) and total subfoveal choroidal area. The LCA/SCA ratio (p<0.001) and the choroidal vascularity index (CVI) (p<0.001) were significantly different between FEP, UHR-P and HCs. CVI and LCA/SCA ratio were significantly higher in patients with FEP compared to help-seeking youth at UHR-P. CVI and LCA/SCA ratio were not different between UHR-P and HCs. However, CVI was higher in UHR-P compared to HCs after excluding the outliers for the sensitivity analysis (p = 0.002). Current findings suggest that choroidal thickness is normal, but there are abnormalities in choroidal microvasculature in prodromal and first-episode psychosis. Further longitudinal studies are needed to investigate oculomics, especially CVI, as a promising biomarker for the prediction of conversion to psychosis in individuals at clinical high-risk.
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11
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Shoham N, Lewis G, Hayes JF, Silverstein SM, Cooper C. Association between visual impairment and psychosis: A longitudinal study and nested case-control study of adults. Schizophr Res 2023; 254:81-89. [PMID: 36805651 DOI: 10.1016/j.schres.2023.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/08/2023] [Accepted: 02/09/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Theories propose that visual impairment might increase the risk of psychosis, and vice versa. We aimed to investigate the relationship between visual impairment and psychosis in the UK Biobank cohort. STUDY DESIGN In a nested case control study of ~116,000 adults, we tested whether a Schizophrenia Spectrum Disorder (SSD) diagnosis as exposure was associated with visual impairment. We also tested longitudinally whether poorer visual acuity, and thinner retinal structures on Optical Coherence Tomography (OCT) scans in 2009 were associated with psychotic experiences in 2016. We adjusted for age, sex, depression and anxiety symptoms; and socioeconomic variables and vascular risk factors where appropriate. We compared complete case with multiple imputation models, designed to reduce bias potentially introduced by missing data. RESULTS People with visual impairment had greater odds of SSD than controls in multiply imputed data (Adjusted Odds Ratio [AOR] 1.42, 95 % Confidence Interval [CI] 1.05-1.93, p = 0.021). We also found evidence that poorer visual acuity was associated with psychotic experiences during follow-up (AOR per 0.1 point worse visual acuity score 1.06, 95 % CI 1.01-1.11, p = 0.020; and 1.04, 95 % CI 1.00-1.08, p = 0.037 in right and left eye respectively). In complete case data (15 % of this cohort) we found no clear association, although confidence intervals included the multiple imputation effect estimates. OCT measures were not associated with psychotic experiences. CONCLUSIONS Our findings highlight the importance of eye care for people with psychotic illnesses. We could not conclude whether visual impairment is a likely causal risk factor for psychosis.
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Affiliation(s)
- Natalie Shoham
- University College London Division of Psychiatry, 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, UK.
| | - Gemma Lewis
- University College London Division of Psychiatry, 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | - Joseph F Hayes
- University College London Division of Psychiatry, 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, UK
| | - Steven M Silverstein
- University of Rochester Medical Center, Department of Psychiatry, 300 Crittenden Boulevard, Rochester, NY 14642, USA; Center for Visual Science, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Claudia Cooper
- University College London Division of Psychiatry, 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University London, London E1 2AD, UK; East London NHS Foundation Trust, UK
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12
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Zhao B, Li Y, Fan Z, Wu Z, Shu J, Yang X, Yang Y, Wang X, Li B, Wang X, Copana C, Yang Y, Lin J, Li Y, Stein JL, O'Brien JM, Li T, Zhu H. Eye-brain connections revealed by multimodal retinal and brain imaging genetics in the UK Biobank. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.16.23286035. [PMID: 36824893 PMCID: PMC9949187 DOI: 10.1101/2023.02.16.23286035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
As an anatomical extension of the brain, the retina of the eye is synaptically connected to the visual cortex, establishing physiological connections between the eye and the brain. Despite the unique opportunity retinal structures offer for assessing brain disorders, less is known about their relationship to brain structure and function. Here we present a systematic cross-organ genetic architecture analysis of eye-brain connections using retina and brain imaging endophenotypes. Novel phenotypic and genetic links were identified between retinal imaging biomarkers and brain structure and function measures derived from multimodal magnetic resonance imaging (MRI), many of which were involved in the visual pathways, including the primary visual cortex. In 65 genomic regions, retinal imaging biomarkers shared genetic influences with brain diseases and complex traits, 18 showing more genetic overlaps with brain MRI traits. Mendelian randomization suggests that retinal structures have bidirectional genetic causal links with neurological and neuropsychiatric disorders, such as Alzheimer's disease. Overall, cross-organ imaging genetics reveals a genetic basis for eye-brain connections, suggesting that the retinal images can elucidate genetic risk factors for brain disorders and disease-related changes in intracranial structure and function.
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Affiliation(s)
- Bingxin Zhao
- Department of Statistics and Data Science, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Statistics, Purdue University, West Lafayette, IN 47907, USA
| | - Yujue Li
- Department of Statistics, Purdue University, West Lafayette, IN 47907, USA
| | - Zirui Fan
- Department of Statistics and Data Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Zhenyi Wu
- Department of Statistics, Purdue University, West Lafayette, IN 47907, USA
| | - Juan Shu
- Department of Statistics, Purdue University, West Lafayette, IN 47907, USA
| | - Xiaochen Yang
- Department of Statistics, Purdue University, West Lafayette, IN 47907, USA
| | - Yilin Yang
- Department of Computer and Information Science and Electrical and Systems Engineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Xifeng Wang
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Bingxuan Li
- Department of Computer Science, Purdue University, West Lafayette, IN 47907, USA
| | - Xiyao Wang
- Department of Computer Science, Purdue University, West Lafayette, IN 47907, USA
| | - Carlos Copana
- Department of Statistics, Purdue University, West Lafayette, IN 47907, USA
| | - Yue Yang
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jinjie Lin
- Yale School of Management, Yale University, New Haven, CT 06511, USA
| | - Yun Li
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jason L. Stein
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- UNC Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joan M. O'Brien
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Penn Medicine Center for Ophthalmic Genetics in Complex Diseases, PA, 19104, USA
| | - Tengfei Li
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Biomedical Research Imaging Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Hongtu Zhu
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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13
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Shoham N, Dunca D, Cooper C, Hayes JF, McQuillin A, Bass N, Lewis G, Kuchenbaecker K. Investigating the association between schizophrenia and distance visual acuity: Mendelian randomisation study. BJPsych Open 2023; 9:e33. [PMID: 36746515 PMCID: PMC9970182 DOI: 10.1192/bjo.2023.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Increased rates of visual impairment are observed in people with schizophrenia. AIMS We assessed whether genetically predicted poor distance acuity is causally associated with schizophrenia, and whether genetically predicted schizophrenia is causally associated with poorer visual acuity. METHOD We used bidirectional, two-sample Mendelian randomisation to assess the effect of poor distance acuity on schizophrenia risk, poorer visual acuity on schizophrenia risk and schizophrenia on visual acuity, in European and East Asian ancestry samples ranging from approximately 14 000 to 500 000 participants. Genetic instrumental variables were obtained from the largest available summary statistics: for schizophrenia, from the Psychiatric Genomics Consortium; for visual acuity, from the UK Biobank; and for poor distance acuity, from a meta-analysis of case-control samples. We used the inverse variance-weighted method and sensitivity analyses to test validity of results. RESULTS We found little evidence that poor distance acuity was causally associated with schizophrenia (odds ratio 1.00, 95% CI 0.91-1.10). Genetically predicted schizophrenia was associated with poorer visual acuity (mean difference in logMAR score: 0.024, 95% CI 0.014-0.033) in European ancestry samples, with a similar but less precise effect that in smaller East Asian ancestry samples (mean difference: 0.186, 95% CI -0.008 to 0.379). CONCLUSIONS Genetic evidence supports schizophrenia being a causal risk factor for poorer visual acuity, but not the converse. This highlights the importance of visual care for people with psychosis and refutes previous hypotheses that visual impairment is a potential target for prevention of schizophrenia.
