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Shinn AK, Hurtado-Puerto AM, Roh YS, Ho V, Hwang M, Cohen BM, Öngür D, Camprodon JA. Cerebellar transcranial magnetic stimulation in psychotic disorders: intermittent, continuous, and sham theta-burst stimulation on time perception and symptom severity. Front Psychiatry 2023; 14:1218321. [PMID: 38025437 PMCID: PMC10679721 DOI: 10.3389/fpsyt.2023.1218321] [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: 05/07/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background The cerebellum contributes to the precise timing of non-motor and motor functions, and cerebellum abnormalities have been implicated in psychosis pathophysiology. In this study, we explored the effects of cerebellar theta burst stimulation (TBS), an efficient transcranial magnetic stimulation protocol, on temporal discrimination and self-reported mood and psychotic symptoms. Methods We conducted a case-crossover study in which patients with psychosis (schizophrenias, schizoaffective disorders, or bipolar disorders with psychotic features) were assigned to three sessions of TBS to the cerebellar vermis: one session each of intermittent (iTBS), continuous (cTBS), and sham TBS. Of 28 enrolled patients, 26 underwent at least one TBS session, and 20 completed all three. Before and immediately following TBS, participants rated their mood and psychotic symptoms and performed a time interval discrimination task (IDT). We hypothesized that cerebellar iTBS and cTBS would modulate these measures in opposing directions, with iTBS being adaptive and cTBS maladaptive. Results Reaction time (RT) in the IDT decreased significantly after iTBS vs. Sham (LS-mean difference = -73.3, p = 0.0001, Cohen's d = 1.62), after iTBS vs. cTBS (LS-mean difference = -137.6, p < 0.0001, d = 2.03), and after Sham vs. cTBS (LS-mean difference = -64.4, p < 0.0001, d = 1.33). We found no effect on IDT accuracy. We did not observe any effects on symptom severity after correcting for multiple comparisons. Conclusion We observed a frequency-dependent dissociation between the effects of iTBS vs. cTBS to the cerebellar midline on the reaction time of interval discrimination in patients with psychosis. iTBS showed improved (adaptive) while cTBS led to worsening (maladaptive) speed of response. These results demonstrate behavioral target engagement in a cognitive dimension of relevance to patients with psychosis and generate testable hypotheses about the potential therapeutic role of cerebellar iTBS in this clinical population. Clinical Trial Registration clinicaltrials.gov, identifier NCT02642029.
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Affiliation(s)
- Ann K. Shinn
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Aura M. Hurtado-Puerto
- Laboratory for Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Boston, MA, United States
| | - Youkyung S. Roh
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
| | - Victoria Ho
- Laboratory for Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Boston, MA, United States
| | - Melissa Hwang
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
| | - Bruce M. Cohen
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Program for Neuropsychiatric Research, McLean Hospital, Belmont, MA, United States
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Joan A. Camprodon
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Laboratory for Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Boston, MA, United States
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Medalia A, Saperstein A, Javitt DC, Qian M, Meyler S, Styke S. Feasibility and clinical utility of using the tone matching test for assessment of early auditory processing in schizophrenia. Psychiatry Res 2023; 323:115152. [PMID: 36907004 PMCID: PMC10106445 DOI: 10.1016/j.psychres.2023.115152] [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: 01/25/2023] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023]
Abstract
Early auditory processing (EAP) deficits are prevalent in schizophrenia and linked to disturbances in higher order cognition and daily functioning. Treatments that target EAP have the potential to drive downstream cognitive and functional improvements, but clinically feasible means to detect EAP impairment are lacking. This report describes the clinical feasibility and utility of using the Tone Matching (TM) Test to assess EAP in adults with schizophrenia. Clinicians were trained to administer the TM Test as part of a baseline cognitive battery to inform choice of cognitive remediation (CR) exercises. Only if the TM Test indicated EAP impairment, were the recommended CR exercises to include EAP training. Results indicated clinicians included the TM Test in all baseline assessments and identified 51.72% as EAP impaired. There were significant positive relationships between TM Test performance and cognitive summary scores, confirming instrumental validity. All clinicians found the TM Test useful for CR treatment planning. CR participants with impaired EAP spent significantly more training time on EAP exercises compared to CR participants with intact EAP (20.11% vs 3.32%). This study found that it is feasible to use the TM Test in community clinics and the test was perceived as clinically useful for personalizing treatment.
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Affiliation(s)
- Alice Medalia
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, NY, USA.
| | - Alice Saperstein
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, NY, USA
| | - Daniel C Javitt
- Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Experimental Therapeutics Division, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Min Qian
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY 10032, United States
| | - Shanique Meyler
- The Graduate Center, City University of New York, New York, NY 10016, USA
| | - Sarah Styke
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461, USA
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3
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Study of Coordination Between Patients with Schizophrenia and Socially Assistive Robot During Physical Activity. Int J Soc Robot 2021. [DOI: 10.1007/s12369-021-00750-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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4
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Benson PJ, Wallace L, Beedie SA. Sensory auditory interval perception errors in developmental dyslexia. Neuropsychologia 2020; 147:107587. [DOI: 10.1016/j.neuropsychologia.2020.107587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022]
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5
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Martel A, Apicella P. Temporal processing in the striatum: Interplay between midbrain dopamine neurons and striatal cholinergic interneurons. Eur J Neurosci 2020; 53:2090-2099. [DOI: 10.1111/ejn.14741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Anne‐Caroline Martel
- Institut de Neurosciences de la Timone UMR 7289 Aix Marseille Université, CNRS Marseille France
| | - Paul Apicella
- Institut de Neurosciences de la Timone UMR 7289 Aix Marseille Université, CNRS Marseille France
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6
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Medalia A, Saperstein AM, Qian M, Javitt DC. Impact of baseline early auditory processing on response to cognitive remediation for schizophrenia. Schizophr Res 2019; 208:397-405. [PMID: 30665714 PMCID: PMC6739117 DOI: 10.1016/j.schres.2019.01.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 01/07/2019] [Accepted: 01/10/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Early auditory processing (EAP) has increasingly become a focus of efforts to identify biomarkers of treatment response in schizophrenia. EAP deficits lead to poor functional outcome via impaired cognition, and treatments that target EAP may drive downstream cognitive improvements. Assessment of baseline need provides an opportunity for cognitive remediation (CR) programs that give EAP training to personalize treatment and optimize its impact. This initial efficacy study examined the differential benefit of EAP training for those with and without baseline EAP deficits as defined by performance on the Tone Matching Test. METHODS 103 outpatient adults diagnosed with schizophrenia or schizoaffective disorder were classified as having intact (48.5%) or impaired (51.5%) EAP and randomized to a CR program with restorative exercise plans that either included EAP training (N = 49) or did not (N = 54). Cognitive and functional outcomes were measured post-treatment and 3 months later. RESULTS Only in EAP impaired participants was there a significant benefit from EAP training on verbal learning. Treatment condition did not significantly impact global cognitive or functional outcomes for either EAP group. Cognitive gains partially mediated the relationship between gains in EAP and functional capacity. CONCLUSION These findings support the importance of addressing basic auditory deficits when attempting to remediate higher order auditory impairments such as verbal learning. In addition, they highlight the need for routine assessment of EAP in cognitive remediation participants, as well as the need for more effective programs to reverse these impairments.
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Affiliation(s)
- Alice Medalia
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, NY 10032, USA.
| | - Alice M Saperstein
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA.
| | - Min Qian
- Columbia University Mailman School of Public Health, Department of Biostatistics, New York, NY 10032, USA.
| | - Daniel C Javitt
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA.
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Dacewicz A, Szymaszek A, Nowak K, Szelag E. Training-Induced Changes in Rapid Auditory Processing in Children With Specific Language Impairment: Electrophysiological Indicators. Front Hum Neurosci 2018; 12:310. [PMID: 30131683 PMCID: PMC6091056 DOI: 10.3389/fnhum.2018.00310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 07/16/2018] [Indexed: 11/13/2022] Open
Abstract
The brain’s ability to recognize acoustic changes occurring in rapid temporal succession is important for speech and successful language development. Children with specific language impairment (SLI) are characterized by deficient dynamics of temporal information processing (TIP) in the millisecond time range accompanied by disordered language development. Furthermore, previous studies have found that intervention based on amelioration of TIP resulted in improvement of both language and other cognitive functions. This study aimed to explain the changes associated with TIP training from the perspective of event-related potentials (ERPs). Thirty-six children aged 5–8 years (26 boys, 10 girls) diagnosed with SLI underwent two types of intense audio-visual computer intervention: experimental TIP training targeted at the millisecond time range (n = 18) or control non-TIP training (n = 18). Paired 50 ms tones of 1000 Hz and 1200 Hz were presented with inter-stimulus intervals (ISIs) of either 50 ms (Short ISI Condition) or 200 ms (Long ISI Condition). Auditory ERPs were measured in a passive oddball paradigm before and after each type of training. The mismatch negativity (MMN) paradigm was applied as an electrophysiological indicator of the brain’s ability to automatically detect violations of regularity in paired tones presented in rapid succession. Moreover, the P3a component was also analyzed. After 24 sessions of temporal training (in the experimental group) MMN amplitude enhancement was observed in both ISI conditions, reflecting increased efficiency in perceiving changes in rapid auditory sequences. In both experimental and control groups, P3a amplitude was enhanced in both ISIs. This may be due to the improvement of involuntary attention shifting to the auditory events involved in each training type. To conclude, temporal training, compared to non-temporal control training, improved the ability to detect changes in a rapid auditory stream in children with SLI.
