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Ballerini A, Tortorelli M, Marino P, Appignanesi C, Baschirotto C, Mallardo L, Tofani T, Pietrini F, D'Anna G, Rossi A, Ricca V, Santella M. Aberrant salience relationship with first rank symptoms. Ann Gen Psychiatry 2022; 21:8. [PMID: 35172844 PMCID: PMC8851729 DOI: 10.1186/s12991-022-00383-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 12/26/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Aberrant salience is the incorrect assignment of salience, significance, or value to different innocuous stimuli that might precede the onset of psychotic symptoms. The present study aimed to perform a preliminary evaluation of potentially different correlations between the Aberrant Salience Inventory (ASI) score and dimensional or categorical diagnostic approaches. METHODS 168 adult outpatients with a current psychiatric diagnosis were consecutively enrolled. Patients were evaluated using different psychometric scales. ASI was used to evaluate aberrant salience, and to evaluate the association between ASI scores and first rank symptoms (FRS), and/or with a psychiatric diagnosis. Principal dichotomic clusters of ASI were identified using the Chi-square automatic interaction detection (CHAID) method. RESULTS Current (16.76 ± 6.02 vs 13.37 ± 5.76; p = 0.001), lifetime (15.74 ± 6.08 vs 13.16 ± 5.74; p = 0.005) and past (15.75 ± 6.01 vs 13.33 ± 5.80; p = 0.009) FRS were the main clusters dichotomizing ASI. The average ASI score did not significantly differ among patients with different diagnoses. CONCLUSIONS ASI could be used as a tool to identify psychopathological dimensions, rather than the categorical diagnoses, in the schizophrenic spectrum.
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Affiliation(s)
- Andrea Ballerini
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Marta Tortorelli
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Paolo Marino
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Cristina Appignanesi
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Cinzia Baschirotto
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Luca Mallardo
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Tommaso Tofani
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesco Pietrini
- Department of Mental Health and Addictions, Central Tuscany NHS Trust, Florence, Italy
| | - Giulio D'Anna
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Rossi
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Marina Santella
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Abstract
Perceptual disturbances in psychosis, such as auditory verbal hallucinations, are associated with increased baseline activity in the associative auditory cortex and increased dopamine transmission in the associative striatum. Perceptual disturbances are also associated with perceptual biases that suggest increased reliance on prior expectations. We review theoretical models of perceptual inference and key supporting physiological evidence, as well as the anatomy of associative cortico-striatal loops that may be relevant to auditory perceptual inference. Integrating recent findings, we outline a working framework that bridges neurobiology and the phenomenology of perceptual disturbances via theoretical models of perceptual inference.
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Gross ME, Araujo DB, Zedelius CM, Schooler JW. Is perception the missing link between creativity, curiosity and schizotypy? Evidence from spontaneous eye-movements and responses to auditory oddball stimuli. Neuroimage 2019; 202:116125. [DOI: 10.1016/j.neuroimage.2019.116125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/01/2019] [Accepted: 08/23/2019] [Indexed: 11/25/2022] Open
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Animal models in addiction research: A dimensional approach. Neurosci Biobehav Rev 2018; 106:91-101. [PMID: 30309630 DOI: 10.1016/j.neubiorev.2018.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/13/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
Drug addiction affects approximately 10% of the population and these numbers are rising. Treatment and prevention of addiction are impeded by current diagnostic systems, such as DSM-5, which are based on outcomes rather than processes. Here, we review the importance of adopting a dimensional framework, specifically the Research Domain Criteria (RDoC), to identify protective and vulnerability mechanisms in addiction. We discuss how preclinical researchers should work within this framework to develop animal models based on domains of function. We highlight RDoC paradigms related to addiction and discuss how these can be used to investigate the biological underpinnings of an addiction cycle (i.e., binge/intoxication, negative affect, and craving). Using this information, we then outline the critical role of animal research in ongoing revisions to the RDoC matrix (specifically the functional significance of domains, constructs and subconstructs) and its contribution to the development and refinement of addiction theories. We conclude with an overview of the contribution that animal research has made to the development of pharmacological and behavioural treatments for addiction.