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Affiliation(s)
- Natalie Shoham
- Division of Psychiatry, University College London, UK; and Islington Early Intervention Service, Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
- Correspondence: Natalie Shoham.
| | - Diana Dunca
- UCL Genetics Institute, University College London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, UK; and Tower Hamlets Memory Service, East London NHS Foundation Trust, London, UK
| | - Joseph F. Hayes
- Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | | | - Nick Bass
- Division of Psychiatry, University College London, UK; and Tower Hamlets Memory Service, East London NHS Foundation Trust, London, UK
| | - Gemma Lewis
- Division of Psychiatry, University College London, UK
| | - Karoline Kuchenbaecker
- Division of Psychiatry, University College London, UK; and UCL Genetics Institute, University College London, UK
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14
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Pokorny VJ, Schallmo MP, Sponheim SR, Olman CA. Weakened untuned gain control is associated with schizophrenia while atypical orientation-tuned suppression depends on visual acuity. J Vis 2023; 23:2. [PMID: 36723929 PMCID: PMC9904333 DOI: 10.1167/jov.23.2.2] [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] [Indexed: 02/02/2023] Open
Abstract
Perceptual distortions are core features of psychosis. Weakened contrast surround suppression has been proposed as a neural mechanism underlying atypical perceptual experiences. Although previous work has measured suppression by asking participants to report the perceived contrast of a low-contrast target surrounded by a high-contrast surround, it is possible to modulate perceived contrast solely by manipulating the orientation of a matched-contrast center and surround. Removing the bottom-up segmentation cue of contrast difference and isolating orientation-dependent suppression may clarify the neural processes responsible for atypical surround suppression in psychosis. We examined surround suppression across a spectrum of psychotic psychopathology including people with schizophrenia (PSZ; N = 31) and people with bipolar disorder (PBD; N = 29), first-degree biological relatives of these patient groups (PBDrel, PSZrel; N = 28, N = 21, respectively), and healthy controls (N = 29). PSZ exhibited reduced surround suppression across orientations; although group differences were minimal at the condition that produced the strongest suppression. PBD and PSZrel exhibited intermediate suppression, whereas PBDrel performed most similarly to controls. Intriguingly, group differences in orientation-dependent surround suppression magnitude were moderated by visual acuity. A simulation in which visual acuity and/or focal attention interact with untuned gain control reproduces the observed pattern of results, including the lack of group differences when orientation of center and surround are the same. Our findings further elucidate perceptual mechanisms of impaired center-surround processing in psychosis and provide insights into the effects of visual acuity on orientation-dependent suppression in PSZ.
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Affiliation(s)
- Victor J Pokorny
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.,Department of Psychology, University of Minnesota, Minneapolis, MN, USA.,
| | - Michael-Paul Schallmo
- Department of Psychiatry and Behavioral Science, University of Minnesota, Minneapolis, MN, USA.,
| | - Scott R Sponheim
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.,Department of Psychiatry and Behavioral Science, University of Minnesota, Minneapolis, MN, USA.,Department of Psychology, University of Minnesota, Minneapolis, MN, USA.,
| | - Cheryl A Olman
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA.,
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15
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Giersch A, Laprévote V. Perceptual Functioning. Curr Top Behav Neurosci 2023; 63:79-113. [PMID: 36306053 DOI: 10.1007/7854_2022_393] [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] [Indexed: 06/16/2023]
Abstract
Perceptual disorders are not part of the diagnosis criteria for schizophrenia. Yet, a considerable amount of work has been conducted, especially on visual perception abnormalities, and there is little doubt that visual perception is altered in patients. There are several reasons why such perturbations are of interest in this pathology. They are observed during the prodromal phase of psychosis, they are related to the pathophysiology (clinical disorganization, disorders of the sense of self), and they are associated with neuronal connectivity disorders. Perturbations occur at different levels of processing and likely affect how patients interact and adapt to their surroundings. The literature has become very large, and here we try to summarize different models that have guided the exploration of perception in patients. We also illustrate several lines of research by showing how perception has been investigated and by discussing the interpretation of the results. In addition to discussing domains such as contrast sensitivity, masking, and visual grouping, we develop more recent fields like processing at the level of the retina, and the timing of perception.
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Affiliation(s)
- Anne Giersch
- University of Strasbourg, INSERM U1114, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France.
| | - Vincent Laprévote
- University of Strasbourg, INSERM U1114, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
- CLIP Centre de Liaison et d'Intervention Précoce, Centre Psychothérapique de Nancy, Laxou, France
- Faculté de Médecine, Université de Lorraine, Vandoeuvre-lès-Nancy, France
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16
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A comparative study of retinal layer changes among patients with schizophrenia and healthy controls. Acta Neuropsychiatr 2022; 35:165-176. [PMID: 36476516 DOI: 10.1017/neu.2022.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM This study aimed to evaluate the retinal nerve fibre layer changes among different group of patients with schizophrenia and compare it with healthy controls by using swept-source optical coherence tomography. METHODOLOGY Patients with first-episode schizophrenia (n = 21) in remission (n = 35) or with treatment-resistant schizophrenia (TRS) (n = 35) and 36 healthy controls were evaluated for retinal thickness. RESULTS Patients with psychotic illnesses had significantly lower sub-foveal choroidal thickness (effect size 0.84-0.86), when compared to the healthy controls. When patients with first-episode schizophrenia were compared with patients with TRS, TRS patients had significant lower sub-foveal choroidal thickness (left eye) when the various confounders (such as age, gender, duration of treatment, smoking, current medications, body mass index, waist circumference, blood pressure, fasting glucose, HbA1c, presence or absence of metabolic syndrome) were taken into account. When the patients with TRS were compared with healthy controls, initially significant differences were observed for the macular volume (left and right) and the ganglion cell thickness (right eye) but these differences disappeared after controlling for the various covariates. CONCLUSIONS Compared to healthy controls, patients with schizophrenia, psychotic illnesses have thinning of the retina, especially in the sub-foveal choroidal thickness.
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17
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Qian N, Lipkin RM, Kaszowska A, Silipo G, Dias EC, Butler PD, Javitt DC. Computational modeling of excitatory/inhibitory balance impairments in schizophrenia. Schizophr Res 2022; 249:47-55. [PMID: 32291128 PMCID: PMC8760932 DOI: 10.1016/j.schres.2020.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 12/14/2022]
Abstract
Deficits in glutamatergic function are well established in schizophrenia (SZ) as reflected in "input" dysfunction across sensory systems. By contrast, less is known about contributions of the GABAergic system to impairments in excitatory/inhibitory balance. We investigated this issue by measuring contrast thresholds for orientation detection, orientation discriminability, and orientation-tilt-aftereffect curves in schizophrenia subjects and matched controls. These measures depend on the amplitude and width of underlying orientation tuning curves, which, in turn, depend on excitatory and inhibitory interactions. By simulating a well-established V1 orientation selectivity model and its link to perception, we demonstrate that reduced cortical excitation and inhibition are both necessary to explain our psychophysical data. Reductions in GABAergic feedback may represent a compensatory response to impaired glutamatergic input in SZ, or a separate pathophysiological event. We also found evidence for the widely accepted, but rarely tested, inverse relationship between orientation discriminability and tuning width.
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Affiliation(s)
- Ning Qian
- Department of Neuroscience, Zuckerman Institute, Department of Physiology & Cellular Biophysics, Columbia University, New York, NY 10027, United States of America
| | - Richard M Lipkin
- Department of Neuroscience, Zuckerman Institute, Department of Physiology & Cellular Biophysics, Columbia University, New York, NY 10027, United States of America
| | - Aleksandra Kaszowska
- Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States of America; Department of Electronic Systems, Aalborg University, Denmark
| | - Gail Silipo
- Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States of America
| | - Elisa C Dias
- Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States of America
| | - Pamela D Butler
- Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States of America
| | - Daniel C Javitt
- Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States of America; Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, New York, NY 10032, United States of America.
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18
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Atagun MI, Sonugur G, Yusifova A, Celik I, Ugurlu N. Machine learning algorithms revealed distorted retinal vascular branching in individuals with bipolar disorder. J Affect Disord 2022; 315:35-41. [PMID: 35905794 DOI: 10.1016/j.jad.2022.07.060] [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: 03/15/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Converging evidence designate vascular vulnerability in bipolar disorder. The predisposition progresses into distortion in time, thus detection of the vascular susceptibility may help reducing morbidity and mortality. It was aimed to assess retinal fundus vasculature in cardiovascular risk-free patients with bipolar disorder. METHODS Total of 68 individuals (38 patients with bipolar disorder, 30 healthy controls) were enrolled. In order to avoid from degenerative processes, participants were between 18 and 45 years of age, vascular risk factors were eliminated. Microscopic retinal fundus images were processed with machine learning algorithms (multilayer perceptron and support vector machine) and artificial neural network approaches. RESULTS In comparison to the healthy control group, the bipolar disorder group had lower number of breaking points (P < 0.001), lower number of curved vessel segments (P < 0.001). Total length of smooth vessels was longer (P = 0.040), and total length of curved vessel segments was significantly shorter (P < 0.001) than the control group. Vascular endothelial growth factor levels and gender were the confounders. There were significant correlations between vascular measures and serum lipid levels. LIMITATIONS Sample size was small and patients were on various medications. CONCLUSIONS These results indicate distortion in retinal vascular branching in bipolar disorder. Disrupted branching may reflect disturbed prosperity of retinal vascular plexus in patients with bipolar disorder. Alterations in the retinal vessels might be indicators of disruption in cerebral vascular system efficiency and thus neurovascular unit dysfunction in bipolar disorder.