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Affiliation(s)
- Anna Dacewicz
- Laboratory of Neuropsychology, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Warsaw, Poland
| | - Aneta Szymaszek
- Laboratory of Neuropsychology, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Warsaw, Poland
| | - Kamila Nowak
- Laboratory of Social Psychology, Department of Ergonomics, Central Institute for Labour Protection-National Research Institute, Warsaw, Poland
| | - Elzbieta Szelag
- Laboratory of Neuropsychology, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Warsaw, Poland
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Wilquin H, Delevoye-Turrell Y, Dione M, Giersch A. Motor Synchronization in Patients With Schizophrenia: Preserved Time Representation With Abnormalities in Predictive Timing. Front Hum Neurosci 2018; 12:193. [PMID: 29867416 PMCID: PMC5965021 DOI: 10.3389/fnhum.2018.00193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/20/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: Basic temporal dysfunctions have been described in patients with schizophrenia, which may impact their ability to connect and synchronize with the outer world. The present study was conducted with the aim to distinguish between interval timing and synchronization difficulties and more generally the spatial-temporal organization disturbances for voluntary actions. A new sensorimotor synchronization task was developed to test these abilities. Method: Twenty-four chronic schizophrenia patients matched with 27 controls performed a spatial-tapping task in which finger taps were to be produced in synchrony with a regular metronome to six visual targets presented around a virtual circle on a tactile screen. Isochronous (time intervals of 500 ms) and non-isochronous auditory sequences (alternated time intervals of 300/600 ms) were presented. The capacity to produce time intervals accurately versus the ability to synchronize own actions (tap) with external events (tone) were measured. Results: Patients with schizophrenia were able to produce the tapping patterns of both isochronous and non-isochronous auditory sequences as accurately as controls producing inter-response intervals close to the expected interval of 500 and 900 ms, respectively. However, the synchronization performances revealed significantly more positive asynchrony means (but similar variances) in the patient group than in the control group for both types of auditory sequences. Conclusion: The patterns of results suggest that patients with schizophrenia are able to perceive and produce both simple and complex sequences of time intervals but are impaired in the ability to synchronize their actions with external events. These findings suggest a specific deficit in predictive timing, which may be at the core of early symptoms previously described in schizophrenia.
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Affiliation(s)
- Hélène Wilquin
- Aix Marseille Univ, Laboratory of Clinical Psychology, Psychopathology and Psychoanalysis, Aix-en-Provence, France
| | - Yvonne Delevoye-Turrell
- SCALab, UMR 9193 – National Center for Scientific Research, University of Lille, Villeneuve d’Ascq, France
| | - Mariama Dione
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne Giersch
- INSERM U1114, Department of Psychiatry, Federation of Translational Medicine of Strasbourg, Strasbourg University Hospital, Strasbourg, France
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Marinho V, Oliveira T, Rocha K, Ribeiro J, Magalhães F, Bento T, Pinto GR, Velasques B, Ribeiro P, Di Giorgio L, Orsini M, Gupta DS, Bittencourt J, Bastos VH, Teixeira S. The dopaminergic system dynamic in the time perception: a review of the evidence. Int J Neurosci 2017; 128:262-282. [PMID: 28950734 DOI: 10.1080/00207454.2017.1385614] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Dopaminergic system plays a key role in perception, which is an important executive function of the brain. Modulation in dopaminergic system forms an important biochemical underpinning of neural mechanisms of time perception in a very wide range, from milliseconds to seconds to longer daily rhythms. Distinct types of temporal experience are poorly understood, and the relationship between processing of different intervals by the brain has received little attention. A comprehensive understanding of interval timing functions should be sought within a wider context of temporal processing, involving genetic aspects, pharmacological models, cognitive aspects, motor control and the neurological diseases with impaired dopaminergic system. Particularly, an unexplored question is whether the role of dopamine in interval timing can be integrated with the role of dopamine in non-interval timing temporal components. In this review, we explore a wider perspective of dopaminergic system, involving genetic polymorphisms, pharmacological models, executive functions and neurological diseases on the time perception. We conclude that the dopaminergic system has great participation in impact on time perception and neurobiological basis of the executive functions and neurological diseases.
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Affiliation(s)
- Victor Marinho
- a Brain Mapping and Plasticity Laboratory, Federal University of Piauí (UFPI) , Parnaíba , Brazil.,b Genetics and Molecular Biology Laboratory, Federal University of Piauí , Parnaíba , Brazil
| | - Thomaz Oliveira
- a Brain Mapping and Plasticity Laboratory, Federal University of Piauí (UFPI) , Parnaíba , Brazil.,b Genetics and Molecular Biology Laboratory, Federal University of Piauí , Parnaíba , Brazil
| | - Kaline Rocha
- a Brain Mapping and Plasticity Laboratory, Federal University of Piauí (UFPI) , Parnaíba , Brazil
| | - Jéssica Ribeiro
- a Brain Mapping and Plasticity Laboratory, Federal University of Piauí (UFPI) , Parnaíba , Brazil
| | - Francisco Magalhães
- a Brain Mapping and Plasticity Laboratory, Federal University of Piauí (UFPI) , Parnaíba , Brazil
| | - Thalys Bento
- a Brain Mapping and Plasticity Laboratory, Federal University of Piauí (UFPI) , Parnaíba , Brazil
| | - Giovanny R Pinto
- b Genetics and Molecular Biology Laboratory, Federal University of Piauí , Parnaíba , Brazil
| | - Bruna Velasques
- c Brain Mapping and Sensory Motor Integration Laboratory, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ) , Rio de Janeiro , Brazil
| | - Pedro Ribeiro
- c Brain Mapping and Sensory Motor Integration Laboratory, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ) , Rio de Janeiro , Brazil
| | - Luiza Di Giorgio
- c Brain Mapping and Sensory Motor Integration Laboratory, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ) , Rio de Janeiro , Brazil
| | - Marco Orsini
- c Brain Mapping and Sensory Motor Integration Laboratory, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ) , Rio de Janeiro , Brazil.,d Rehabilitation Science Program, Analysis of Human Movement Laboratory, Augusto Motta University Center (UNISUAM) , Rio de Janeiro , Brazil
| | - Daya S Gupta
- e Department of Biology , Camden County College , Blackwood , NJ , USA
| | - Juliana Bittencourt
- f Biomedical Engineering Program (COPPE), Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Victor Hugo Bastos
- g Brain Mapping and Functionality Laboratory, Federal University of Piauí (UFPI) , Parnaíba , Brazil
| | - Silmar Teixeira
- a Brain Mapping and Plasticity Laboratory, Federal University of Piauí (UFPI) , Parnaíba , Brazil
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Zvyagintsev M, Parisi C, Mathiak K. Temporal processing deficit leads to impaired multisensory binding in schizophrenia. Cogn Neuropsychiatry 2017; 22:361-372. [PMID: 28578638 DOI: 10.1080/13546805.2017.1331160] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Schizophrenia has been characterised by neurodevelopmental dysconnectivity resulting in cognitive and perceptual dysmetria. Hence patients with schizophrenia may be impaired to detect the temporal relationship between stimuli in different sensory modalities. However, only a few studies described deficit in perception of temporally asynchronous multisensory stimuli in schizophrenia. METHODS We examined the perceptual bias and the processing time of synchronous and delayed sounds in the streaming-bouncing illusion in 16 patients with schizophrenia and a matched control group of 18 participants. RESULTS Equal for patients and controls, the synchronous sound biased the percept of two moving squares towards bouncing as opposed to the more frequent streaming percept in the condition without sound. In healthy controls, a delay of the sound presentation significantly reduced the bias and led to prolonged processing time whereas patients with schizophrenia did not differentiate between this condition and the condition with synchronous sound. CONCLUSION Schizophrenia leads to a prolonged window of simultaneity for audiovisual stimuli. Therefore, temporal processing deficit in schizophrenia can lead to hyperintegration of temporally unmatched multisensory stimuli.
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Affiliation(s)
- Mikhail Zvyagintsev
- a Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School , RWTH Aachen University , Aachen , Germany.,b IZKF Aachen , RWTH Aachen University , Aachen , Germany.,c JARA-Translational Brain Medicine , Aachen , Germany
| | - Carmen Parisi
- a Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School , RWTH Aachen University , Aachen , Germany
| | - Klaus Mathiak
- a Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School , RWTH Aachen University , Aachen , Germany.,c JARA-Translational Brain Medicine , Aachen , Germany
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Thoenes S, Oberfeld D. Meta-analysis of time perception and temporal processing in schizophrenia: Differential effects on precision and accuracy. Clin Psychol Rev 2017; 54:44-64. [DOI: 10.1016/j.cpr.2017.03.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 03/19/2017] [Accepted: 03/25/2017] [Indexed: 12/11/2022]
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Tone-matching ability in patients with schizophrenia: A systematic review and meta-analysis. Schizophr Res 2017; 181:94-99. [PMID: 27742161 DOI: 10.1016/j.schres.2016.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/23/2016] [Accepted: 10/04/2016] [Indexed: 12/14/2022]
Abstract
CONTEXT Patients with schizophrenia display abnormalities in pitch discrimination of non-verbal tones as revealed by the Tone-Matching Task (TMT). It may lead to deficits in higher-order cognitive functions and clinical symptoms. OBJECTIVES We conducted a systematic review and meta-analysis pooling data about TMT score differences between patients with schizophrenia and healthy controls, to evaluate the deficit's effect size, and to develop reliable knowledge about pitch processing impairment and its pejorative impact. METHOD Relevant publications were identified by a systematic search of PubMed and EMBASE databases. Then, we excluded non-relevant studies for the meta-analysis. Effect size for percent of correct responses to the TMT was expressed as standardized mean difference (SMD). RESULTS Eighteen of 167 identified studies met eligibility criteria for review, of which 10 were included in the meta-analysis. Our meta-analysis showed that the effect size for the percent of correct response to the TMT between patients (N=371) and controls (N=342) was large: SMD=1.17 [95% CI: 0.926-1.418] (z-value=9.338 and p-value<0.001). Meta-analysis showed moderate heterogeneity between studies (Q(9)=17.22, p=0.04, I2=47.74%). The relationship between tone-matching impairment and clinical symptoms of schizophrenia remains heterogeneous across studies. Some authors observed significant correlations between tone-matching performance and a number of higher-order cognitive abilities. CONCLUSION This review and meta-analysis highlights a large significant disturbance in tone-matching ability in patients as compared with controls. The study of basic auditory processing opens promising perspectives for pathophysiological modelling of the disorder and therapeutic issues.