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Knolle F, Ermakova AO, Justicia A, Fletcher PC, Bunzeck N, Düzel E, Murray GK. Brain responses to different types of salience in antipsychotic naïve first episode psychosis: An fMRI study. Transl Psychiatry 2018; 8:196. [PMID: 30242202 PMCID: PMC6154975 DOI: 10.1038/s41398-018-0250-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/16/2018] [Accepted: 07/24/2018] [Indexed: 02/07/2023] Open
Abstract
Abnormal salience processing has been suggested to contribute to the formation of positive psychotic symptoms in schizophrenia and related conditions. Previous research utilising reward learning or anticipation paradigms has demonstrated cortical and subcortical abnormalities in people with psychosis, specifically in the prefrontal cortex, the dopaminergic midbrain and the striatum. In these paradigms, reward prediction errors attribute motivational salience to stimuli. However, little is known about possible abnormalities across different forms of salience processing in psychosis patients, and whether any such abnormalities involve the dopaminergic midbrain. The aim of our study was, therefore, to investigate possible alterations in psychosis in neural activity in response to various forms of salience: novelty, negative emotion, targetness (task-driven salience) and rareness/deviance. We studied 14 antipsychotic naïve participants with first episode psychosis, and 37 healthy volunteers. During fMRI scanning, participants performed a visual oddball task containing these four forms of salience. Psychosis patients showed abnormally reduced signalling in the substantia nigra/ventral tegmental area (SN/VTA) for novelty, negative emotional salience and targetness; reduced striatal and occipital (lingual gyrus) signalling to novelty and negative emotional salience, reduced signalling in the amygdala, anterior cingulate cortex and parahippocamal gyrus to negative emotional salience, and reduced cerebellar signalling to novelty and negative emotional salience. Our results indicate alterations of several forms of salience processing in patients with psychosis in the midbrain SN/VTA, with additional subcortical and cortical regions also showing alterations in salience signalling, the exact pattern of alterations depending on the form of salience in question.
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Affiliation(s)
- Franziska Knolle
- Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.
| | - Anna O Ermakova
- Unit for Social & Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, East London NHS Foundation Trust, Cambridge, UK
| | - Azucena Justicia
- Unit for Social & Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, East London NHS Foundation Trust, Cambridge, UK
- IMIM (Hospital del Mar Medical Research Institute)., Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Paul C Fletcher
- Unit for Social & Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, East London NHS Foundation Trust, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Nico Bunzeck
- Institute of Psychology, University of Lübeck, Lübeck, Germany
| | - Emrah Düzel
- Otto-von-Guericke University Magdeburg, Institute of Cognitive Neurology and Dementia Research, Magdeburg, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Graham K Murray
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Unit for Social & Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, East London NHS Foundation Trust, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Grimm O, Löffler M, Kamping S, Hartmann A, Rohleder C, Leweke M, Flor H. Probing the endocannabinoid system in healthy volunteers: Cannabidiol alters fronto-striatal resting-state connectivity. Eur Neuropsychopharmacol 2018; 28:841-849. [PMID: 29887287 DOI: 10.1016/j.euroneuro.2018.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 04/25/2018] [Accepted: 04/30/2018] [Indexed: 01/08/2023]
Abstract
Tetrahydrocannabinol (THC) and Cannabidiol (CBD) are two substances from cannabis sativa that have beenimplicated in the treatment of mental and neurological disorders. We concentrated on a previously validated neuroimaging phenotype, fronto-striatal connectivity across different striatal seeds, because of this loop's relevance to executive functioning, decision making, salience generation and motivation and its link to various neuropsychiatric conditions. Therefore, we studied the effect of THC and CBD on fronto-striatal circuitry by a seed-voxel connectivity approach using seeds from the caudate and the putamen. We conducted a cross-over pharmaco-fMRI study in 16 healthy male volunteers with placebo, 10 mg oral THC and 600 mg oral CBD. Resting state was measured in a 3 T scanner. CBD lead to an increase of fronto-striatal connectivity in comparison to placebo. In contrast to our expectation that THC and CBD show opposing effects, THC versus placebo did not show any significant effects, probably due to insufficient concentration of THC during scanning. The effect of CBD on enhancing fronto-striatal connectivity is of interest because it might be a neural correlate of its anti-psychotic effect in patients.