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Affiliation(s)
- Murat Ilhan Atagun
- Department of Psychiatry, Canakkale Onsekiz Mart University Faculty of Medicine, Canakkale, Turkey.
| | - Guray Sonugur
- Mechatronics Engineering, Faculty of Technology, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | | | - Ibrahim Celik
- Mechatronics Engineering, Faculty of Technology, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Nagihan Ugurlu
- Department of Ophtalmology, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
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19
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Fattal J, Brascamp JW, Slate RE, Lehet M, Achtyes ED, Thakkar KN. Blunted pupil light reflex is associated with negative symptoms and working memory in individuals with schizophrenia. Schizophr Res 2022; 248:254-262. [PMID: 36115190 PMCID: PMC9613610 DOI: 10.1016/j.schres.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 08/21/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
Two largely separate lines of research have documented altered pupillary dynamics in individuals diagnosed with schizophrenia. An older set of studies has demonstrated reductions in the pupillary light reflex (PLR) in individuals with schizophrenia; however, clinical and cognitive correlates of this blunted PLR have been relatively unexplored. More recently, a large body of work has demonstrated reductions in pupillary dilation in response to cognitive demands in individuals with schizophrenia, and the degree of this blunted pupil dilation has been related to more severe cognitive deficits and motivational negative symptoms. These clinically relevant alterations in the cognitive modulation of pupil size have been interpreted as reflecting insufficient information processing resources or inappropriate effort allocation. To begin to bridge these two lines of work, we investigated the PLR in 34 individuals with schizophrenia and 30 healthy controls and related the amplitude of the PLR to motivational negative symptoms and cognitive performance. Consistent with prior work, we found that the PLR was reduced in individuals with schizophrenia, and furthermore, that these measurements were highly reliable across individuals. Blunted constriction was associated with more severe motivational negative symptoms and poorer working memory among individuals with schizophrenia. These observed correlates provide a bridge between older literature documenting an altered PLR and more recent work reporting associations between negative symptoms, cognition, and blunted pupillary dilation in response to cognitive demands in individuals with schizophrenia. We provide possible mechanistic interpretations of our data and consider a parsimonious explanation for reduced cognitive- and light-related modulation of pupil size.
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Affiliation(s)
- Jessica Fattal
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America
| | - Jan W Brascamp
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America
| | - Rachael E Slate
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America
| | - Matthew Lehet
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America
| | - Eric D Achtyes
- Division of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, MI, United States of America; Cherry Health, Grand Rapids, MI, United States of America
| | - Katharine N Thakkar
- Department of Psychology, Michigan State University, East Lansing, MI, United States of America; Division of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, MI, United States of America.
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20
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Dahdouh O, Solh T, Lahoud C, Haddad C, Hallit S. Association between cognition and color discrimination among Lebanese patients with schizophrenia. BMC Psychiatry 2022; 22:606. [PMID: 36096757 PMCID: PMC9465930 DOI: 10.1186/s12888-022-04245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/06/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with schizophrenia (SCZ) exhibit poorer color discrimination than normal individuals. Although retinal abnormalities, as well as cortical and subcortical alterations, found in patients with SCZ have been suggested to cause this poor color discrimination, the impact of cognitive impairment remains to be determined. Dopamine (DA) and glutamate (Glu), known to be disrupted in SCZ, are also suggested to play a role in color discrimination. Our objective was to investigate the contribution of cognitive impairment to color discrimination deficits in SCZ and to examine if these deficits are correlated to SCZ symptoms. METHODS This study includes 127 patients with SCZ between July and September 2021. The participants completed several questionnaires, specifically the Positive and Negative Syndrome Scale (PANSS), the Montreal Cognitive Assessment (MoCA) test, and the Farnsworth D-15 test, to assess the extent of SCZ symptoms, cognition, and color discrimination respectively. RESULTS Higher cognition (Beta = - 0.279) was significantly associated with a lower total error score (TES). Moreover, a higher positive PANSS score (Beta = 0.217) was significantly associated with a higher TES. A multinomial regression analysis taking the type of color blindness as the dependent variable showed that female sex (ORa = 5.46) was significantly associated with a certain type of color blindness. CONCLUSION Color discrimination deficits in patients with SCZ may be due to the effect of cognitive impairment and/or SCZ itself.
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Affiliation(s)
- Oussama Dahdouh
- grid.512933.f0000 0004 0451 7867Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Tala Solh
- grid.411324.10000 0001 2324 3572Faculty of Sciences, Lebanese University, Fanar, Lebanon
| | - Corinne Lahoud
- grid.444434.70000 0001 2106 3658School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Chadia Haddad
- grid.512933.f0000 0004 0451 7867Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon ,INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon ,grid.444428.a0000 0004 0508 3124School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon
| | - Souheil Hallit
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon. .,School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon. .,Psychology Department, College of Humanities, Effat University, Jeddah, 21478, Saudi Arabia.
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21
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Komatsu H, Onoguchi G, Jerotic S, Kanahara N, Kakuto Y, Ono T, Funakoshi S, Yabana T, Nakazawa T, Tomita H. Retinal layers and associated clinical factors in schizophrenia spectrum disorders: a systematic review and meta-analysis. Mol Psychiatry 2022; 27:3592-3616. [PMID: 35501407 DOI: 10.1038/s41380-022-01591-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The retina shares structural and functional similarities with the brain. Furthermore, structural changes in the retina have been observed in patients with schizophrenia spectrum disorders (SSDs). This systematic review and meta-analysis investigated retinal abnormalities and their association with clinical factors for SSD. METHODS Studies related to retinal layers in SSD patients were retrieved from PubMed, Scopus, Web of Science, Cochrane Controlled Register of Trials, International Clinical Trials Registry Platform, and PSYNDEX databases from inception to March 31, 2021. We screened and assessed the eligibility of the identified studies. EZR ver.1.54 and the metafor package in R were used for the meta-analysis and a random-effects or fixed-effects model was used to report standardized mean differences (SMDs). RESULTS Twenty-three studies (2079 eyes of patients and 1571 eyes of controls) were included in the systematic review and meta-analysis. The average peripapillary retinal nerve fiber layer (pRNFL) thickness, average macular thickness (MT), and macular ganglion cell layer-inner plexiform layer (GCL-IPL) thickness were significantly lower in patients than in controls (n = 14, 6, and 3, respectively; SMD = -0.33, -0.49, and -0.43, respectively). Patients also had significantly reduced macular volume (MV) compared to controls (n = 7; SMD = -0.53). The optic cup volume (OCV) was significantly larger in patients than in controls (n = 3; SMD = 0.28). The meta-regression analysis indicated an association between several clinical factors, such as duration of illness and the effect size of the pRNFL, macular GCL-IPL, MT, and MV. CONCLUSION Thinning of the pRNFL, macular GCL-IPL, MT, and MV and enlargement of the OCV in SSD were observed. Retinal abnormalities may be applicable as state/trait markers in SSDs. The accumulated evidence was mainly cross-sectional and requires verification by longitudinal studies to characterize the relationship between OCT findings and clinical factors.
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Affiliation(s)
- Hiroshi Komatsu
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan. .,Department of Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan. .,Miyagi Psychiatric Center, Natori, Japan.
| | - Goh Onoguchi
- Department of Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Stefan Jerotic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nobuhisa Kanahara
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan.,Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Yoshihisa Kakuto
- Miyagi Psychiatric Center, Natori, Japan.,Department of Community Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | | | - Shunichi Funakoshi
- Miyagi Psychiatric Center, Natori, Japan.,Department of Community Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takeshi Yabana
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Collaborative Program for Ophthalmic Drug Discovery, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Tomita
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan.,Department of Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan.,Department of Disaster Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan.,Department of Disaster Psychiatry, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
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22
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Boudriot E, Schworm B, Slapakova L, Hanken K, Jäger I, Stephan M, Gabriel V, Ioannou G, Melcher J, Hasanaj G, Campana M, Moussiopoulou J, Löhrs L, Hasan A, Falkai P, Pogarell O, Priglinger S, Keeser D, Kern C, Wagner E, Raabe FJ. Optical coherence tomography reveals retinal thinning in schizophrenia spectrum disorders. Eur Arch Psychiatry Clin Neurosci 2022; 273:575-588. [PMID: 35930031 PMCID: PMC10085905 DOI: 10.1007/s00406-022-01455-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Schizophrenia spectrum disorders (SSDs) are presumed to be associated with retinal thinning. However, evidence is lacking as to whether these retinal alterations reflect a disease-specific process or are rather a consequence of comorbid diseases or concomitant microvascular impairment. METHODS The study included 126 eyes of 65 patients with SSDs and 143 eyes of 72 healthy controls. We examined macula and optic disc measures by optical coherence tomography (OCT) and OCT angiography (OCT-A). Additive mixed models were used to assess the impact of SSDs on retinal thickness and perfusion and to explore the association of retinal and clinical disease-related parameters by controlling for several ocular and systemic covariates (age, sex, spherical equivalent, intraocular pressure, body mass index, diabetes, hypertension, smoking status, and OCT signal strength). RESULTS OCT revealed significantly lower parafoveal macular, macular ganglion cell-inner plexiform layer (GCIPL), and macular retinal nerve fiber layer (RNFL) thickness and thinner mean and superior peripapillary RNFL in SSDs. In contrast, the applied OCT-A investigations, which included macular and peripapillary perfusion density, macular vessel density, and size of the foveal avascular zone, did not reveal any significant between-group differences. Finally, a longer duration of illness and higher chlorpromazine equivalent doses were associated with lower parafoveal macular and macular RNFL thickness. CONCLUSIONS This study strengthens the evidence for disease-related retinal thinning in SSDs.
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Affiliation(s)
- Emanuel Boudriot
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Benedikt Schworm
- Department of Ophthalmology, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Lenka Slapakova
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), 80804, Munich, Germany
| | - Katharina Hanken
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Iris Jäger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Marius Stephan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), 80804, Munich, Germany
| | - Vanessa Gabriel
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Georgios Ioannou
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Julian Melcher
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Genc Hasanaj
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Mattia Campana
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Joanna Moussiopoulou
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Lisa Löhrs
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, 86156, Augsburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany.,Max Planck Institute of Psychiatry, 80804, Munich, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany.,NeuroImaging Core Unit Munich (NICUM), University Hospital, LMU Munich, 80336, Munich, Germany.,Munich Center for Neurosciences (MCN), LMU Munich, 82152, Planegg-Martinsried, Germany
| | - Christoph Kern
- Department of Ophthalmology, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Florian J Raabe
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany. .,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), 80804, Munich, Germany.