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de Montalembert M, Coulon N, Cohen D, Bonnot O, Tordjman S. Time perception of simultaneous and sequential events in early-onset schizophrenia. Neurocase 2016; 22:392-9. [PMID: 27388526 DOI: 10.1080/13554794.2016.1205098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Timing disorders in schizophrenia are a well-known phenomenon. However, no studies have yet assessed the role of temporal distortions in early-onset schizophrenia (EOS), despite evidence that distorted time perception may share genetic risk factors with schizophrenia and may be a useful indicator in identifying individuals at risk for schizophrenia. In the present study, we investigated the ability of 10 patients with EOS (mean age = 21.5 years, SD = 6) matched with 20 healthy control participants (mean age = 25.3 years, SD = 4.6) in order to compare the durations of two visual events, presented either sequentially or overlapping in time, along with neuropsychological assessments of attention, working memory, and executive functions. Each participant had to judge a total of 336 stimuli. We found that temporal overlap had a greater negative effect on ability to judge the duration of a pair of stimuli in EOS patients than in healthy control participants. In addition, EOS patients showed impairments in attention and executive functions. Furthermore, in EOS patients, the scores for executive and attentional functions were significantly correlated with accuracy of temporal estimation in the overlap condition (r = 0.31, p < 0.05 and r = 0.57, p < 0.05, respectively). These preliminary results suggest that impairments in neuropsychological functions participate in the deficit in time estimation observed in patients with EOS. These conclusions highlight the importance of testing time perception in patients with EOS and could contribute to the development of cognitive remediation-based therapy for these patients.
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Affiliation(s)
- M de Montalembert
- a Laboratoire Cognitions Humaine et Artificielle (CHArt-UPO, EA 4004) & Université Paris Ouest Nanterre la Défense , Nanterre, France
| | - N Coulon
- b Laboratoire Psychologie de la Perception (CNRS UMR 8242) , Université Paris Descartes , Paris, France.,c Département de Psychiatrie , Université de Brest, CHU de Brest , Brest, France
| | - D Cohen
- d Service de Psychiatrie de l'enfant et de l'adolescent, CNRS UMR 7222 Institut des Systèmes Intelligents et Robotiques, GH Pitié Salpêtrière, AP-HP, UPMC , Paris , France
| | - O Bonnot
- e Unité Universitaire de Psychiatrie de l'Enfant et de l'Adolescent , Hôpital Mère-Enfant, CHU de Nantes , France
| | - S Tordjman
- b Laboratoire Psychologie de la Perception (CNRS UMR 8242) , Université Paris Descartes , Paris, France.,f Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent de Rennes , Université de Rennes 1 , Rennes, France
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Halberstadt AL, Sindhunata IS, Scheffers K, Flynn AD, Sharp RF, Geyer MA, Young JW. Effect of 5-HT2A and 5-HT2C receptors on temporal discrimination by mice. Neuropharmacology 2016; 107:364-375. [PMID: 27020041 DOI: 10.1016/j.neuropharm.2016.03.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/10/2016] [Accepted: 03/23/2016] [Indexed: 11/25/2022]
Abstract
Timing deficits are observed in patients with schizophrenia. Serotonergic hallucinogens can also alter the subjective experience of time. Characterizing the mechanism through which the serotonergic system regulates timing will increase our understanding of the linkage between serotonin (5-HT) and schizophrenia, and will provide insight into the mechanism of action of hallucinogens. We investigated whether interval timing in mice is altered by hallucinogens and other 5-HT2 receptor ligands. C57BL/6J mice were trained to perform a discrete-trials temporal discrimination task. In the discrete-trials task, mice were presented with two levers after a variable interval. Responding on lever A was reinforced if the interval was <6.5 s, and responding on lever B was reinforced if the interval was >6.5 s. A 2-parameter logistic function was fitted to the proportional choice for lever B (%B responding), yielding estimates of the indifference point (T50) and the Weber fraction (a measure of timing precision). The 5-HT2A antagonist M100907 increased T50, whereas the 5-HT2C antagonist SB-242,084 reduced T50. The results indicate that 5-HT2A and 5-HT2C receptors have countervailing effects on the speed of the internal pacemaker. The hallucinogen 2,5-dimethoxy-4-iodoamphetamine (DOI; 3 mg/kg IP), a 5-HT2 agonist, flattened the response curve at long stimulus intervals and shifted it to the right, causing both T50 and the Weber fraction to increase. The effect of DOI was antagonized by M100907 (0.03 mg/kg SC) but was unaffected by SB-242,084 (0.1 mg/kg SC). Similar to DOI, the selective 5-HT2A agonist 25CN-NBOH (6 mg/kg SC) reduced %B responding at long stimulus intervals, and increased T50 and the Weber fraction. These results demonstrate that hallucinogens alter temporal perception in mice, effects that are mediated by the 5-HT2A receptor. It appears that 5-HT regulates temporal perception, suggesting that altered serotonergic signaling may contribute to the timing deficits observed in schizophrenia and other psychiatric disorders.
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Affiliation(s)
- Adam L Halberstadt
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Research Service, VA San Diego Healthcare System, San Diego, CA, United States.
| | - Ivan S Sindhunata
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Kees Scheffers
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Aaron D Flynn
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Richard F Sharp
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Mark A Geyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Research Service, VA San Diego Healthcare System, San Diego, CA, United States
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Research Service, VA San Diego Healthcare System, San Diego, CA, United States
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15
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Ciullo V, Spalletta G, Caltagirone C, Jorge RE, Piras F. Explicit Time Deficit in Schizophrenia: Systematic Review and Meta-Analysis Indicate It Is Primary and Not Domain Specific. Schizophr Bull 2016; 42:505-18. [PMID: 26253596 PMCID: PMC4753592 DOI: 10.1093/schbul/sbv104] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Although timing deficits are a robust finding in schizophrenia (SZ), the notion of a genuine time perception disorder in SZ is still being debated because distortions in timing might depend on neuropsychological deficits that are characteristics of the illness. Here we used meta-analytic methods to summarize the evidence of timing deficits in SZ and moderator analyses to determine whether defective timing in SZ arises from nontemporal sources or from defective time perception. PubMed Services, PsycNET, and Scopus were searched through March 2015, and all references in articles were investigated to find other relevant studies. Studies were selected if they included subjects with a primary diagnosis of SZ compared to a healthy control (HC) group and if they reported behavioral measures of duration estimation (perceptual and motor explicit timing). Data from 24 studies published from 1956 to 2015, which comprised 747 SZ individuals and 808 HC, were included. Results indicate that SZ individuals are less accurate than HC in estimating time duration across a wide range of tasks. Subgroup analyses showed that the fundamental timing deficit in SZ is independent from the length of the to-be-timed duration (automatic and cognitively controlled timing) and from methods of stimuli estimation (perceptual and motor timing). Thus, time perception per se is disturbed in SZ (not just task-specific timing processes) and this perturbation is independent from more generalized cognitive impairments. Behavioral evidence of disturbed automatic timing should be more thoroughly investigated with the aim of defining it as a cognitive phenotype for more homogeneous diagnostic subgrouping.
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Affiliation(s)
- Valentina Ciullo
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Gianfranco Spalletta
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX;
| | - Carlo Caltagirone
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Ricardo E Jorge
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Federica Piras
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
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16
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Alústiza I, Radua J, Albajes-Eizagirre A, Domínguez M, Aubá E, Ortuño F. Meta-Analysis of Functional Neuroimaging and Cognitive Control Studies in Schizophrenia: Preliminary Elucidation of a Core Dysfunctional Timing Network. Front Psychol 2016; 7:192. [PMID: 26925013 PMCID: PMC4756542 DOI: 10.3389/fpsyg.2016.00192] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/31/2016] [Indexed: 12/04/2022] Open
Abstract
Timing and other cognitive processes demanding cognitive control become interlinked when there is an increase in the level of difficulty or effort required. Both functions are interrelated and share neuroanatomical bases. A previous meta-analysis of neuroimaging studies found that people with schizophrenia had significantly lower activation, relative to normal controls, of most right hemisphere regions of the time circuit. This finding suggests that a pattern of disconnectivity of this circuit, particularly in the supplementary motor area, is a trait of this mental disease. We hypothesize that a dysfunctional temporal/cognitive control network underlies both cognitive and psychiatric symptoms of schizophrenia and that timing dysfunction is at the root of the cognitive deficits observed. The goal of our study was to look, in schizophrenia patients, for brain structures activated both by execution of cognitive tasks requiring increased effort and by performance of time perception tasks. We conducted a signed differential mapping (SDM) meta-analysis of functional neuroimaging studies in schizophrenia patients assessing the brain response to increasing levels of cognitive difficulty. Then, we performed a multimodal meta-analysis to identify common brain regions in the findings of that SDM meta-analysis and our previously-published activation likelihood estimate (ALE) meta-analysis of neuroimaging of time perception in schizophrenia patients. The current study supports the hypothesis that there exists an overlap between neural structures engaged by both timing tasks and non-temporal cognitive tasks of escalating difficulty in schizophrenia. The implication is that a deficit in timing can be considered as a trait marker of the schizophrenia cognitive profile.