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Affiliation(s)
- Oliver Grimm
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt am Main, Germany
| | - Martin Löffler
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Sandra Kamping
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany; Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Aljoscha Hartmann
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Cathrin Rohleder
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Markus Leweke
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
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Abstract
OBJECTIVE The relationship between cannabis use and the onset of psychosis is well established. Aberrant salience processing is widely thought to underpin many of these symptoms. Literature explicitly investigating the relationship between aberrant salience processing and cannabis use is scarce; with those few studies finding that acute tetrahydrocannabinol (THC) administration (the main psychoactive component of cannabis) can result in abnormal salience processing in healthy cohorts, mirroring that observed in psychosis. Nevertheless, the extent of and mechanisms through which cannabis has a modulatory effect on aberrant salience, following both acute and chronic use, remain unclear. METHODS Here, we systematically review recent findings on the effects of cannabis use - either through acute THC administration or in chronic users - on brain regions associated with salience processing (through functional MRI data); and performance in cognitive tasks that could be used as either direct or indirect measures of salience processing. We identified 13 studies either directly or indirectly exploring salience processing. Three types of salience were identified and discussed - incentive/motivational, emotional/affective, and attentional salience. RESULTS The results demonstrated an impairment of immediate salience processing, following acute THC administration. Amongst the long-term cannabis users, normal salience performance appeared to be underpinned by abnormal neural processes. CONCLUSIONS Overall, the lack of research specifically exploring the effects of cannabis use on salience processing, weaken any conclusions drawn. Additional research explicitly focussed on salience processing and cannabis use is required to advance our understanding of the neurocognitive mechanisms underlying the association between cannabis use and development of psychosis.
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Blessing WW, Blessing EM, Mohammed M, Ootsuka Y. Clozapine, chlorpromazine and risperidone dose-dependently reduce emotional hyperthermia, a biological marker of salience. Psychopharmacology (Berl) 2017; 234:3259-3269. [PMID: 28812124 PMCID: PMC5660844 DOI: 10.1007/s00213-017-4710-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/02/2017] [Indexed: 10/27/2022]
Abstract
RATIONALE We recently introduced a new rat model of emotional hyperthermia in which a salient stimulus activates brown adipose tissue (BAT) thermogenesis and tail artery constriction. Antipsychotic drugs, both classical and second generation, act to reduce excessive assignment of salience to objects and events in the external environment. The close association between salient occurrences and increases in body temperature suggests that antipsychotic drugs may also reduce emotional hyperthermia. OBJECTIVES We determined whether chlorpromazine, clozapine, and risperidone dose dependently reduce emotionally elicited increases in BAT thermogenesis, cutaneous vasoconstriction, and body temperature in rats. METHODS Rats, chronically instrumented for measurement of BAT and body temperature and tail artery blood flow, singly housed, were confronted with an intruder rat (confined within a small wire-mesh cage) after systemic pre-treatment of the resident rat with vehicle or antipsychotic agent. BAT and body temperatures, tail blood flow, and behavioral activity were continuously measured. RESULTS Clozapine (30 μg-2 mg/kg), chlorpromazine (0.1-5 mg/kg), and risperidone (6.25 μg-1 mg/kg) robustly and dose-relatedly reduced intruder-elicited BAT thermogenesis and tail artery vasoconstriction, with consequent dose-related reduction in emotional hyperthermia. CONCLUSIONS Chlorpromazine, a first-generation antipsychotic, as well as clozapine and risperidone, second-generation agents, dose-dependently reduce emotional hyperthermia. Dopamine D2 receptor antagonist properties of chlorpromazine do not contribute to thermoregulatory effects. Interactions with monoamine receptors are important, and these monoamine receptor interactions may also contribute to the therapeutic effects of all three antipsychotics. Thermoregulatory actions of putative antipsychotic agents may constitute a biological marker of their therapeutic properties.