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23
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Abstract
Working memory (WM) refers to the ability to maintain a small number of representations in an activated, easily accessible state for a short period of time in the service of ongoing cognitive processing and behavior. Because WM is a resource critical for multiple forms of complex cognition and executive control of behavior, it is of central interest in the study of disorders such as schizophrenia that involve a broad compromise of cognitive function and in the regulation of goal-directed behavior. There is now robust evidence that WM impairment is characteristic of people with schizophrenia. The impairment includes both elementary storage capacity as well as more complex forms of WM that involve the manipulation and updating of WM representations. These impairments appear to underlie a substantial portion of the generalized cognitive deficit in schizophrenia. Neuroimaging studies have implicated widespread abnormalities in the broad neural system that subserves WM performance, consistent with the evidence of broad cognitive impairment seen in PSZ.
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Affiliation(s)
- James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Steven J Luck
- Center for Mind & Brain and Department of Psychology, University of California, Davis, CA, USA
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24
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Analysis of color vision and cognitive function in first-episode schizophrenia before and after antipsychotic treatment. J Psychiatr Res 2022; 152:278-288. [PMID: 35759980 DOI: 10.1016/j.jpsychires.2022.06.012] [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: 02/08/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND A large body of recent research has demonstrated that patients with schizophrenia exhibit significant changes in visual function and ocular tissue structure in the early stages of onset. It is therefore possible to explore a novel scientific breakthrough in the etiology of schizophrenia by transforming the traditional study of brain structure and function with a view to examining the potential field of eye tissue and function. However, few studies have investigated the correlation between iris characteristics and schizophrenia, and evidence is lacking in this regard. Thus, further exploration is needed. PURPOSE This study was designed to analyze the characteristics of iris structure, color vision function and cognitive function, as well as the changes therein in patients with the first-episode drug-free schizophrenia before and after antipsychotic treatment. It aimed to preliminarily identify easily-measurable biomarkers for early clinical screening and diagnosis of schizophrenia. METHODS This study recruited 61 patients (22 males) with first-episode schizophrenia. Prior to the commencement of treatment with antipsychotic drugs, the Montreal Cognitive Assessment (MoCA) and Farnsworth-Munsell Dichotomous (D-15 Hue Test) were used as assessment tools to evaluate cognitive function and color vision function, respectively. Over a 6-week period, patients received a second-generation antipsychotic treatment (all converted to olanzapine equivalent dose) as prescribed by the doctor, and the Positive and Negative Syndrome Scale (PANSS) was applied to evaluate the clinical treatment effects before treatment (baseline), as well as at the 2nd, 4th, and 6th weeks after drug treatment. On the basis of iris characteristics, the patients were divided into groups. The observed differences in drug treatment effects between the groups were then compared and analyzed to further clarify the relationship between treatment efficacy and iris characteristics. Finally, changes in the cognitive function and color vision function of patients at baseline and at the 6th week after drug treatment were compared, and the effects of antipsychotic drug treatment on the above-mentioned functions were analyzed. RESULTS On the basis of structural iris characteristics, 61 patients were classified as follows: 28 patients without iris crypts and 33 with iris crypts; 35 without iris pigment dots and 26 with iris pigment dots; 42 without iris wrinkles and 19 with iris wrinkles. No significant difference was observed in the PANSS scores of all of the patients at baseline; however, significant differences were found in patients with iris crypts and iris pigment dots at each follow-up timepoint (i.e., at the 2nd, 4th, and 6th week). Moreover, it is noteworthy that, compared with other patients, the PANSS scores of patients without specific iris structure characteristics (iris crypts and pigment dots) decreased significantly (P<0.05), which indicated that the drug therapy was highly effective. Excluding the interference of drug factors, a significant correlation was found between the results of the D-15 (color vision function) and MoCA (cognitive function) in first-episode untreated patients (r = -0.401, P < 0.05). In addition, the MoCA scores (mean difference = 2.36, t = 10.05, P ˂ 0.01) were significantly higher after 6 weeks of antipsychotic drug treatment compared to conditions at baseline. CONCLUSIONS The findings of this study demonstrated that color vision function of patients with schizophrenia improved with the improvement of cognitive function. The structural characteristics of the iris with crypts and pigment dots could have a significant impact on the drug treatment effect of schizophrenia and could be considered as a potential biomarker for detecting and recognizing schizophrenia.
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25
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Gonzalez-Diaz JM, Radua J, Sanchez-Dalmau B, Camos-Carreras A, Zamora DC, Bernardo M. Mapping Retinal Abnormalities in Psychosis: Meta-analytical Evidence for Focal Peripapillary and Macular Reductions. Schizophr Bull 2022; 48:1194-1205. [PMID: 35810337 PMCID: PMC9673251 DOI: 10.1093/schbul/sbac085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Several studies have suggested that the retina structure is affected in schizophrenia spectrum disorders (SSD). We aimed to investigate the location and size of the potential differences between patients and healthy controls (HC) in several thickness and volume measures across the retina. STUDY DESIGN We included cross-sectional studies comparing peripapillary retinal nerve fiber layer (pRNFL) thickness, macular volume, macular thickness (MT), foveal thickness, ganglion cell and inner plexiform layer thickness (GCL+IPL), cup volume, and cup/disc ratio (C/D) in the right and/or left eyes and/or the pRNFL and MT quadrants between patients with SSD and HC. Search databases were MEDLINE, Web of Science, PsycINFO, Cochrane Central, and medrxiv.org. Risk of bias was assessed with the Newcastle-Ottawa Scale. Standardized mean differences (SMD), subgroup analysis, and meta-regression with several variables were computed using the dmetar package in R. PROSPERO: CRD42021287873. STUDY RESULTS Data from 22 reports (942 patients, 742 HC) were included. We found a retinal thinning in pRNFL (-0.30; 95% CI: -0.46, -0.14), macula (-0.37; 95% CI: -0.61, -0.13), and GCL+IPL (-0.33; 95% CI: -0.57, -0.10). The retinal thinning was especially pronounced in the superior and inferior quadrants of the inner ring of the macula. We also observed a decrease of macular volume (-0.44; 95% CI: -0.68, -0.20) and an increase in C/D ratio (0.35; 95% CI: 0.03, 0.67). CONCLUSIONS Current evidence demonstrates retinal thinning in SSD, affecting both axonal and cellular structures, specially focused in the inner ring of the macula.
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Affiliation(s)
- Jairo M Gonzalez-Diaz
- Universitat de Barcelona, Barcelona, Spain,UR Center for Mental Health—CERSAME, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia,Clinica Nuestra Señora de la Paz, Bogota, Colombia
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain,Early Psychosis: Interventions and Clinical-detection Lab, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,Department of Clinical Neuroscience, Stockholm Health Care Services, Stockholm County Council, Karolinska Institutet, Stockholm, Sweden
| | - Bernardo Sanchez-Dalmau
- Institut Clínic d’Oftalmologia, Hospital Clínic, Barcelona, Spain,Visual Lab. Ocular Inflammation Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain
| | - Anna Camos-Carreras
- Institut Clínic d’Oftalmologia, Hospital Clínic, Barcelona, Spain,Visual Lab. Ocular Inflammation Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Diana C Zamora
- UR Center for Mental Health—CERSAME, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Miquel Bernardo
- To whom correspondence should be addressed; Department of Psychiatry and Psychology, Clinical Institute of Neuroscience. Hospital Clinic of Barcelona, Villarroel, 170. 08036. Barcelona, Spain; tel: +34 93 227 54 00 Ext. 3142, e-mail:
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26
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Postdiction in Visual Awareness in Schizophrenia. Behav Sci (Basel) 2022; 12:bs12060198. [PMID: 35735408 PMCID: PMC9219622 DOI: 10.3390/bs12060198] [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: 05/07/2022] [Revised: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The mistiming of predictive thought and real perception leads to postdiction in awareness. Individuals with high delusive thinking confuse prediction and perception, which results in impaired reality testing. The present observational study investigated how antipsychotic medications and cognitive-behavioral therapy (CBT) modulate postdiction in schizophrenia. We hypothesized that treatment reduces postdiction, especially when antipsychotics and CBT are combined. Methods: We enrolled patients with schizophrenia treated in a natural clinical setting and not in a randomized controlled trial. We followed up two schizophrenia groups matched for age, sex, education, and illness duration: patients on antipsychotics (n = 25) or antipsychotics plus CBT (n = 25). The treating clinician assigned the patients to the two groups. Participants completed a postdiction and a temporal discrimination task at weeks 0 and 12. Results: At week 0, postdiction was enhanced in patients relative to controls at a short prediction–perception time interval, which correlated with PANSS positive symptoms and delusional conviction. At week 12, postdiction was reduced in schizophrenia, especially when they received antipsychotics plus CBT. Patients with schizophrenia were also impaired on the temporal discrimination task, which did not change during the treatment. During the 12-week observational period, all PANSS scores were significantly reduced in both clinical groups, but the positive symptoms and emotional distress exhibited a more pronounced response in the antipsychotics plus CBT group. Conclusion: Perceptual postdiction is a putative neurocognitive marker of delusive thinking. Combined treatment with antipsychotics and CBT significantly ameliorates abnormally elevated postdiction in schizophrenia.