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Affiliation(s)
- Irene Alústiza
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de NavarraPamplona, Spain; Instituto de Investigación Sanitaria de NavarraNavarra, Spain
| | - Joaquim Radua
- Department of Psychosis Studies, Institute of Psychiatry, Kings CollegeLondon, UK; FIDMAG Germanes Hospitalaries Hospital Sant RafaelBarcelona, Spain; Centro de Investigación Biomédicaen Redde Salud MentalBarcelona, Spain
| | - Anton Albajes-Eizagirre
- FIDMAG Germanes Hospitalaries Hospital Sant RafaelBarcelona, Spain; Centro de Investigación Biomédicaen Redde Salud MentalBarcelona, Spain
| | - Manuel Domínguez
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de NavarraPamplona, Spain; Instituto de Investigación Sanitaria de NavarraNavarra, Spain
| | - Enrique Aubá
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de NavarraPamplona, Spain; Instituto de Investigación Sanitaria de NavarraNavarra, Spain
| | - Felipe Ortuño
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de NavarraPamplona, Spain; Instituto de Investigación Sanitaria de NavarraNavarra, Spain
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17
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Ramage EM, Klimas N, Vogel SJ, Vertinski M, Yerkes BD, Flores A, Sutton GP, Ringdahl EN, Allen DN, Snyder JS. Concurrent sound segregation impairments in schizophrenia: The contribution of auditory-specific and general cognitive factors. Schizophr Res 2016; 170:95-101. [PMID: 26644302 PMCID: PMC4707099 DOI: 10.1016/j.schres.2015.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/19/2015] [Accepted: 11/22/2015] [Indexed: 01/02/2023]
Abstract
The present study sought to test whether perceptual segregation of concurrently played sounds is impaired in schizophrenia (SZ), whether impairment in sound segregation predicts difficulties with a real-world speech-in-noise task, and whether auditory-specific or general cognitive processing accounts for sound segregation problems. Participants with SZ and healthy controls (HCs) performed a mistuned harmonic segregation task during recording of event-related potentials (ERPs). Participants also performed a brief speech-in-noise task. Participants with SZ showed deficits in the mistuned harmonic task and the speech-in-noise task, compared to HCs. No deficit in SZ was found in the ERP component related to mistuned harmonic segregation at around 150ms (the object-related negativity or ORN), but instead showed a deficit in processing at around 400ms (the P4 response). However, regression analyses showed that indexes of education level and general cognitive function were the best predictors of sound segregation difficulties, suggesting non-auditory specific causes of concurrent sound segregation problems in SZ.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Joel S. Snyder
- Corresponding author at: Department of Psychology, University of Nevada Las Vegas, 4505 S. Maryland Parkway, MS 5030, Las Vegas, NV 89154-5030, USA. (J.S. Snyder)
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18
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Ameqrane I, Wattiez N, Pouget P, Missal M, Pouget P, Pierre P, Missal M, Marcus M. A subanesthetic dose of ketamine in the Rhesus monkey reduces the occurrence of anticipatory saccades. Psychopharmacology (Berl) 2015; 232:3563-72. [PMID: 26153067 DOI: 10.1007/s00213-015-4005-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 06/28/2015] [Indexed: 12/20/2022]
Abstract
RATIONALE It has been shown that antagonism of the glutamatergic N-methyl-D-aspartate (NMDA) receptor with subanesthetic doses of ketamine perturbs the perception of elapsed time. Anticipatory eye movements are based on an internal representation of elapsed time. Therefore, the occurrence of anticipatory saccades could be a particularly sensitive indicator of abnormal time perception due to NMDA receptors blockade. OBJECTIVES The objective of this study was to determine whether the occurrence of anticipatory saccades could be selectively altered by a subanesthetic dose of ketamine. METHODS Three Rhesus monkeys were trained in a simple visually guided saccadic task with a variable delay. Monkeys were rewarded for making a visually guided saccade at the end of the delay. Premature anticipatory saccades to the future position of the eccentric target initiated before the end of the delay were not rewarded. A subanesthetic dose of ketamine (0.25 mg/kg) or a saline solution of the same volume was injected i.m. during the task. RESULTS We found that the injected dose of ketamine did not induce sedation or abnormal behavior. However, in ∼4 min, ketamine induced a strong reduction of the occurrence of anticipatory saccades but did not reduce the occurrence of visually guided saccades. CONCLUSION This unexpected reduction of anticipatory saccade occurrence could be interpreted as resulting from an altered use of the perception of elapsed time during the delay period induced by NMDA receptors antagonism.
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Su L, Wyble B, Zhou LQ, Wang K, Wang YN, Cheung EFC, Bowman H, Chan RCK. Temporal perception deficits in schizophrenia: integration is the problem, not deployment of attentions. Sci Rep 2015; 5:9745. [PMID: 25940093 PMCID: PMC4419531 DOI: 10.1038/srep09745] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 03/17/2015] [Indexed: 11/27/2022] Open
Abstract
Patients with schizophrenia are known to have impairments in sensory processing. In order to understand the specific temporal perception deficits of schizophrenia, we investigated and determined to what extent impairments in temporal integration can be dissociated from attention deployment using Attentional Blink (AB). Our findings showed that there was no evident deficit in the deployment of attention in patients with schizophrenia. However, patients showed an increased temporal integration deficit within a hundred-millisecond timescale. The degree of such integration dysfunction was correlated with the clinical manifestations of schizophrenia. There was no difference between individuals with/without schizotypal personality disorder in temporal integration. Differently from previous studies using the AB, we did not find a significant impairment in deployment of attention in schizophrenia. Instead, we used both theoretical and empirical approaches to show that previous findings (using the suppression ratio to correct for the baseline difference) produced a systematic exaggeration of the attention deficits. Instead, we modulated the perceptual difficulty of the task to bring the baseline levels of target detection between the groups into closer alignment. We found that the integration dysfunction rather than deployment of attention is clinically relevant, and thus should be an additional focus of research in schizophrenia.
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Affiliation(s)
- Li Su
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Brad Wyble
- Department of Psychology, The Pennsylvania State University, Pennsylvania, USA
| | - Lai-quan Zhou
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, The Pennsylvania State University, Pennsylvania, USA
- University of Chinese Academy of Sciences, Beijing, China
| | - Kui Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yu-na Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Eric F. C. Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Howard Bowman
- School of Computing, University of Kent, Canterbury, UK
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Raymond C. K. Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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20
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Bernard JA, Mittal VA. Cerebellar-motor dysfunction in schizophrenia and psychosis-risk: the importance of regional cerebellar analysis approaches. Front Psychiatry 2014; 5:160. [PMID: 25505424 PMCID: PMC4243486 DOI: 10.3389/fpsyt.2014.00160] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 10/25/2014] [Indexed: 12/21/2022] Open
Abstract
Motor abnormalities in individuals with schizophrenia and those at-risk for psychosis are well documented. An accumulating body of work has also highlighted motor abnormalities related to cerebellar dysfunction in schizophrenia including eye-blink conditioning, timing, postural control, and motor learning. We have also recently found evidence for motor dysfunction in individuals at ultra high-risk for psychosis (1-3). This is particularly relevant as the cerebellum is thought to be central to the cognitive dysmetria model of schizophrenia, and these overt motor signs may point to more general cerebellar dysfunction in the etiology of psychotic disorders. While studies have provided evidence indicative of motor cerebellar dysfunction in at-risk populations and in schizophrenia, findings with respect to the cerebellum have been mixed. One factor potentially contributing to these mixed results is the whole-structure approach taken when investigating the cerebellum. In non-human primates, there are distinct closed-loop circuits between the cerebellum, thalamus, and brain with motor and non-motor cortical regions. Recent human neuroimaging has supported this finding and indicates that there is a cerebellar functional topography (4), and this information is being missed with whole-structure approaches. Here, we review cerebellar-motor dysfunction in individuals with schizophrenia and those at-risk for psychosis. We also discuss cerebellar abnormalities in psychosis, and the cerebellar functional topography. Because of the segregated functional regions of the cerebellum, we propose that it is important to look at the structure regionally in order to better understand its role in motor dysfunction in these populations. This is analogous to approaches taken with the basal ganglia, where each region is considered separately. Such an approach is necessary to better understand cerebellar pathophysiology on a macro-structural level with respect to the pathogenesis of psychosis.
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Affiliation(s)
- Jessica A Bernard
- Department of Psychology and Neuroscience, University of Colorado Boulder , Boulder, CO , USA
| | - Vijay A Mittal
- Department of Psychology and Neuroscience, University of Colorado Boulder , Boulder, CO , USA ; Center for Neuroscience, University of Colorado Boulder , Boulder, CO , USA
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21
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Radhakrishnan R, Wilkinson ST, D'Souza DC. Gone to Pot - A Review of the Association between Cannabis and Psychosis. Front Psychiatry 2014; 5:54. [PMID: 24904437 PMCID: PMC4033190 DOI: 10.3389/fpsyt.2014.00054] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 05/02/2014] [Indexed: 01/01/2023] Open
Abstract
Cannabis is the most commonly used illicit drug worldwide, with ~5 million daily users worldwide. Emerging evidence supports a number of associations between cannabis and psychosis/psychotic disorders, including schizophrenia. These associations-based on case-studies, surveys, epidemiological studies, and experimental studies indicate that cannabinoids can produce acute, transient effects; acute, persistent effects; and delayed, persistent effects that recapitulate the psychopathology and psychophysiology seen in schizophrenia. Acute exposure to both cannabis and synthetic cannabinoids (Spice/K2) can produce a full range of transient psychotomimetic symptoms, cognitive deficits, and psychophysiological abnormalities that bear a striking resemblance to symptoms of schizophrenia. In individuals with an established psychotic disorder, cannabinoids can exacerbate symptoms, trigger relapse, and have negative consequences on the course of the illness. Several factors appear to moderate these associations, including family history, genetic factors, history of childhood abuse, and the age at onset of cannabis use. Exposure to cannabinoids in adolescence confers a higher risk for psychosis outcomes in later life and the risk is dose-related. Individuals with polymorphisms of COMT and AKT1 genes may be at increased risk for psychotic disorders in association with cannabinoids, as are individuals with a family history of psychotic disorders or a history of childhood trauma. The relationship between cannabis and schizophrenia fulfills many but not all of the standard criteria for causality, including temporality, biological gradient, biological plausibility, experimental evidence, consistency, and coherence. At the present time, the evidence indicates that cannabis may be a component cause in the emergence of psychosis, and this warrants serious consideration from the point of view of public health policy.