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Affiliation(s)
- William W Blessing
- Center for Neuroscience, Department of Human Physiology, Flinders University, Adelaide, SA, Australia.
| | - Esther M Blessing
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Mazher Mohammed
- Center for Neuroscience, Department of Human Physiology, Flinders University, Adelaide, SA, Australia
| | - Youichirou Ootsuka
- Center for Neuroscience, Department of Human Physiology, Flinders University, Adelaide, SA, Australia
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Walter A, Suenderhauf C, Smieskova R, Lenz C, Harrisberger F, Schmidt A, Vogel T, Lang UE, Riecher-Rössler A, Eckert A, Borgwardt S. Altered Insular Function during Aberrant Salience Processing in Relation to the Severity of Psychotic Symptoms. Front Psychiatry 2016; 7:189. [PMID: 27933003 PMCID: PMC5120113 DOI: 10.3389/fpsyt.2016.00189] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/09/2016] [Indexed: 12/31/2022] Open
Abstract
There is strong evidence for abnormal salience processing in patients with psychotic experiences. In particular, there are indications that the degree of aberrant salience processing increases with the severity of positive symptoms. The aim of the present study was to elucidate this relationship by means of brain imaging. Functional magnetic resonance imaging was acquired to assess hemodynamic responses during the Salience Attribution Test, a paradigm for reaction time that measures aberrant salience to irrelevant stimulus features. We included 42 patients who were diagnosed as having a psychotic disorder and divided them into two groups according to the severity of their positive symptoms. Whole brain analysis was performed using Statistical Parametric Mapping. We found no significant behavioral differences with respect to task performance. Patients with more positive symptoms showed increased hemodynamic responses in the left insula corresponding to aberrant salience than in patients with less positive symptoms. In addition, left insula activation correlated negatively with cumulative antipsychotic medication. Aberrant salience processing in the insula may be increased in psychosis, depending on the severity of positive symptoms. This study indicates that clinically similar psychosis manifestations share the same functional characteristics. In addition, our results suggest that antipsychotic medication can modulate insular function.
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Affiliation(s)
- Anna Walter
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | | | - Renata Smieskova
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Claudia Lenz
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | | | - André Schmidt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Tobias Vogel
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Undine E. Lang
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | | | - Anne Eckert
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
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Smieskova R, Roiser JP, Chaddock CA, Schmidt A, Harrisberger F, Bendfeldt K, Simon A, Walter A, Fusar-Poli P, McGuire PK, Lang UE, Riecher-Rössler A, Borgwardt S. Modulation of motivational salience processing during the early stages of psychosis. Schizophr Res 2015; 166:17-23. [PMID: 25999039 DOI: 10.1016/j.schres.2015.04.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 04/15/2015] [Accepted: 04/27/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Deficits in motivational salience processing have been related to psychotic symptoms and disturbances in dopaminergic neurotransmission. We aimed at exploring changes in salience processing and brain activity during different stages of psychosis and antipsychotic medication effect. METHODS We used fMRI during the Salience Attribution Task to investigate hemodynamic differences between 19 healthy controls (HCs), 34 at-risk mental state (ARMS) individuals and 29 individuals with first-episode psychosis (FEP), including a subgroup of 17 FEP without antipsychotic medication (FEP-UM) and 12 FEP with antipsychotic medication (FEP-M). Motivational salience processing was operationalized by brain activity in response to high-probability rewarding cues (adaptive salience) and in response to low-probability rewarding cues (aberrant salience). RESULTS Behaviorally, adaptive salience response was not accelerated in FEP, although they correctly distinguished between trials with low and high reward probability. In comparison to HC, ARMS exhibited a lower hemodynamic response during adaptive salience in the right inferior parietal lobule and FEP-UM in the left dorsal cingulate gyrus. The FEP-M group exhibited a lower adaptive salience response than HC in the right insula and than ARMS in the anterior cingulate gyrus. In unmedicated individuals, the severity of hallucinations and delusions correlated negatively with the insular- and anterior cingulate hemodynamic response during adaptive salience. We found no differences in aberrant salience processing associated with behavior or medication. CONCLUSION The changes in adaptive motivational salience processing during psychosis development reveal neurofunctional abnormalities in the somatosensory and premotor cortex. Antipsychotic medication seems to modify hemodynamic responses in the anterior cingulate and insula.