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Silverstein SM, Choi JJ, Green KM, Bowles-Johnson KE, Ramchandran RS. Schizophrenia in Translation: Why the Eye? Schizophr Bull 2022; 48:728-737. [PMID: 35640030 PMCID: PMC9212100 DOI: 10.1093/schbul/sbac050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Schizophrenia is increasingly recognized as a systemic disease, characterized by dysregulation in multiple physiological systems (eg, neural, cardiovascular, endocrine). Many of these changes are observed as early as the first psychotic episode, and in people at high risk for the disorder. Expanding the search for biomarkers of schizophrenia beyond genes, blood, and brain may allow for inexpensive, noninvasive, and objective markers of diagnosis, phenotype, treatment response, and prognosis. Several anatomic and physiologic aspects of the eye have shown promise as biomarkers of brain health in a range of neurological disorders, and of heart, kidney, endocrine, and other impairments in other medical conditions. In schizophrenia, thinning and volume loss in retinal neural layers have been observed, and are associated with illness progression, brain volume loss, and cognitive impairment. Retinal microvascular changes have also been observed. Abnormal pupil responses and corneal nerve disintegration are related to aspects of brain function and structure in schizophrenia. In addition, studying the eye can inform about emerging cardiovascular, neuroinflammatory, and metabolic diseases in people with early psychosis, and about the causes of several of the visual changes observed in the disorder. Application of the methods of oculomics, or eye-based biomarkers of non-ophthalmological pathology, to the treatment and study of schizophrenia has the potential to provide tools for patient monitoring and data-driven prediction, as well as for clarifying pathophysiology and course of illness. Given their demonstrated utility in neuropsychiatry, we recommend greater adoption of these tools for schizophrenia research and patient care.
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Affiliation(s)
- Steven M Silverstein
- To whom correspondence should be addressed; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA; tel: +1 585-275-6742, e-mail:
| | - Joy J Choi
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Kyle M Green
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Rajeev S Ramchandran
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA,Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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28
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Hsu TW, Bai YM, Tsai SJ, Chen TJ, Liang CS, Chen MH. Risk of retinal disease in patients with bipolar disorder: A nationwide cohort study. Psychiatry Clin Neurosci 2022; 76:106-113. [PMID: 34994991 DOI: 10.1111/pcn.13326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/06/2021] [Accepted: 12/21/2021] [Indexed: 12/13/2022]
Abstract
AIMS Patients with brain diseases have been associated with several retinal abnormalities. This study aimed to assess the risk of retinal diseases in patients with bipolar disorder (BD). METHODS This nationwide cohort of 73,271 patients with BD was enrolled between 2001 and 2009. To identify newly diagnosed retinal diseases, the patients were followed to the end of 2011. The control group included 293,084 patients, matched for demographic characteristics and medical and ophthalmological comorbidities. The Kaplan-Meier method was used to estimate incidence rates of retinal diseases. Cox regression was applied to calculate the hazard ratios (HRs) with 95% confidence intervals (CIs) after adjusting for confounders. RESULTS Patients with BD had higher incidence rates of any retinal disease than the controls (1.27% vs 0.48%, P < 0.001), and retinal diseases were diagnosed at a young age (54.23 years [±12.68 years] vs 57.01 years [±13.12 years], P < 0.001). After adjusting for demographic characteristics, physical and ophthalmological comorbidities, and medications, the HR was 3.24 (95% CI, 2.18-4.82) for retinal detachment, 2.35 (95% CI, 1.83-3.03) for primary retinopathy, 2.26 (95% CI, 1.91-2.68) for diabetes retinopathy, 2.39 (95% CI, 1.49-3.82) for hypertensive retinopathy, and 3.46 (95% CI, 2.45-4.89) for retinal vascular complications in patients with BD vs controls. The cumulative daily dose of bipolar medications was not associated with the incidence of any retinal disease. CONCLUSION Patients with BD were associated with a higher risk of retinal detachment, primary retinopathy, diabetes retinopathy, hypertensive retinopathy, and retinal vascular complications than the controls. Further studies are needed to examine the mechanisms mediating these retinal diseases in patients with BD.
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Affiliation(s)
- Tien-Wei Hsu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Sung Liang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
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Adámek P, Langová V, Horáček J. Early-stage visual perception impairment in schizophrenia, bottom-up and back again. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:27. [PMID: 35314712 PMCID: PMC8938488 DOI: 10.1038/s41537-022-00237-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/17/2022] [Indexed: 01/01/2023]
Abstract
Visual perception is one of the basic tools for exploring the world. However, in schizophrenia, this modality is disrupted. So far, there has been no clear answer as to whether the disruption occurs primarily within the brain or in the precortical areas of visual perception (the retina, visual pathways, and lateral geniculate nucleus [LGN]). A web-based comprehensive search of peer-reviewed journals was conducted based on various keyword combinations including schizophrenia, saliency, visual cognition, visual pathways, retina, and LGN. Articles were chosen with respect to topic relevance. Searched databases included Google Scholar, PubMed, and Web of Science. This review describes the precortical circuit and the key changes in biochemistry and pathophysiology that affect the creation and characteristics of the retinal signal as well as its subsequent modulation and processing in other parts of this circuit. Changes in the characteristics of the signal and the misinterpretation of visual stimuli associated with them may, as a result, contribute to the development of schizophrenic disease.
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Affiliation(s)
- Petr Adámek
- Third Faculty of Medicine, Charles University, Prague, Czech Republic. .,Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Klecany, Czech Republic.
| | - Veronika Langová
- Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Klecany, Czech Republic
| | - Jiří Horáček
- Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Klecany, Czech Republic
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30
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Zibetti C. Deciphering the Retinal Epigenome during Development, Disease and Reprogramming: Advancements, Challenges and Perspectives. Cells 2022; 11:cells11050806. [PMID: 35269428 PMCID: PMC8908986 DOI: 10.3390/cells11050806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 02/01/2023] Open
Abstract
Retinal neurogenesis is driven by concerted actions of transcription factors, some of which are expressed in a continuum and across several cell subtypes throughout development. While seemingly redundant, many factors diversify their regulatory outcome on gene expression, by coordinating variations in chromatin landscapes to drive divergent retinal specification programs. Recent studies have furthered the understanding of the epigenetic contribution to the progression of age-related macular degeneration, a leading cause of blindness in the elderly. The knowledge of the epigenomic mechanisms that control the acquisition and stabilization of retinal cell fates and are evoked upon damage, holds the potential for the treatment of retinal degeneration. Herein, this review presents the state-of-the-art approaches to investigate the retinal epigenome during development, disease, and reprogramming. A pipeline is then reviewed to functionally interrogate the epigenetic and transcriptional networks underlying cell fate specification, relying on a truly unbiased screening of open chromatin states. The related work proposes an inferential model to identify gene regulatory networks, features the first footprinting analysis and the first tentative, systematic query of candidate pioneer factors in the retina ever conducted in any model organism, leading to the identification of previously uncharacterized master regulators of retinal cell identity, such as the nuclear factor I, NFI. This pipeline is virtually applicable to the study of genetic programs and candidate pioneer factors in any developmental context. Finally, challenges and limitations intrinsic to the current next-generation sequencing techniques are discussed, as well as recent advances in super-resolution imaging, enabling spatio-temporal resolution of the genome.
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Affiliation(s)
- Cristina Zibetti
- Department of Ophthalmology, Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, Building 36, 0455 Oslo, Norway
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31
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Green KM, Choi JJ, Ramchandran RS, Silverstein SM. OCT and OCT Angiography Offer New Insights and Opportunities in Schizophrenia Research and Treatment. Front Digit Health 2022; 4:836851. [PMID: 35252961 PMCID: PMC8894243 DOI: 10.3389/fdgth.2022.836851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
The human retina and retinal imaging technologies continue to increasingly gain the attention of schizophrenia researchers. With the same embryologic origin as the brain, the retina offers a window into neurovascular changes that may underlie disease. Recently, two technologies that have already revolutionized the field of ophthalmology, optical coherence tomography (OCT), and a functional extension of this, optical coherence tomography angiography (OCTA), have gained traction. Together, these non-invasive technologies allow for microscopic imaging of both structural and vascular features of the retina. With ease of use and no side effects, these devices are likely to prove powerful digital health tools in the study and treatment of schizophrenia. They may also prove key to discovering disease relevant biomarkers that underly neurodevelopmental and neurodegenerative aspects of conditions such as schizophrenia.