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Affiliation(s)
- Rajiv Radhakrishnan
- Department of Psychiatry, Yale University School of Medicine , New Haven, CT , USA
| | - Samuel T Wilkinson
- Department of Psychiatry, Yale University School of Medicine , New Haven, CT , USA
| | - Deepak Cyril D'Souza
- Department of Psychiatry, Yale University School of Medicine , New Haven, CT , USA ; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center , New Haven, CT , USA ; Schizophrenia and Neuropharmacology Research Group, VA Connecticut Healthcare System , West Haven, CT , USA
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22
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Coull JT. Getting the timing right: experimental protocols for investigating time with functional neuroimaging and psychopharmacology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 829:237-64. [PMID: 25358714 DOI: 10.1007/978-1-4939-1782-2_13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Functional Magnetic Resonance Imaging (fMRI) is an effective tool for identifying brain areas and networks implicated in human timing. But fMRI is not just a phrenological tool: by careful design, fMRI can be used to disentangle discrete components of a timing task and control for the underlying cognitive processes (e.g. sustained attention and WM updating) that are critical for estimating stimulus duration in the range of hundreds of milliseconds to seconds. Moreover, the use of parametric designs and correlational analyses allows us to better understand not just where, but also how, the brain processes temporal information. In addition, by combining fMRI with psychopharmacological manipulation, we can begin to uncover the complex relationship between cognition, neurochemistry and anatomy in the healthy human brain. This chapter provides an overview of some of the key findings in the functional imaging literature of both duration estimation and temporal prediction, and outlines techniques that can be used to allow timing-related activations to be interpreted more unambiguously. In our own studies, we have found that estimating event duration, whether that estimate is provided by a motor response or a perceptual discrimination, typically recruits basal ganglia, SMA and right inferior frontal cortex, and can be modulated by dopaminergic activity in these areas. By contrast, orienting attention to predictable moments in time in order to optimize behaviour, whether that is to speed motor responding or improve perceptual accuracy, recruits left inferior parietal cortex.
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Affiliation(s)
- Jennifer T Coull
- Laboratoire de Neurosciences Cognitives, Aix-Marseille Université & CNRS, 3 Place Victor Hugo, 13331, Marseille, Cedex 3, France,
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23
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Abstract
One of the oldest models of schizophrenia is based on the effects of serotonergic hallucinogens such as mescaline, psilocybin, and (+)-lysergic acid diethylamide (LSD), which act through the serotonin 5-HT(2A) receptor. These compounds produce a 'model psychosis' in normal individuals that resembles at least some of the positive symptoms of schizophrenia. Based on these similarities, and because evidence has emerged that the serotonergic system plays a role in the pathogenesis of schizophrenia in some patients, animal models relevant to schizophrenia have been developed based on hallucinogen effects. Here we review the behavioural effects of hallucinogens in four of those models, the receptor and neurochemical mechanisms for the effects and their translational relevance. Despite the difficulty of modelling hallucinogen effects in nonverbal species, animal models of schizophrenia based on hallucinogens have yielded important insights into the linkage between 5-HT and schizophrenia and have helped to identify receptor targets and interactions that could be exploited in the development of new therapeutic agents.
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24
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McLachlan NM, Phillips DS, Rossell SL, Wilson SJ. Auditory processing and hallucinations in schizophrenia. Schizophr Res 2013; 150:380-5. [PMID: 24054462 DOI: 10.1016/j.schres.2013.08.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 08/27/2013] [Accepted: 08/27/2013] [Indexed: 11/19/2022]
Abstract
The aim of this study was to investigate whether deficits in auditory processing are associated with auditory hallucinations in patients with schizophrenia. It was hypothesised that individuals with a diagnosis of schizophrenia would demonstrate deficits in processing the spectral and temporal aspects of sound and that such deficits would be more pronounced in patients with a history of auditory hallucinations (hallucinators) than those without such a history (non-hallucinators). A community sample meeting clinical criteria for schizophrenia or schizoaffective disorder (19 hallucinators, 15 non-hallucinators) and a matched healthy control group (n=17) completed a broad range of auditory processing tasks involving pitch discrimination of modulated (temporal) and unmodulated (spectral) pure tones, auditory streaming and affective prosodic identification, as well as measures assessing current psychiatric symptoms. In all experimental tasks patients were impaired compared to controls. Specifically hallucinators performed worse than non-hallucinators and controls for pitch discrimination of unmodulated tones and auditory streaming, and both hallucinators and non-hallucinators performed significantly worse than controls for discrimination of modulated tones and affective prosody. These findings suggest that impaired temporal processing may contribute to general difficulties identifying affective speech prosody in patients with schizophrenia, while spectral processing deficits may specifically compromise melodic streaming in hallucinators, which combined with deficits in temporal processing, contribute to the experience of auditory hallucinations.
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Affiliation(s)
- Neil M McLachlan
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia.
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25
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Peterburs J, Nitsch AM, Miltner WHR, Straube T. Impaired Representation of Time in Schizophrenia Is Linked to Positive Symptoms and Cognitive Demand. PLoS One 2013; 8:e67615. [PMID: 23826328 PMCID: PMC3695031 DOI: 10.1371/journal.pone.0067615] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 05/20/2013] [Indexed: 12/18/2022] Open
Abstract
Time processing critically relies on the mesencephalic dopamine system and striato-prefrontal projections and has thus been suggested to play a key role in schizophrenia. Previous studies have provided evidence for an acceleration of the internal clock in schizophrenia that may be linked to dopaminergic pathology. The present study aimed to assess the relationship between altered time processing in schizophrenia and symptom manifestation in 22 patients and 22 controls. Subjects were required to estimate the time needed for a visual stimulus to complete a horizontal movement towards a target position on trials of varying cognitive demand. It was hypothesized that patients – compared to controls – would be less accurate at estimating the movement time, and that this effect would be modulated by symptom manifestation and task difficulty. In line with the notion of an accelerated internal clock due to dopaminergic dysregulation, particularly patients with severe positive symptoms were expected to underestimate movement time. However, if altered time perception in schizophrenia was better explained in terms of cognitive deficits, patients with severe negative symptoms should be specifically impaired, while generally, task performance should correlate with measures of processing speed and cognitive flexibility. Patients underestimated movement time on more demanding trials, although there was no link to disease-related cognitive dysfunction. Task performance was modulated by symptom manifestation. Impaired estimation of movement time was significantly correlated with PANSS positive symptom scores, with higher positive symptom scores associated with stronger underestimation of movement time. The present data thus support the notion of a deficit in anticipatory and predictive mechanisms in schizophrenia that is modulated both by symptom manifestation and by cognitive demand.
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Affiliation(s)
- Jutta Peterburs
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
- * E-mail:
| | - Alexander M. Nitsch
- Department of Biological and Clinical Psychology, University of Jena, Jena, Germany
| | | | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
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26
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Hunsaker MR. The importance of considering all attributes of memory in behavioral endophenotyping of mouse models of genetic disease. Behav Neurosci 2013; 126:371-80. [PMID: 22642882 DOI: 10.1037/a0028453] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In order to overcome difficulties in evaluating cognitive function in mouse models of genetic disorders, it is critical to take into account the background strain of the mouse and reported phenotypes in the clinical population being studied. Recent studies have evaluated cognitive function across a number of background strains and found that spatial memory assayed by the water maze and contextual fear conditioning often does not provide optimal results. The logical extension to these results is to emphasize not only spatial, but all attributes or domains of memory function in behavioral phenotyping experiments. A careful evaluation of spatial, temporal, sensory/perceptual, affective, response, executive, proto-linguistic, and social behaviors designed to specifically evaluate the cognitive function each mouse model can be performed in a rapid, relatively high throughput manner. Such results would not only provide a more comprehensive snapshot of brain function in mouse disease models than the more common approach that approaches nonspecific spatial memory tasks to evaluate cognition, but also would better model the disorders being studied.
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Affiliation(s)
- Michael R Hunsaker
- Department of Neurological Surgery, University of California, Davis, CA 95616, USA.
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27
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Sewell RA, Schnakenberg A, Elander J, Radhakrishnan R, Williams A, Skosnik PD, Pittman B, Ranganathan M, D’Souza DC. Acute effects of THC on time perception in frequent and infrequent cannabis users. Psychopharmacology (Berl) 2013; 226. [PMID: 23179965 PMCID: PMC3581701 DOI: 10.1007/s00213-012-2915-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
RATIONALE Cannabinoids have been shown to alter time perception, but existing literature has several limitations. Few studies have included both time estimation and production tasks, few control for subvocal counting, most had small sample sizes, some did not record subjects' cannabis use, many tested only one dose, and used either oral or inhaled administration of Δ⁹-tetrahydrocannabinol (THC), leading to variable pharmacokinetics, and some used whole-plant cannabis containing cannabinoids other than THC. Our study attempted to address these limitations. OBJECTIVES This study aims to characterize the acute effects of THC and frequent cannabis use on seconds-range time perception. THC was hypothesized to produce transient, dose-related time overestimation and underproduction. Frequent cannabis smokers were hypothesized to show blunted responses to these alterations. METHODS IV THC was administered at doses from 0.015 to 0.05 mg/kg to 44 subjects who participated in several double-blind, randomized, counterbalanced, crossover, placebo-controlled studies. Visual time estimation and production tasks in the seconds range were presented to subjects three times on each test day. RESULTS All doses induced time overestimation and underproduction. Chronic cannabis use had no effect on baseline time perception. While infrequent/nonsmokers showed temporal overestimation at medium and high doses and temporal underproduction at all doses, frequent cannabis users showed no differences. THC effects on time perception were not dose related. CONCLUSIONS A psychoactive dose of THC increases internal clock speed as indicated by time overestimation and underproduction. This effect is not dose related and is blunted in chronic cannabis smokers who did not otherwise have altered baseline time perception.