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Affiliation(s)
- Renata Smieskova
- Psychiatric University Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, Basel, Switzerland; Medical Image Analysis Center, University Hospital Basel, Switzerland
| | | | | | - André Schmidt
- Psychiatric University Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, Basel, Switzerland; Medical Image Analysis Center, University Hospital Basel, Switzerland
| | - Fabienne Harrisberger
- Psychiatric University Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, Basel, Switzerland; Medical Image Analysis Center, University Hospital Basel, Switzerland
| | - Kerstin Bendfeldt
- Medical Image Analysis Center, University Hospital Basel, Switzerland
| | - Andor Simon
- Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, Bruderholz, Switzerland
| | - Anna Walter
- Psychiatric University Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, Basel, Switzerland
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - Philip K McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - Undine E Lang
- Psychiatric University Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, Basel, Switzerland
| | - Anita Riecher-Rössler
- Psychiatric University Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, Basel, Switzerland
| | - Stefan Borgwardt
- Psychiatric University Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, Basel, Switzerland; Medical Image Analysis Center, University Hospital Basel, Switzerland; Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
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Bhattacharyya S, Falkenberg I, Martin-Santos R, Atakan Z, Crippa JA, Giampietro V, Brammer M, McGuire P. Cannabinoid modulation of functional connectivity within regions processing attentional salience. Neuropsychopharmacology 2015; 40:1343-52. [PMID: 25249057 PMCID: PMC4397391 DOI: 10.1038/npp.2014.258] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 05/18/2014] [Accepted: 06/12/2014] [Indexed: 12/31/2022]
Abstract
There is now considerable evidence to support the hypothesis that psychotic symptoms are the result of abnormal salience attribution, and that the attribution of salience is largely mediated through the prefrontal cortex, the striatum, and the hippocampus. Although these areas show differential activation under the influence of delta-9-tetrahydrocannabinol (delta-9-THC) and cannabidiol (CBD), the two major derivatives of cannabis sativa, little is known about the effects of these cannabinoids on the functional connectivity between these regions. We investigated this in healthy occasional cannabis users by employing event-related functional magnetic resonance imaging (fMRI) following oral administration of delta-9-THC, CBD, or a placebo capsule. Employing a seed cluster-based functional connectivity analysis that involved using the average time series from each seed cluster for a whole-brain correlational analysis, we investigated the effect of drug condition on functional connectivity between the seed clusters and the rest of the brain during an oddball salience processing task. Relative to the placebo condition, delta-9-THC and CBD had opposite effects on the functional connectivity between the dorsal striatum, the prefrontal cortex, and the hippocampus. Delta-9-THC reduced fronto-striatal connectivity, which was related to its effect on task performance, whereas this connection was enhanced by CBD. Conversely, mediotemporal-prefrontal connectivity was enhanced by delta-9-THC and reduced by CBD. Our results suggest that the functional integration of brain regions involved in salience processing is differentially modulated by single doses of delta-9-THC and CBD and that this relates to the processing of salient stimuli.