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Affiliation(s)
- Kyle M. Green
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, United States
| | - Joy J. Choi
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| | - Rajeev S. Ramchandran
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Steven M. Silverstein
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States
- Center for Visual Science, University of Rochester, Rochester, NY, United States
- *Correspondence: Steven M. Silverstein
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32
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Ponirakis G, Ghandi R, Ahmed A, Gad H, Petropoulos IN, Khan A, Elsotouhy A, Vattoth S, Alshawwaf MKM, Khoodoruth MAS, Ramadan M, Bhagat A, Currie J, Mahfoud Z, Al Hamad H, Own A, M Haddad P, Alabdulla M, Malik RA, Woodruff PW. Abnormal corneal nerve morphology and brain volume in patients with schizophrenia. Sci Rep 2022; 12:1870. [PMID: 35115592 PMCID: PMC8814184 DOI: 10.1038/s41598-022-05609-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/13/2022] [Indexed: 12/27/2022] Open
Abstract
Neurodevelopmental and neurodegenerative pathology occur in Schizophrenia. This study compared the utility of corneal confocal microscopy (CCM), an ophthalmic imaging technique with MRI brain volumetry in quantifying neuronal pathology and its relationship to cognitive dysfunction and symptom severity in schizophrenia. Thirty-six subjects with schizophrenia and 26 controls underwent assessment of cognitive function, symptom severity, CCM and MRI brain volumetry. Subjects with schizophrenia had lower cognitive function (P ≤ 0.01), corneal nerve fiber density (CNFD), length (CNFL), branch density (CNBD), CNBD:CNFD ratio (P < 0.0001) and cingulate gyrus volume (P < 0.05) but comparable volume of whole brain (P = 0.61), cortical gray matter (P = 0.99), ventricle (P = 0.47), hippocampus (P = 0.10) and amygdala (P = 0.68). Corneal nerve measures and cingulate gyrus volume showed no association with symptom severity (P = 0.35–0.86 and P = 0.50) or cognitive function (P = 0.35–0.86 and P = 0.49). Corneal nerve measures were not associated with metabolic syndrome (P = 0.61–0.64) or diabetes (P = 0.057–0.54). The area under the ROC curve distinguishing subjects with schizophrenia from controls was 88% for CNFL, 84% for CNBD and CNBD:CNFD ratio, 79% for CNFD and 73% for the cingulate gyrus volume. This study has identified a reduction in corneal nerve fibers and cingulate gyrus volume in schizophrenia, but no association with symptom severity or cognitive dysfunction. Corneal nerve loss identified using CCM may act as a rapid non-invasive surrogate marker of neurodegeneration in patients with schizophrenia.
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Affiliation(s)
- Georgios Ponirakis
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Reem Ghandi
- Psychiatry Hospital, Mental Health Service, Hamad Medical Corporation, Doha, Qatar
| | - Amani Ahmed
- Psychiatry Hospital, Mental Health Service, Hamad Medical Corporation, Doha, Qatar
| | - Hoda Gad
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Ioannis N Petropoulos
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Adnan Khan
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Ahmed Elsotouhy
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.,Neuroradiology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Surjith Vattoth
- Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | - Marwan Ramadan
- Geriatric, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Anjushri Bhagat
- Psychiatry Hospital, Mental Health Service, Hamad Medical Corporation, Doha, Qatar
| | - James Currie
- Psychiatry Hospital, Mental Health Service, Hamad Medical Corporation, Doha, Qatar
| | - Ziyad Mahfoud
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Hanadi Al Hamad
- Geriatric, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Neuroradiology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Peter M Haddad
- Psychiatry Hospital, Mental Health Service, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar.,Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Majid Alabdulla
- Psychiatry Hospital, Mental Health Service, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.,Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Peter W Woodruff
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar. .,Psychiatry Hospital, Mental Health Service, Hamad Medical Corporation, Doha, Qatar. .,Department of Neuroscience, School of Medicine,, University of Sheffield, Western Bank, Sheffield, S10 2TN, South Yorkshire, UK.
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Bernardin F, Schwitzer T, Schwan R, Angioi-Duprez K, Ligier F, Bourion-Bedes S, Jansen C, Giersch A, Laprevote V. Altered central vision and amacrine cells dysfunction as marker of hypodopaminergic activity in treated patients with schizophrenia. Schizophr Res 2022; 239:134-141. [PMID: 34891077 DOI: 10.1016/j.schres.2021.11.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 10/07/2021] [Accepted: 11/28/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Retinal dysfunction is widely documented in schizophrenia using flash (fERG) and pattern electroretinograms (PERG), but the role of dopamine transmission has seldom been explored. METHODS We explored the role of dopamine transmission by evaluating the spatial location of retinal anomalies using multifocal ERG (mfERG) in photopic condition and the oscillatory potentials (OPs) extracted from fERG measured in scotopic condition in 29 patients with schizophrenia and 29 healthy controls. RESULTS With the mfERG, our main results revealed reduced amplitudes in the center of the retina: P1 (p < .005) and N2 amplitudes (p < .01) in the <2° region, N1 (p < .0005) and P1 amplitudes (p < .001) in the 2-5° region and P1 amplitude (p < .05) in the 5-10° region. For OPs, our results showed a decrease in the O1 (p < .005), O2 (p < .005), O3 (p < .05) and overall O1, O2, O3 index amplitudes (p < .005) in patients with schizophrenia. CONCLUSIONS Both the central location of retinal dysfunctions of the mfERG and OPs results could reflect a hypodopaminergic effect in patients with schizophrenia. In future studies, OPs should be considered as a measure to evaluate the hypodopaminergy in patients.
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Affiliation(s)
- Florent Bernardin
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France; INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Pôle de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France.
| | - Thomas Schwitzer
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France; INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Pôle de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France; Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Raymund Schwan
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France; INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Pôle de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France; Université de Lorraine, Vandœuvre-lès-Nancy, France
| | | | - Fabienne Ligier
- Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, Laxou, France; Université de Lorraine, EA 4360 APEMAC, équipe MICS, France
| | - Stéphanie Bourion-Bedes
- Université de Lorraine, EA 4360 APEMAC, équipe MICS, France; Service Médico Psychologique Régional, Metz, France
| | - Claire Jansen
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
| | - Anne Giersch
- INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Pôle de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Vincent Laprevote
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France; INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Pôle de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France; Université de Lorraine, Vandœuvre-lès-Nancy, France
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34
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Friedel EBN, Tebartz van Elst L, Schmelz C, Ebert D, Maier S, Endres D, Runge K, Domschke K, Bubl E, Kornmeier J, Bach M, Heinrich SP, Nickel K. Replication of Reduced Pattern Electroretinogram Amplitudes in Depression With Improved Recording Parameters. Front Med (Lausanne) 2021; 8:732222. [PMID: 34778295 PMCID: PMC8585854 DOI: 10.3389/fmed.2021.732222] [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: 06/28/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The retina has gained increasing attention in non-ophthalmological research in recent years. The pattern electroretinogram (PERG), a method to evaluate retinal ganglion cell function, has been used to identify objective correlates of the essentially subjective state of depression. A reduction in the PERG contrast gain was demonstrated in patients with depression compared to healthy controls with normalization after remission. PERG responses are not only modulated by stimulus contrast, but also by check size and stimulation frequency. Therefore, the rationale was to evaluate potentially more feasible procedures for PERG recordings in daily diagnostics in psychiatry. Methods: Twenty-four participants (12 patients with major depression (MDD) and 12 age- and sex-matched healthy controls) were examined in this pilot study. We investigated PERG amplitudes for two steady-state pattern reversal frequencies (12.5/18.75 rps) and four sizes of a checkerboard stimulus (0.8°, 1.6°, 3.2°, and 16°) to optimize the PERG recordings in MDD patients. Results: Smaller PERG amplitudes in MDD patients were observed for all parameters, whereby the extent of the reduction appeared to be stimulus-specific. The most pronounced decline in the PERG of MDD patients was observed at the higher stimulation frequency and the finest pattern, whilst responses for the largest check size were less affected. Following the PERG ratio protocol for early glaucoma, where similar stimulus dependent modulations have been reported, we calculated PERG ratios (0.8°/16°) for all participants. At the higher frequency (18.75 rps), significantly reduced ratios were observed in MDD patients. Conclusion: The “normalization” of the PERG responses—via building a ratio—appears to be a very promising approach with regard to the development of an objective biomarker of the depressive state, facilitating inter-individual assessments of PERG recordings in patients with psychiatric disorders.
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Affiliation(s)
- Evelyn B N Friedel
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Céline Schmelz
- Pfalzklinikum-Clinic for Psychiatry and Neurology, Klingenmünster, Germany
| | - Dieter Ebert
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Maier
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kimon Runge
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Emanuel Bubl
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Kornmeier
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
| | - Michael Bach
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sven P Heinrich
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Nickel
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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35
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Shoham N, Hayes JF, Cooper C, Theodorsson M, Lewis G. Association Between Childhood Visual Acuity and Late Adolescent Psychotic Experiences: A Prospective Birth Cohort Study. Schizophr Bull 2021; 48:325-334. [PMID: 34624117 PMCID: PMC8886579 DOI: 10.1093/schbul/sbab121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A cross-sectional association between visual impairment and psychosis exists, but longitudinal evidence from children and young people is limited. We investigated whether childhood visual acuity was associated with subsequent psychotic experiences. Our sample was 6686 individuals from the Avon Longitudinal Study of Parents and Children (ALSPAC). We investigated whether our primary exposures, best corrected visual acuity at ages 7 and 11, were associated with psychotic experiences at ages 17 and 24. We also tested whether the following exposures at ages 7 and 11 were associated with subsequent psychotic experiences: requiring glasses, presence of any visual impairment, and between-eye visual acuity difference; and at age 7: strabismus, measures of binocular vision, history of eye patch, near vision impairment, and abnormal saccadic or pursuit eye movements. Analyses used multilevel models before and after adjusting for confounders. Odds of psychotic experiences increased with each 0.1-point deterioration in visual acuity score at age 11 (adjusted odds ratio [AOR] 1.23; 95% confidence interval [CI] 1.06-1.42), and at age 7 (AOR 1.18; 95% CI 1.00-1.40). Wearing glasses and visual impairment at age 11 were associated with psychotic experiences (AOR 1.63; 95% CI 1.21-2.19; AOR 1.64; 95% CI 1.23-2.19, respectively). There was no evidence of an association with other visual exposures. Visual acuity impairment in childhood is associated with psychotic experiences in late adolescence. Future research should aim to elucidate the nature of this association.