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Affiliation(s)
- R. Andrew Sewell
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
| | - Ashley Schnakenberg
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
| | - Jacqueline Elander
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
| | - Rajiv Radhakrishnan
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
| | - Ashley Williams
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
| | - Patrick D. Skosnik
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
| | - Brian Pittman
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
| | - Mohini Ranganathan
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
| | - D. Cyril D’Souza
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
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Abstract
Time estimation, within a range of seconds, involves cognitive functions which depend on multiple brain regions. Here we report on studies investigating the reproduction and production of three durations (5, 14, and 38 seconds) in four groups of patients. The amnesic patient underproduced the length of the long durations because of episodic memory deficit following bilateral medial temporal lesions. Epileptic patients (n = 9) with right medial temporal lobe resections underproduced the three durations because of a distorted representation of time in long-term memory. Traumatic brain injury patients (n = 15) made more variable duration productions and reproductions because of working memory deficits following frontal-lobe dysfunction. Patients with Parkinson's disease (n = 18) overproduced the short duration and underproduced the long duration because of a possible increase in internal clock speed following levodopa treatment, as well as working memory deficits associated with frontal-lobe damage. Further research, in neurological and psychiatric patients, is required to better understand the underlying mechanisms of time estimation.
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Affiliation(s)
- Séverine Perbal-Hatif
- Cognitive Neuroscience and Cerebral Imaging Unit, Hôpital de la Salpêtrière, Paris, France.
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29
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Papageorgiou C, Karanasiou IS, Kapsali F, Stachtea X, Kyprianou M, Tsianaka EI, Karakatsanis NA, Rabavilas AD, Uzunoglu NK, Papadimitriou GN. Temporal processing dysfunction in schizophrenia as measured by time interval discrimination and tempo reproduction tasks. Prog Neuropsychopharmacol Biol Psychiatry 2013; 40:173-9. [PMID: 23367507 DOI: 10.1016/j.pnpbp.2012.07.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Time perception deficiency has been implicated in schizophrenia; however the exact nature of this remains unclear. The present study was designed with the aim to delineate timing deficits in schizophrenia by examining performance of patients with schizophrenia and healthy volunteers in an interval discrimination test and their accuracy and precision in a pacing reproduction–replication test. METHODS The first task involved temporal discrimination of intervals, in which participants (60 patients with schizophrenia and 35 healthy controls) had to judge whether intervals were longer, shorter or equal than a standard interval. The second task required repetitive self-paced tapping to test accuracy and precision in the reproduction and replication of tempos. RESULTS Patients were found to differ significantly from the controls in the psychoticism scale of EPQ, the proportion of correct responses in the interval discrimination test and the overall accuracy and precision in the reproduction and replication of sound sequences (p < 0.01). Within the patient group bad responders concerning the ability to discriminate time intervals were associated with increased scores in the Positive and Negative Syndrome Scale (PANSS) and in the Brief Psychiatric Rating Scale (BPRS) in comparison to good responders (p < 0.01). There were no gender effects and there were no differences between subgroups of patients taking different kinds or combinations of drugs. CONCLUSIONS Analysis has shown that performance on timing tasks decreased with increasing psychopathology and therefore that timing dysfunctions are directly linked to the severity of the illness. Different temporal dysfunctions can be traced to different psychophysiological origins that can be explained using the Scalar Expectancy Theory (SET).
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30
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Roy M, Grondin S, Roy MA. Time perception disorders are related to working memory impairment in schizophrenia. Psychiatry Res 2012; 200:159-66. [PMID: 22862910 DOI: 10.1016/j.psychres.2012.06.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 05/31/2012] [Accepted: 06/10/2012] [Indexed: 11/28/2022]
Abstract
Time perception (TP) impairment in schizophrenia has been originally described by clinicians and afterwards addressed in laboratory. Previous studies generally observed that schizophrenia patients overestimate time and that their timing sensitivity is impaired. However, because of the disease cognitive impairments, no study until now allows to draw definitive conclusions about the nature of TP disturbances. The aim of this study is to isolate a genuine TP disorder in schizophrenia, i.e., a disorder that would be related to the functioning of an internal clock. The main hypothesis tested is that patients' internal clock runs faster than that of healthy controls. Twenty-five patients suffering from a first-episode of schizophrenia and twenty-five healthy controls performed an innovative task called method of dynamic stimuli, designed to measure the natural frequency (F(n)) of the internal clock, concomitant with a neuropsychological assessment. We observed no significant difference in F(n) between groups. Compared to controls, there was a marginally higher variability in time reproduction in patients. Patients' pattern of results and significant correlations between TP tasks and memory outcomes suggest that TP impairments are related to memory impairment in schizophrenia. These conclusions are supported by a growing literature showing that cognition is involved in TP in schizophrenia.
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Affiliation(s)
- Martin Roy
- École de psychologie, Université Laval, Québec, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Québec, Université Laval, Québec, Canada.
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31
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Ramage EM, Weintraub DM, Allen DN, Snyder JS. Evidence for stimulus-general impairments on auditory stream segregation tasks in schizophrenia. J Psychiatr Res 2012; 46:1540-5. [PMID: 23017812 PMCID: PMC3485434 DOI: 10.1016/j.jpsychires.2012.08.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 06/26/2012] [Accepted: 08/27/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Auditory impairments in schizophrenia have been demonstrated previously, especially for tasks requiring precise encoding of frequency, although it is unclear the extent to which they have difficulty using pitch information and other cues to segregate sounds. We determined the extent to which those with schizophrenia have difficulty using pitch information and other auditory cues to segregate sounds that are presented sequentially. METHODS Ten participants with schizophrenia and nine healthy/normal control participants completed a battery of tasks that tested for the ability to perform sequential auditory stream segregation using pitch, amplitude modulation, or inter-aural phase difference as cues to segregation. RESULTS All three sequential segregation tasks showed reduced tendency for those with schizophrenia to perceive segregated sounds, compared to control participants. CONCLUSIONS These findings extend prior research by demonstrating a general impairment on sequential sound segregation tasks in schizophrenia, and not just on tasks that require precise encoding of frequency. Together, the pattern of results provide evidence that auditory impairments in schizophrenia result from selective abnormalities in neural circuits that carry out specific computations necessary for stream segregation, as opposed to an impairment in processing specific cues.
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Affiliation(s)
- Erin M Ramage
- Department of Psychology, University of Nevada, Las Vegas, NV 89154-5030, USA
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32
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A ticking clock for the production of sequential actions: where does the problem lie in schizophrenia? Schizophr Res 2012; 135:51-4. [PMID: 22260961 DOI: 10.1016/j.schres.2011.12.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 12/11/2011] [Accepted: 12/25/2011] [Indexed: 11/20/2022]
Abstract
Schizophrenia has been associated to a distorted time clock. By subtracting contact duration from Inter Response Interval, we report evidence for preserved internal clock in schizophrenia, with normal spontaneous tapping tempo. Contact durations were however increased in patients suggesting a specific problem in the fast integration of incoming haptic feedback with outgoing motor efferences. This integration deficit would emerge at an early phase, since Ultra High Risk patients also revealed abnormal tapping stability. Tactile screens revealed to be a simple and low cost apparatus that may constitute a suitable measuring kit for the characterisation of sensory motor deficits in clinical settings.
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33
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Ward RD, Kellendonk C, Kandel ER, Balsam PD. Timing as a window on cognition in schizophrenia. Neuropharmacology 2012; 62:1175-81. [PMID: 21530549 PMCID: PMC3155658 DOI: 10.1016/j.neuropharm.2011.04.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 03/24/2011] [Accepted: 04/11/2011] [Indexed: 11/25/2022]
Abstract
Distorted interval timing is a common feature of the cognitive impairment observed in patients with schizophrenia. The neural circuits which are required for interval timing and those thought to be compromised in schizophrenia overlap and include the cortico-striatal pathways. Here, we suggest that a focus on temporal information processing offers a window into understanding the cognitive deficits of schizophrenia and how deficits might contribute to a variety of symptoms. A disruption in the functioning of the cortico-striatal pathways may lead to cognitive deficits which in turn lead to impaired processing of temporal information. Disrupted temporal processing may also contribute to a variety of other symptoms associated with the disorder. Because interval timing is a cognitive/behavioral phenotype that can easily be assessed in animals it can be used as a sensitive screen for deficits in animal models. Using a recently developed transgenic mouse that models increased D2 receptor upregulation in the striatum similar to that observed in patients with schizophrenia we illustrate the utility of an interval timing approach in assessing cognitive impairment. We further discuss how variants of timing procedures can be used to assess attention and working memory performance as well as other necessary components of adaptive cognitive function.
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Affiliation(s)
- Ryan D Ward
- Department of Psychiatry, Columbia University, New York, NY 10032, USA.
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Coull JT, Morgan H, Cambridge VC, Moore JW, Giorlando F, Adapa R, Corlett PR, Fletcher PC. Ketamine perturbs perception of the flow of time in healthy volunteers. Psychopharmacology (Berl) 2011; 218:543-56. [PMID: 21603893 PMCID: PMC3210361 DOI: 10.1007/s00213-011-2346-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 05/04/2011] [Indexed: 11/29/2022]
Abstract
RATIONALE Disturbances in the subjective experience of time have been observed both in schizophrenia and following acute administration of ketamine. However, effects of ketamine on more objective timing tasks have not yet been measured in humans, nor has it been established that timing effects are not merely secondary to a more general dysfunction in working memory (WM). OBJECTIVE AND METHODS In a double-blind placebo-controlled crossover study, we characterised the effects of ketamine (100 ng/ml blood plasma level) on performance of perceptual timing and colour discrimination tasks, which were matched for WM and attentional demands. To test the ubiquity of ketamine's effects on timing, we also examined two distinct measures of temporal predictability. RESULTS Ketamine significantly distorted the subjective experience of time as measured by the Clinician-Administered Dissociative States Scales. Critically, ketamine also impaired accuracy on the perceptual timing task while having no effect on performance of the colour perception task. Although ketamine did not impair the ability to use prelearned temporal (or spatial) cues to predict target onset (or location), it did slow reaction times at long delays following non-informative neutral cues, suggesting an impaired ability to use the unidirectional flow of time itself to make temporal predictions. CONCLUSIONS Ketamine induced selective impairments in timing, which could not be explained by more fundamental effects on the ability to hold information in WM. Rather our collected findings suggest that ketamine may disturb timing by selectively impairing the way in which information is temporally manipulated within WM.