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Affiliation(s)
- Sagnik Bhattacharyya
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, UK,Department of Psychosis Studies, Psychosis Clinical Academic Group, King's College London, Institute of Psychiatry, 6th Floor, Main Building, PO Box 067, De Crespigny Park, London SE5 8AF, UK, Tel: +44 (0)20 78480955, Fax: +44 (0)20 78480976, E-mail:
| | - Irina Falkenberg
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, UK,Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Rocio Martin-Santos
- Instituto de Investigaciones Biomedicas August Pi i Sunyer (IDIBAPS), and Centro de Investigación Biomedica en Red en Salud Mental (CIBERSAM), Barcelona, Spain,Department of Psychiatry and Psychology, Hospital Clinic, University of Barcelona, Barcelona, Spain,INCT Translational Medicine (CNPq), Rio de Janeiro, Brazil
| | - Zerrin Atakan
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, UK
| | - Jose A Crippa
- INCT Translational Medicine (CNPq), Rio de Janeiro, Brazil,Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Vincent Giampietro
- Department of Neuroimaging, King's College London, Institute of Psychiatry, London, UK
| | - Mick Brammer
- Department of Neuroimaging, King's College London, Institute of Psychiatry, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, UK
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Klosterkötter J. The usefulness for indicated prevention of severe mental disorders should play a central part in the further development of CBT. World Psychiatry 2014; 13:259-60. [PMID: 25273296 PMCID: PMC4219064 DOI: 10.1002/wps.20163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Thase ME, Kingdon D, Turkington D. The promise of cognitive behavior therapy for treatment of severe mental disorders: a review of recent developments. World Psychiatry 2014; 13:244-50. [PMID: 25273290 PMCID: PMC4219058 DOI: 10.1002/wps.20149] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cognitive behavior therapy (CBT), as exemplified by the model of psychotherapy developed and refined over the past 40 years by A.T. Beck and colleagues, is one of the treatments of first choice for ambulatory depressive and anxiety disorders. Over the past several decades, there have been vigorous efforts to adapt CBT for treatment of more severe mental disorders, including schizophrenia and the more chronic and/or treatment refractory mood disorders. These efforts have primarily studied CBT as an adjunctive therapy, i.e., in combination with pharmacotherapy. Given the several limitations of state-of-the-art pharmacotherapies for these severe mental disorders, demonstration of clinically meaningful additive effects for CBT would have important implications for improving public health. This paper reviews the key developments in this important area of therapeutics, providing a summary of the current state of the art and suggesting directions for future research.
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Affiliation(s)
- Michael E Thase
- Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Affairs Medical Center3535 Market St., Philadelphia, PA, 19104, USA
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Bustillo JR, Chen H, Jones T, Lemke N, Abbott C, Qualls C, Canive J, Gasparovic C. Increased glutamine in patients undergoing long-term treatment for schizophrenia: a proton magnetic resonance spectroscopy study at 3 T. JAMA Psychiatry 2014; 71:265-72. [PMID: 24402128 PMCID: PMC8185982 DOI: 10.1001/jamapsychiatry.2013.3939] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE The N-methyl-d-aspartic acid receptor hypofunction model of schizophrenia predicts a paradoxical increase in synaptic glutamate release. In vivo measurement of glutamatergic neurotransmission in humans is challenging, but glutamine, the principal metabolite of synaptic glutamate, can be quantified with proton magnetic resonance spectroscopy (1H-MRS). Although a few studies have measured glutamate, glutamine, and glutamine to glutamate ratio, it is not clear which of these 1H-MRS indices of glutamatergic neurotransmission is altered in schizophrenia. OBJECTIVE To examine glutamine, glutamate, and glutamine to glutamate ratio in the dorsal anterior cingulate, as well as their relationships with symptoms and cognition in schizophrenia. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional design using 3-T 1H-MRS in participants recruited from university-based psychiatric outpatient clinics who underwent neuroimaging at an affiliated research facility. Participants were 84 patients with a DSM-IV-TR diagnosis of schizophrenia and 81 psychiatrically healthy volunteers, matched in age, sex, ethnicity, and occupational level to the head of household of family of origin. MAIN OUTCOMES AND MEASURES Glutamine, glutamate, and glutamine to glutamate ratio. Also symptoms and cognition. RESULTS Glutamine was increased in the schizophrenia group (P = .01) as well as the glutamine to glutamate ratio (P = .007) but not glutamate (P = .89). Glutamine levels were positively correlated with severity of psychotic symptoms (P = .02). Choline was also increased in schizophrenia (P = .002). CONCLUSIONS AND RELEVANCE Elevated glutamine, which was directly related to psychotic symptoms, is consistent with increased glutamatergic synaptic release in schizophrenia, as predicted by the N-methyl-d-aspartic acid receptor hypofunction model. Further understanding the underlying mechanism of glutamatergic dysfunction in schizophrenia may lead to new pharmacological strategies to treat psychosis.