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Affiliation(s)
- Natalie Shoham
- Division of Psychiatry, University College London, London, UK,Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK,To whom correspondence should be addressed; Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London W1C 7NF, UK; e-mail:
| | - Joseph F Hayes
- Division of Psychiatry, University College London, London, UK,Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK,Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | | | - Gemma Lewis
- Division of Psychiatry, University College London, London, UK
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36
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Jerotic S, Lalovic N, Pejovic S, Mihaljevic M, Pavlovic Z, Britvic D, Risimic D, Soldatovic I, Silverstein SM, Maric NP. Sex differences in macular thickness of the retina in patients with psychosis spectrum disorders. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110280. [PMID: 33567332 DOI: 10.1016/j.pnpbp.2021.110280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/26/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Imaging of retinal structure in psychosis spectrum disorders (PSD) is a novel approach to studying effect of this illness class on CNS structure. Studies of optical coherence tomography (OCT) have revealed significant reductions in regarding: retinal nerve fiber layer (RNFL), macular thickness (MT), ganglion cell-inner plexiform layer (GC-IPL) and macular volume (MV). Sex differences in retinal structure in PSD have not been previously explored. METHODS This cross-sectional pilot study included 81 participant of age matched patients and controls. There were no differences between genders regarding illness duration and antipsychotic daily dose in the patient group. SD-OCT assessed RNFL, GC-IPL, MT, MV, and optic nerve cup-to-disc (C/D) ratio. In order to assess the main effects of illness, sex, and illness × sex interaction on the retinal parameters, general linear model was performed. RESULTS Patients demonstrated abnormalities on all OCT indices. Effects of sex were observed for central subfield MT and C/D ratio, which were lower in females. An illness × sex interaction effect was observed for the left MT, indicating greater thinning in female patients. CONCLUSION Sex differences in OCT findings in PSD appear to be most prominent considering macular parameters. These preliminary data may have important implications for the valid interpretation of OCT findings as potential biomarkers for PSD.
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Affiliation(s)
- Stefan Jerotic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia.
| | - Nikola Lalovic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Slobodanka Pejovic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marina Mihaljevic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zorana Pavlovic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dubravka Britvic
- Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Dijana Risimic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Ophthalmology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ivan Soldatovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Nadja P Maric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Mental Health, Belgrade, Serbia
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Silverstein SM, Lai A, Green KM, Crosta C, Fradkin SI, Ramchandran RS. Retinal Microvasculature in Schizophrenia. Eye Brain 2021; 13:205-217. [PMID: 34335068 PMCID: PMC8318708 DOI: 10.2147/eb.s317186] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/15/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Schizophrenia is associated with alterations in neural structure and function of the retina that are similar to changes seen in the retina and brain in multiple neurodegenerative disorders. Preliminary evidence suggests that retinal microvasculature may also be compromised in schizophrenia. The goal of this study was to determine, using optical coherence tomography angiography (OCTA), whether 1) schizophrenia is associated with alterations in retinal microvasculature density; and 2) microvasculature reductions are associated with retinal neural layer thinning and performance on a measure of verbal IQ. PATIENTS AND METHODS Twenty-eight outpatients with schizophrenia or schizoaffective disorder and 37 psychiatrically healthy control subjects completed OCT and OCTA exams, and the Wechsler Test of Adult Reading. RESULTS Schizophrenia patients were characterized by retinal microvasculature density reductions, and enlarged foveal avascular zones, in both eyes. These microvascular abnormalities were generally associated with thinning of retinal neural (macular and peripapillary nerve fiber layer) tissue (but the data were stronger for the left than the right eye) and lower scores on a proxy measure of verbal IQ. First- and later-episode patients did not differ significantly on OCTA findings. CONCLUSION The retinal microvasculature impairments seen in schizophrenia appear to be a biomarker of overall brain health, as is the case for multiple neurological conditions. Additional research is needed, however, to clarify contributions of social disadvantage and medical comorbidities to the findings.
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Affiliation(s)
- Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
- Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Adriann Lai
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Kyle M Green
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
| | - Christen Crosta
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, USA
| | | | - Rajeev S Ramchandran
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Korann V, Appaji A, Jacob A, Devi P, Nagendra B, Chako DM, Padmanabha A, Thonse U, Bharath RD, Kumar V, Varambally S, Venkatasubramanian G, Rao SV, Webers CAB, Berendschot TTJM, Rao NP. Association between retinal vascular caliber and brain structure in schizophrenia. Asian J Psychiatr 2021; 61:102707. [PMID: 34052670 DOI: 10.1016/j.ajp.2021.102707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/11/2021] [Accepted: 05/21/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Several lines of research in the last decade have indicated the potential utility of retina as a window to the brain. Emerging evidence suggests abnormalities in retinal vascular caliber in schizophrenia. However, the relationship between retinal vascular measures and brain structure has not been examined in schizophrenia to date. Hence, we examined the relationship between retinal vasculature measured using fundus photography and brain structure measured using magnetic resonance imaging. METHOD We recruited 17 healthy volunteers and 20 patients with schizophrenia. Using a non-mydriatic camera, we captured the images for left and right eyes separately and retinal vascular calibers were calculated using a semi-automated software package. Whole-brain anatomical T1 MPRAGE images were acquired using a 3-Tesla MRI scanner. Whole-brain and regional volume and cortical thickness were calculated using the Freesurfer software package. We used FreeSurfer's QDEC interface to compute vertex-by-vertex for analysis of the volume and cortical thickness. The relation between brain volume, cortical thickness, and retinal vascular caliber was examined using partial correlation and regression analysis. RESULTS There was a significant negative correlation between average CRVE and global cortical mean thickness in schizophrenia but not in healthy. In schizophrenia patients, there was a significant negative correlation between average CRVE and cortical thickness in frontal regions - left rostral middle frontal, left superior frontal, and right caudal middle frontal gyri and posterior brain regions - left lateral occipital gyrus and left posterior cingulate cortex. DISCUSSION The findings of the study suggest potential utility of retinal venular diameter as a proxy marker to abnormal neurodevelopment in schizophrenia.
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Affiliation(s)
- Vittal Korann
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Abhishek Appaji
- Department of Medical Electronics, BMS College of Engineering, Bangalore, India
| | - Arpitha Jacob
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Priyanka Devi
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Bhargavi Nagendra
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dona Maria Chako
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ananth Padmanabha
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Umesh Thonse
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Rose Dawn Bharath
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vijay Kumar
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | | | - Shyam Vasudeva Rao
- Department of Medical Electronics, BMS College of Engineering, Bangalore, India
| | - Carroll A B Webers
- University Eye Clinic Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Tos T J M Berendschot
- University Eye Clinic Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Naren P Rao
- National Institute of Mental Health and Neurosciences, Bangalore, India.
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Wolf A, Ueda K, Hirano Y. Recent updates of eye movement abnormalities in patients with schizophrenia: A scoping review. Psychiatry Clin Neurosci 2021; 75:82-100. [PMID: 33314465 PMCID: PMC7986125 DOI: 10.1111/pcn.13188] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/27/2020] [Accepted: 12/09/2020] [Indexed: 12/15/2022]
Abstract
AIM Although eye-tracking technology expands beyond capturing eye data just for the sole purpose of ensuring participants maintain their gaze at the presented fixation cross, gaze technology remains of less importance in clinical research. Recently, impairments in visual information encoding processes indexed by novel gaze metrics have been frequently reported in patients with schizophrenia. This work undertakes a scoping review of research on saccadic dysfunctions and exploratory eye movement deficits among patients with schizophrenia. It gathers promising pieces of evidence of eye movement abnormalities in attention-demanding tasks on the schizophrenia spectrum that have mounted in recent years and their outcomes as potential biological markers. METHODS The protocol was drafted based on PRISMA for scoping review guidelines. Electronic databases were systematically searched to identify articles published between 2010 and 2020 that examined visual processing in patients with schizophrenia and reported eye movement characteristics as potential biomarkers for this mental illness. RESULTS The use of modern eye-tracking instrumentation has been reported by numerous neuroscientific studies to successfully and non-invasively improve the detection of visual information processing impairments among the screened population at risk of and identified with schizophrenia. CONCLUSIONS Eye-tracking technology has the potential to contribute to the process of early intervention and more apparent separation of the diagnostic entities, being put together by the syndrome-based approach to the diagnosis of schizophrenia. However, context-processing paradigms should be conducted and reported in equally accessible publications to build comprehensive models.