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Affiliation(s)
- Jennifer T Coull
- Laboratoire de Neurobiologie de la Cognition, Université de Provence & CNRS, Pôle 3C, 3 Place Victor Hugo, 13331 Marseille Cedex 3, France.
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35
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Allman MJ, Meck WH. Pathophysiological distortions in time perception and timed performance. ACTA ACUST UNITED AC 2011; 135:656-77. [PMID: 21921020 DOI: 10.1093/brain/awr210] [Citation(s) in RCA: 292] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Distortions in time perception and timed performance are presented by a number of different neurological and psychiatric conditions (e.g. Parkinson's disease, schizophrenia, attention deficit hyperactivity disorder and autism). As a consequence, the primary focus of this review is on factors that define or produce systematic changes in the attention, clock, memory and decision stages of temporal processing as originally defined by Scalar Expectancy Theory. These findings are used to evaluate the Striatal Beat Frequency Theory, which is a neurobiological model of interval timing based upon the coincidence detection of oscillatory processes in corticostriatal circuits that can be mapped onto the stages of information processing proposed by Scalar Timing Theory.
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Affiliation(s)
- Melissa J Allman
- Kennedy Krieger Institute, and Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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36
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Tschacher W, Bergomi C. Cognitive binding in schizophrenia: weakened integration of temporal intersensory information. Schizophr Bull 2011; 37 Suppl 2:S13-22. [PMID: 21860043 PMCID: PMC3160115 DOI: 10.1093/schbul/sbr074] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cognitive functioning is based on binding processes, by which different features and elements of neurocognition are integrated and coordinated. Binding is an essential ingredient of, for instance, Gestalt perception. We have implemented a paradigm of causality perception based on the work of Albert Michotte, in which 2 identical discs move from opposite sides of a monitor, steadily toward, and then past one another. Their coincidence generates an ambiguous percept of either "streaming" or "bouncing," which the subjects (34 schizophrenia spectrum patients and 34 controls with mean age 27.9 y) were instructed to report. The latter perception is a marker of the binding processes underlying perceived causality (type I binding). In addition to this visual task, acoustic stimuli were presented at different times during the task (150 ms before and after visual coincidence), which can modulate perceived causality. This modulation by intersensory and temporally delayed stimuli is viewed as a different type of binding (type II). We show here, using a mixed-effects hierarchical analysis, that type II binding distinguishes schizophrenia spectrum patients from healthy controls, whereas type I binding does not. Type I binding may even be excessive in some patients, especially those with positive symptoms; Type II binding, however, was generally attenuated in patients. The present findings point to ways in which the disconnection (or Gestalt) hypothesis of schizophrenia can be refined, suggesting more specific markers of neurocognitive functioning and potential targets of treatment.
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Affiliation(s)
- Wolfgang Tschacher
- University Hospital of Psychiatry, University of Bern, Laupenstrasse 49, 3010 Bern, Switzerland.
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37
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Ward RD, Simpson EH, Kandel ER, Balsam PD. Modeling motivational deficits in mouse models of schizophrenia: behavior analysis as a guide for neuroscience. Behav Processes 2011; 87:149-56. [PMID: 21338658 PMCID: PMC3085964 DOI: 10.1016/j.beproc.2011.02.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 02/03/2011] [Accepted: 02/10/2011] [Indexed: 01/01/2023]
Abstract
In recent years it has become possible to develop animal models of psychiatric disease in genetically modified mice. While great strides have been made in the development of genetic and neurobiological tools with which to model psychiatric disease, elucidation of neural and molecular mechanisms thought to underlie behavioral phenotypes has been hindered by an inadequate analysis of behavior. This is unfortunate given the fact that the experimental analysis of behavior has created powerful methods for isolating and describing the functional properties of behavioral mechanisms that are capable of providing deep understanding of behavioral phenotypes. A better understanding of the biological basis of normal behavior and its disturbance in psychiatric disease will require the application of these rigorous behavior analytic tools to animal models. In this review we provide an example of a merging of genetic and behavioral methods and illustrate its utility in the analysis of a mouse model of the motivational deficits in schizophrenia. The synergy between basic behavior analysis, neuroscience, and animal models of psychiatric disease has great potential for achieving a deeper understanding of behavior and its neurobiological mechanisms as well as for leading to improvements in diagnosis and treatment in clinical settings.
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Affiliation(s)
- Ryan D Ward
- Department of Psychiatry, Columbia University, NewYork, NY 10032, United States.
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38
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[Production of rhythms in schizophrenia: the central role of attention]. Encephale 2011; 37:86-93. [PMID: 21482225 DOI: 10.1016/j.encep.2010.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 03/22/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Schizophrenia is a psychiatric illness that is characterised by a deficit in the fluent sequencing of thought and action. This problem of discoordination might be due to unreliable timing processes associated with a difficulty in allocating sufficient attention. In the present study, we placed ourselves within the hypothesis that schizophrenic patients may have difficulties in producing rhythmic tapping actions and that this deficit may be correlated with the degree of attention abnormalities. METHOD Subjects were required to tap in rhythm with alternating force levels and/or alternating time intervals (<1s) during trials lasting 24s. In addition, all patients performed an attention task (D2 test). A qualitative analysis of the tap trials was conducted in order to characterise the nature of the deficits that patients revealed. RESULTS Results showed that all patients revealed significant difficulties in performing the tapping trials. The number of trials removed was correlated with the level of attention dysfunction. Finally, our qualitative analysis revealed that 60% of patients presented attentional lapses - which were never observed in the healthy controls. CONCLUSION This study revealed deficits in the timing of action that resemble, at least on a behaviour level, the clinical lapses observed in schizophrenia. These lapses seem to be correlated to the degree of attention deficits. Future studies are now required in order to gain better understanding of the nature of the attention deficits in schizophrenia. More specifically, a better definition of the possible functional relationship between clinical lapses, cognitive lapses and action freezing is needed to develop innovating tools for rehabilitation.
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Davalos DB, Rojas DC, Tregellas JR. Temporal processing in schizophrenia: effects of task-difficulty on behavioral discrimination and neuronal responses. Schizophr Res 2011; 127:123-30. [PMID: 20674279 PMCID: PMC4105224 DOI: 10.1016/j.schres.2010.06.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 06/26/2010] [Accepted: 06/28/2010] [Indexed: 11/16/2022]
Abstract
Deficits in temporal judgment in schizophrenia have been observed in behavioral and electrophysiological studies for years. The functional neuroanatomy of temporal judgment in schizophrenia is, however, poorly understood. Recent neurophysiological research suggests that timing deficits in this population may not be widespread across all timing tasks, but specifically associated with high levels of difficulty. We evaluated differences between individuals with schizophrenia (N=16) and healthy subjects (N=18) during a temporal discrimination task at two levels of difficulty. Subjects were studied with functional magnetic resonance imaging (fMRI) at 3T while discriminating tone durations. Behaviorally, the schizophrenia group performed worse than the control group at both levels of difficulty. Similarly, group differences in patterns of brain activation were observed across both difficulty conditions. In the easy condition, individuals with schizophrenia showed less activation in the supplementary motor area and insula/opercula, regions known to be involved in temporal processing. These group differences increased in the difficult condition. In addition, the striatum was less active in individuals with schizophrenia in the difficult condition. Comparing the difficult to easy conditions revealed robust differences in the bilateral striatum and the insula/opercula, suggesting that the striatum plays a key role in temporal processing deficits in schizophrenia, especially under difficult conditions. These observations suggest that temporal judgment deficits reflect widespread neuroanatomical network involvement in schizophrenia, some of which are not directly related to task difficulty. These findings shed light on disparate findings in the timing literature regarding the role of task difficulty in temporal judgment deficits in schizophrenia.
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Affiliation(s)
- Deana B. Davalos
- Department of Psychiatry, University of Colorado Denver, 13001 E. 17 Place, Box F546, Aurora, Colorado, 80045
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Department of Psychology, Colorado State University, Ft. Collins, Colorado, 80523
| | - Donald C. Rojas
- Department of Psychiatry, University of Colorado Denver, 13001 E. 17 Place, Box F546, Aurora, Colorado, 80045
| | - Jason R. Tregellas
- Department of Psychiatry, University of Colorado Denver, 13001 E. 17 Place, Box F546, Aurora, Colorado, 80045
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Horton J, Millar A, Labelle A, Knott VJ. MMN responsivity to manipulations of frequency and duration deviants in chronic, clozapine-treated schizophrenia patients. Schizophr Res 2011; 126:202-11. [PMID: 21194893 DOI: 10.1016/j.schres.2010.11.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 11/25/2010] [Accepted: 11/30/2010] [Indexed: 11/18/2022]
Abstract
Event-related potential (ERP) probing of abnormal sensory processes in schizophrenia with the mismatch negativity (MMN) has shown impairments in auditory change detection, but knowledge of the acoustic features leading to this deficit is incomplete. Changes in the duration and frequency properties of sound stimuli result in diminished MMNs in schizophrenia but it is unclear as to whether this reduced responsiveness is seen with more subtle changes in sound frequency. In a sample of 19 healthy controls and 21 patients with chronic schizophrenia treated with clozapine, MMN was assessed in response to tone frequency changes of 5%, 10% and 20%, and to tone duration changes. Patients exhibited reduced amplitudes and shorter latencies than controls to all frequency changes, and attenuated amplitudes to tone duration increments and decrements. Clozapine dose was related to MMN, with increasing dose being positively associated with frequency-MMN amplitudes (10% ∆f, 20% ∆f) and negatively associated with the amplitude and latency of duration-MMNs. These data support the well-established findings of auditory sensory abnormality in schizophrenia and underscore the sensitivity of MMN to relatively small auditory change detection deficits that may appear to characterize chronic schizophrenia.