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Affiliation(s)
- Juan R. Bustillo
- Department of Psychiatry, University of New Mexico, Albuquerque; Department of Neurosciences, University of New Mexico, Albuquerque
| | - Hongji Chen
- Department of Psychiatry, University of New Mexico, Albuquerque
| | - Thomas Jones
- Department of Psychiatry, University of New Mexico, Albuquerque
| | - Nicholas Lemke
- Department of Psychiatry, University of New Mexico, Albuquerque
| | | | - Clifford Qualls
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque
| | - Jose Canive
- Department of Psychiatry, University of New Mexico, Albuquerque; Department of Neurosciences, University of New Mexico, Albuquerque; Veterans Administration Health Care System, Albuquerque, New Mexico
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Esslinger C, Braun U, Schirmbeck F, Santos A, Meyer-Lindenberg A, Zink M, Kirsch P. Activation of midbrain and ventral striatal regions implicates salience processing during a modified beads task. PLoS One 2013; 8:e58536. [PMID: 23484034 PMCID: PMC3590224 DOI: 10.1371/journal.pone.0058536] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 02/07/2013] [Indexed: 12/02/2022] Open
Abstract
Introduction Metacognition, i.e. critically reflecting on and monitoring one’s own reasoning, has been linked behaviorally to the emergence of delusions and is a focus of cognitive therapy in patients with schizophrenia. However, little is known about the neural processing underlying metacognitive function. To address this issue, we studied brain activity during a modified beads task which has been used to measure a “Jumping to Conclusions” (JTC) bias in schizophrenia patients. Methods We used functional magnetic resonance imaging to identify neural systems active in twenty-five healthy subjects when solving a modified version of the “beads task”, which requires a probabilistic decision after a variable amount of data has been requested by the participants. We assessed brain activation over the duration of a trial and at the time point of decision making. Results Analysis of activation during the whole process of probabilistic reasoning showed an extended network including the prefronto-parietal executive functioning network as well as medial parieto-occipital regions. During the decision process alone, activity in midbrain and ventral striatum was detected, as well as in thalamus, medial occipital cortex and anterior insula. Conclusions Our data show that probabilistic reasoning shares neural substrates with executive functions. In addition, our finding that brain regions commonly associated with salience processing are active during probabilistic reasoning identifies a candidate mechanism that could underlie the behavioral link between dopamine-dependent aberrant salience and JTC in schizophrenia. Further studies with delusional schizophrenia patients will have to be performed to substantiate this link.
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Affiliation(s)
- Christine Esslinger
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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Ventral striatal activation during attribution of stimulus saliency and reward anticipation is correlated in unmedicated first episode schizophrenia patients. Schizophr Res 2012; 140:114-21. [PMID: 22784688 DOI: 10.1016/j.schres.2012.06.025] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 05/31/2012] [Accepted: 06/18/2012] [Indexed: 11/23/2022]
Abstract
Patients with schizophrenia show deficits in motivation, reward anticipation and salience attribution. Several functional magnetic resonance imaging (fMRI) investigations revealed neurobiological correlates of these deficits, raising the hypothesis of a common basis in midbrain dopaminergic signaling. However, investigations of drug-naïve first-episode patients with comprehensive fMRI tasks are still missing. We recruited unmedicated schizophrenia spectrum patients (N=27) and healthy control subjects (N=27) matched for sex, age and educational levels. An established monetary reward anticipation task in combination with a novel task aiming at implicit salience attribution without the confound of monetary incentive was applied. Patients showed reduced right ventral striatal activation during reward anticipation. Furthermore, patients with a more pronounced hypoactivation attributed more salience to neutral stimuli, had more positive symptoms and better executive functioning. In the patient group, a more differentially active striatum during reward anticipation was correlated positively to differential ventral striatal activation in the implicit salience attribution task. In conclusion, a deficit in ventral striatal activation during reward anticipation can already be seen in drug-naïve, first episode schizophrenia patients. The data suggest that rather a deficit in differential ventral striatal activation than a generally reduced activation underlies motivational deficits in schizophrenia and that this deficit is related to the aberrant salience attribution.