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Affiliation(s)
- Alexandra Wolf
- International Research Fellow of Japan Society for the Promotion of Science, Fukuoka, Japan.,Department of Human Science, Research Center for Applied Perceptual Science, Kyushu University, Fukuoka, Japan
| | - Kazuo Ueda
- Department of Human Science, Research Center for Applied Perceptual Science, Kyushu University, Fukuoka, Japan
| | - Yoji Hirano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Affiliation(s)
- Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY,Department of Neuroscience, University of Rochester Medical Center, Rochester, NY,Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY,Center for Visual Science, University of Rochester, Rochester, NY,To whom correspondence should be addressed; Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, US; tel: 505-275-6742, fax: 585-276-2094, e-mail:
| | - Brian P Keane
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY,Department of Neuroscience, University of Rochester Medical Center, Rochester, NY,Center for Visual Science, University of Rochester, Rochester, NY
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Silverstein SM, Lai A. The Phenomenology and Neurobiology of Visual Distortions and Hallucinations in Schizophrenia: An Update. Front Psychiatry 2021; 12:684720. [PMID: 34177665 PMCID: PMC8226016 DOI: 10.3389/fpsyt.2021.684720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/14/2021] [Indexed: 12/15/2022] Open
Abstract
Schizophrenia is characterized by visual distortions in ~60% of cases, and visual hallucinations (VH) in ~25-50% of cases, depending on the sample. These symptoms have received relatively little attention in the literature, perhaps due to the higher rate of auditory vs. visual hallucinations in psychotic disorders, which is the reverse of what is found in other neuropsychiatric conditions. Given the clinical significance of these perceptual disturbances, our aim is to help address this gap by updating and expanding upon prior reviews. Specifically, we: (1) present findings on the nature and frequency of VH and distortions in schizophrenia; (2) review proposed syndromes of VH in neuro-ophthalmology and neuropsychiatry, and discuss the extent to which these characterize VH in schizophrenia; (3) review potential cortical mechanisms of VH in schizophrenia; (4) review retinal changes that could contribute to VH in schizophrenia; (5) discuss relationships between findings from laboratory measures of visual processing and VH in schizophrenia; and (6) integrate findings across biological and psychological levels to propose an updated model of VH mechanisms, including how their content is determined, and how they may reflect vulnerabilities in the maintenance of a sense of self. In particular, we emphasize the potential role of alterations at multiple points in the visual pathway, including the retina, the roles of multiple neurotransmitters, and the role of a combination of disinhibited default mode network activity and enhanced state-related apical/contextual drive in determining the onset and content of VH. In short, our goal is to cast a fresh light on the under-studied symptoms of VH and visual distortions in schizophrenia for the purposes of informing future work on mechanisms and the development of targeted therapeutic interventions.
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Affiliation(s)
- Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States.,Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States.,Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, United States.,Center for Visual Science, University of Rochester Medical Center, Rochester, NY, United States
| | - Adriann Lai
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
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Peredo R, Gagné AM, Gilbert E, Hébert M, Maziade M, Mérette C. Electroretinography may reveal cognitive impairment among a cohort of subjects at risk of a major psychiatric disorder. Psychiatry Res 2020; 291:113227. [PMID: 32593852 DOI: 10.1016/j.psychres.2020.113227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Almost a third of the offspring of parents diagnosed with schizophrenia or bipolar disorder could develop a mental disorder or related symptoms. The objectives of this study were to test the existence of two distinct subgroups of youth at-risk, according to their retinal response to luminance measured with electroretinography (ERG), and to relate the resulting cluster memberships with the cognitive clusters previously reported. METHODOLOGY A clustering analysis was performed with ERG measurements in 107 at-risk offspring. Each subgroup was compared to a healthy control group of 203 individuals. The ERG subgroup memberships were then associated with the cognitive clusters. RESULTS A two-cluster solution was obtained: HR-Cluster1 (n=53) showed a control-like ERG profile and HR-Cluster2 (n=54) showed reduced rod amplitudes and prolonged cone latencies of the b-wave. Subjects in the HR-Cluster2 were 2.7 times more likely to belong to the most detrimental cognitive subgroup than subjects in the HR-Cluster1 (49% Vs 18%). CONCLUSION At-risk offspring showed two distinct ERG profiles: a control-like and an altered profile. A higher risk of impaired cognitive function was observed in subjects with the altered ERG profile, suggesting the ERG as a potential biomarker of susceptibility to mental illness among youth at risk.
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Affiliation(s)
- Rossana Peredo
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec city, QC, Canada; CERVO Brain Research Centre, Quebec city, QC, G1J 2G3, Canada
| | - Anne-Marie Gagné
- CERVO Brain Research Centre, Quebec city, QC, G1J 2G3, Canada; Department of Psychiatry and Neuroscience, Faculty of Medicine, Laval University, Quebec city, QC, Canada
| | - Elsa Gilbert
- CERVO Brain Research Centre, Quebec city, QC, G1J 2G3, Canada; Department of Health Sciences, UQR, Campus Levis, QC, Canada
| | - Marc Hébert
- CERVO Brain Research Centre, Quebec city, QC, G1J 2G3, Canada; Department of Ophthalmology and otorhinolaryngology, Faculty of Medicine, Laval University, Quebec city, QC, Canada
| | - Michel Maziade
- CERVO Brain Research Centre, Quebec city, QC, G1J 2G3, Canada; Department of Psychiatry and Neuroscience, Faculty of Medicine, Laval University, Quebec city, QC, Canada
| | - Chantal Mérette
- CERVO Brain Research Centre, Quebec city, QC, G1J 2G3, Canada; Department of Psychiatry and Neuroscience, Faculty of Medicine, Laval University, Quebec city, QC, Canada.
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Silverstein SM, Demmin DL, Schallek JB, Fradkin SI. Measures of Retinal Structure and Function as Biomarkers in Neurology and Psychiatry. Biomark Neuropsychiatry 2020. [DOI: 10.1016/j.bionps.2020.100018] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Maziade M, Silverstein SM. The place of the retina in psychiatry: Uniting neurobiological and neurodevelopmental research with clinical research in psychiatric disorders. Schizophr Res 2020; 219:1-4. [PMID: 32249123 DOI: 10.1016/j.schres.2020.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Michel Maziade
- Medicine Faculty, University Laval Québec Research Center CERVO, CIUSSS de la Capitale-Nationale.
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Affiliation(s)
- Steven M Silverstein
- Departments of Psychiatry and Ophthalmology, Rutgers University – Robert Wood Johnson Medical School, New Brunswick, NJ
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Fradkin SI, Erickson MA, Demmin DL, Silverstein SM. Absence of Excess Intra-Individual Variability in Retinal Function in People With Schizophrenia. Front Psychiatry 2020; 11:543963. [PMID: 33329084 PMCID: PMC7714716 DOI: 10.3389/fpsyt.2020.543963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/27/2020] [Indexed: 01/26/2023] Open
Abstract
People with schizophrenia exhibit increased intra-individual variability in both behavioral and neural signatures of cognition. Examination of intra-individual variability may uncover a unique functionally relevant aspect of impairment that is not captured by typical between-group comparisons of mean or median values. We and others have observed that retinal activity measured using electroretinography (ERG) is significantly reduced in people with schizophrenia; however, it is currently unclear whether greater intra-individual variability in the retinal response can also be observed. To investigate this, we examined intra-individual variability from 25 individuals with schizophrenia and 24 healthy controls under two fERG conditions: (1) a light-adapted condition in which schizophrenia patients demonstrated reduced amplitudes; and (2) a dark-adapted condition in which the groups did not differ in amplitudes. Intraclass correlation coefficients (ICC) were generated to measure intra-individual variability for each subject, reflecting the consistency of activation values (in μv) across all sampling points (at a 2 kHz sampling rate) within all trials within a condition. Contrary to our predictions, results indicated that the schizophrenia and healthy control groups did not differ in intra-individual variability in fERG responses in either the light- or dark-adapted conditions. This finding remained consistent when variability was calculated as the standard deviation (SD) and coefficient of variation (CV) of maximum positive and negative microvolt values within the a- and b-wave time windows. This suggests that although elevated variability in schizophrenia may be observed at perceptual and cognitive levels of processing, it is not present in the earliest stages of sensory processing in vision.
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Affiliation(s)
- Samantha I Fradkin
- Department of Psychology, Rutgers University, Piscataway, NJ, United States.,University Behavioral Health Care, Rutgers University, Piscataway, NJ, United States.,Department of Psychology, University of Rochester, Rochester, NY, United States
| | - Molly A Erickson
- Department of Psychiatry, University of Chicago, Chicago, IL, United States
| | - Docia L Demmin
- Department of Psychology, Rutgers University, Piscataway, NJ, United States.,University Behavioral Health Care, Rutgers University, Piscataway, NJ, United States
| | - Steven M Silverstein
- University Behavioral Health Care, Rutgers University, Piscataway, NJ, United States.,Departments of Psychiatry and Ophthalmology, Rutgers University, Piscataway, NJ, United States.,Departments of Psychiatry, Neuroscience, and Ophthalmology, and Center for Visual Science, University of Rochester Medical Center, Rochester, NY, United States
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