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Affiliation(s)
- Jemeen Horton
- Geriatrics/Integrated Forensic Program, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada K1Z 7K4
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Arzy S, Mohr C, Molnar-Szakacs I, Blanke O. Schizotypal perceptual aberrations of time: correlation between score, behavior and brain activity. PLoS One 2011; 6:e16154. [PMID: 21267456 PMCID: PMC3022658 DOI: 10.1371/journal.pone.0016154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Accepted: 12/14/2010] [Indexed: 11/22/2022] Open
Abstract
A fundamental trait of the human self is its continuum experience of space and time. Perceptual aberrations of this spatial and temporal continuity is a major characteristic of schizophrenia spectrum disturbances – including schizophrenia, schizotypal personality disorder and schizotypy. We have previously found the classical Perceptual Aberration Scale (PAS) scores, related to body and space, to be positively correlated with both behavior and temporo-parietal activation in healthy participants performing a task involving self-projection in space. However, not much is known about the relationship between temporal perceptual aberration, behavior and brain activity. To this aim, we composed a temporal Perceptual Aberration Scale (tPAS) similar to the traditional PAS. Testing on 170 participants suggested similar performance for PAS and tPAS. We then correlated tPAS and PAS scores to participants' performance and neural activity in a task of self-projection in time. tPAS scores correlated positively with reaction times across task conditions, as did PAS scores. Evoked potential mapping and electrical neuroimaging showed self-projection in time to recruit a network of brain regions at the left anterior temporal cortex, right temporo-parietal junction, and occipito-temporal cortex, and duration of activation in this network positively correlated with tPAS and PAS scores. These data demonstrate that schizotypal perceptual aberrations of both time and space, as reflected by tPAS and PAS scores, are positively correlated with performance and brain activation during self-projection in time in healthy individuals along the schizophrenia spectrum.
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Affiliation(s)
- Shahar Arzy
- Laboratory of Cognitive Neuroscience, Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
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Wilquin H, Delevoye-Turrell Y, Ameller A, Wing AM, Thomas P. Production de rythmes dans la schizophrénie : un déficit de l’alternance de temps. ANNEE PSYCHOLOGIQUE 2010. [DOI: 10.3917/anpsy.104.0517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
CONTEXT Patients with schizophrenia have a high rate of cigarette smoking and also exhibit profound deficits in sensory processing, which may in part be ameliorated by the acute actions of smoke-inhaled nicotine. The mismatch negativity (MMN), a preattentive event-related potential index of auditory sensory memory, is diminished in schizophrenia. The MMN is increased in healthy controls with acute nicotine. OBJECTIVE To utilize the MMN to compare auditory sensory memory in minimally tobacco-deprived (3 hours) patients and matched tobacco-deprived smoking controls and to assess the effects of acute nicotine on MMN-indexed sensory memory processing in the patients. DESIGN Event-related potentials were recorded in 2 auditory oddball paradigms, one involving tone frequency changes (frequency MMN) and one involving tone duration changes (duration MMN). Controls were assessed once under nontreatment conditions, and patients were assessed twice under randomized double-blind treatment conditions involving placebo and nicotine (8 mg) gum. SETTING Outpatient mental health center. PATIENTS Twelve smokers with schizophrenia and twelve control smokers. RESULTS Compared with the controls, the patients showed reduced frequency-MMN (P < 0.001) and duration-MMN (P < 0.04) amplitudes. In addition to prolonging peak latency in duration MMN (P < 0.01), nicotine, relative to placebo, increased the amplitude of the patients' duration MMN (P < 0.01), but not their frequency MMN, to a level comparable with that seen in the controls. CONCLUSIONS These preliminary findings demonstrate for the first time that acute nicotine can normalize temporal aspects of sensory memory processing in patients with schizophrenia, an effect that may be mediated by activation of α7 nicotinic acetylcholine receptors, the function of which is diminished in schizophrenia. These ameliorating actions of nicotine may have implications for understanding the close relationship between tobacco smoking and schizophrenia and for developing nicotinic pharmacotherapies to alleviate sensory memory impairments in schizophrenia.
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Jones CRG, Jahanshahi M. The substantia nigra, the basal ganglia, dopamine and temporal processing. JOURNAL OF NEURAL TRANSMISSION. SUPPLEMENTUM 2010:161-71. [PMID: 20411776 DOI: 10.1007/978-3-211-92660-4_13] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
It has been proposed that the basal ganglia are important to the temporal processing of milliseconds- and seconds-range intervals, both within the motor and perceptual domains. This review summarizes and discuses evidence from animal, pharmacological, clinical, and imaging research that supports this proposal, with particular reference to the role of the substantia nigra (SN).
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Affiliation(s)
- Catherine R G Jones
- Department of Psychology and Human Development, Institute of Education, University of London, London, UK.
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Timing and time perception: A review of recent behavioral and neuroscience findings and theoretical directions. Atten Percept Psychophys 2010; 72:561-82. [PMID: 20348562 DOI: 10.3758/app.72.3.561] [Citation(s) in RCA: 503] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vicario CM, Martino D, Spata F, Defazio G, Giacchè R, Martino V, Rappo G, Pepi AM, Silvestri PR, Cardona F. Time processing in children with Tourette's syndrome. Brain Cogn 2010; 73:28-34. [PMID: 20189281 DOI: 10.1016/j.bandc.2010.01.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 01/26/2010] [Accepted: 01/29/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Tourette syndrome (TS) is characterized by dysfunctional connectivity between prefrontal cortex and sub-cortical structures, and altered meso-cortical and/or meso-striatal dopamine release. Since time processing is also regulated by fronto-striatal circuits and modulated by dopaminergic transmission, we hypothesized that time processing is abnormal in TS. METHODS We compared time processing abilities between nine children with TS-only (i.e. without major psychiatric comorbidities) and 10 age-matched healthy children, employing a time reproduction task in which subjects actively reproduce different temporal intervals, and a time comparison task in which subjects judge whether a test interval is longer or shorter than a reference interval. IQ, sustained and divided attention, and working memory were assessed in both groups using the Leiter International Performance Scale-Revised, and the Digit Span sub-test of the WISC-R. RESULTS Children with TS-only reproduced in an overestimated fashion over-second, but not sub-second, time intervals. The precision of over-second intervals reproduction correlated with tic severity, in that the lower the tic severity, the closer the reproduction of over-second time intervals to their real duration. Time reproduction performance did not significantly correlate with IQ, attention and working memory measures in both groups. No differences between groups were documented in the time comparison task. CONCLUSIONS The improvement of time processing in children with TS-only seems specific for the over-second range of intervals, consistent with an enhancement in the 'cognitively controlled' timing system, which mainly processes longer duration intervals, and depends upon dysfunctional connectivity between the basal ganglia and the dorso-lateral prefrontal cortex. The absence of between-group differences on time comparison, moreover, suggests that TS patients manifest a selective improvement of 'motor' timing abilities, rather than of perceptual time abilities. Our data also support an enhancement of cognitive control processes in TS children, probably facilitated by effortful tic suppression.
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Martin JS, Poirier M, Bowler DM. Brief Report: Impaired Temporal Reproduction Performance in Adults with Autism Spectrum Disorder. J Autism Dev Disord 2009; 40:640-6. [PMID: 19924521 DOI: 10.1007/s10803-009-0904-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ward RD, Kellendonk C, Simpson EH, Lipatova O, Drew MR, Fairhurst S, Kandel ER, Balsam PD. Impaired timing precision produced by striatal D2 receptor overexpression is mediated by cognitive and motivational deficits. Behav Neurosci 2009; 123:720-30. [PMID: 19634929 DOI: 10.1037/a0016503] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Increased striatal dopamine D2 receptor activity is thought to contribute to the pathophysiology of schizophrenia. To model this condition in mice, Kellendonk et al. (2006) generated transgenic mice that selectively overexpress the D2 receptor in striatum (D2OE). Drew et al. (2007) reported that D2OE mice display deficits in interval timing and motivation. The present study further explored the impaired timing in D2OE mice. Experiment 1 assessed the role of motivation in producing timing deficits in the peak procedure and found that performance in D2OE mice was improved by increasing motivation. In addition, performance was impaired in control mice when motivation was decreased. In Experiment 2, we found that D2OE mice have no timing impairment when tested using the bisection task, a procedure in which the measure of timing performance is less influenced by motivation to respond. In Experiment 3, we also used the bisection task and found selective impairment in timing of long durations in D2OE mice. These results suggest that striatal D2 overexpression impairs timing by decreasing motivation and through its impact on working memory and/or sustained attention.
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Affiliation(s)
- Ryan D Ward
- Department of Psychiatry, Columbia University, NY State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
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Waters F, Jablensky A. Time discrimination deficits in schizophrenia patients with first-rank (passivity) symptoms. Psychiatry Res 2009; 167:12-20. [PMID: 19339057 DOI: 10.1016/j.psychres.2008.04.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 03/30/2008] [Accepted: 04/05/2008] [Indexed: 11/29/2022]
Abstract
Schizophrenia patients with first-rank (passivity) symptoms (FRS) report a loss of clear boundaries between the self and others and that their thoughts and actions are controlled by external forces. One of the more widely accepted explanatory models of FRS suggests a dysfunction in the 'forward model' system, whose role consists in predicting the sensory consequences of actions [Frith, C., 2006. The neural basis of hallucinations and delusions. Comptes Rendus Biologies 328, 169-175.]. There has been recent interest in the importance of timing precision underlying both the functioning of the forward model, and in processes contributing to the mechanisms of self-recognition [Haggard, P., Martin, F., Taylor-Clarke, M., Jeannerod, M., Franck, N., 2003. Awareness of action in schizophrenia. Neuroreport 14, 1081-1085.]. In the current study, we examined whether schizophrenia patients with FRS have a time perception impairment, using an auditory discrimination task requiring judgments of temporal intervals. Thirty-five schizophrenia patients (15 with, and 20 without, FRS), and 16 non-clinical controls completed the task. The results showed that patients with FRS experienced time differently by underestimating the duration of time intervals. Given the role of timing in shaping sensory awareness and in the formation of causal mental associations, a breakdown in timing mechanisms may affect the processes relating to the perceived control of actions and mental events, leading to disturbances of self-recognition in FRS.
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Affiliation(s)
- Flavie Waters
- Centre for Clinical Research in Neuropsychiatry, Claremont, Perth, Australia.
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