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Collip D, Oorschot M, Thewissen V, Van Os J, Bentall R, Myin-Germeys I. Social world interactions: how company connects to paranoia. Psychol Med 2011; 41:911-921. [PMID: 20735885 DOI: 10.1017/s0033291710001558] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Experimental studies have indicated that social contact, even when it is neutral, triggers paranoid thinking in people who score high on clinical or subclinical paranoia. We investigated whether contextual variables are predictive of momentary increases in the intensity of paranoid thinking in a sample of participants ranging across a psychometric paranoia continuum. METHOD The sample (n=154) consisted of 30 currently paranoid patients, 34 currently non-paranoid patients, 15 remitted psychotic patients, 38 high-schizotypy participants, and 37 control subjects. Based on their total score on Fenigstein's Paranoia Scale (PS), three groups with different degrees of paranoia were defined. The Experience Sampling Method (ESM), a structured diary technique, was used to assess momentary social context, perceived social threat and paranoia in daily life. RESULTS There were differences in the effect of social company on momentary levels of paranoia and perceived social threat across the range of trait paranoia. The low and medium paranoia groups reported higher levels of perceived social threat when they were with less-familiar compared to familiar individuals. The medium paranoia group reported more paranoia in less-familiar company. The high paranoia group reported no difference in the perception of social threat or momentary paranoia between familiar and unfamiliar contacts. CONCLUSIONS Paranoid thinking is context dependent in individuals with medium or at-risk levels of trait paranoia. Perceived social threat seems to be context dependent in the low paranoia group. However, at high levels of trait paranoia, momentary paranoia and momentary perceived social threat become autonomous and independent of social reality.
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Affiliation(s)
- D Collip
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
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Schmidt K, Roiser JP. Assessing the construct validity of aberrant salience. Front Behav Neurosci 2009; 3:58. [PMID: 20057930 PMCID: PMC2802547 DOI: 10.3389/neuro.08.058.2009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 12/03/2009] [Indexed: 11/18/2022] Open
Abstract
We sought to validate the psychometric properties of a recently developed paradigm that aims to measure salience attribution processes proposed to contribute to positive psychotic symptoms, the Salience Attribution Test (SAT). The “aberrant salience” measure from the SAT showed good face validity in previous results, with elevated scores both in high-schizotypy individuals, and in patients with schizophrenia suffering from delusions. Exploring the construct validity of salience attribution variables derived from the SAT is important, since other factors, including latent inhibition/learned irrelevance (LIrr), attention, probabilistic reward learning, sensitivity to probability, general cognitive ability and working memory could influence these measures. Fifty healthy participants completed schizotypy scales, the SAT, a LIrr task, and a number of other cognitive tasks tapping into potentially confounding processes. Behavioural measures of interest from each task were entered into a principal components analysis, which yielded a five-factor structure accounting for ∼75% of the variance in behaviour. Implicit aberrant salience was found to load onto its own factor, which was associated with elevated “Introvertive Anhedonia” schizotypy, replicating our previous finding. LIrr loaded onto a separate factor, which also included implicit adaptive salience, but was not associated with schizotypy. Explicit adaptive and aberrant salience, along with a measure of probabilistic learning, loaded onto a further factor, though this also did not correlate with schizotypy. These results suggest that the measures of LIrr and implicit adaptive salience might be based on similar underlying processes, which are dissociable both from implicit aberrant salience and explicit measures of salience.
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Affiliation(s)
- Kristin Schmidt
- Institute of Cognitive Neuroscience, University College London London, UK
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Glutaminase-deficient mice display hippocampal hypoactivity, insensitivity to pro-psychotic drugs and potentiated latent inhibition: relevance to schizophrenia. Neuropsychopharmacology 2009; 34:2305-22. [PMID: 19516252 PMCID: PMC2811085 DOI: 10.1038/npp.2009.58] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Dysregulated glutamatergic neurotransmission has been strongly implicated in the pathophysiology of schizophrenia (SCZ). Recently, presynaptic modulation of glutamate transmission has been shown to have therapeutic promise. We asked whether genetic knockdown of glutaminase (gene GLS1) to reduce glutamatergic transmission presynaptically by slowing the recycling of glutamine to glutamate, would produce a phenotype relevant to SCZ and its treatment. GLS1 heterozygous (GLS1 het) mice showed about a 50% global reduction in glutaminase activity, and a modest reduction in glutamate levels in brain regions relevant to SCZ pathophysiology, but displayed neither general behavioral abnormalities nor SCZ-associated phenotypes. Functional imaging, measuring regional cerebral blood volume, showed hippocampal hypometabolism mainly in the CA1 subregion and subiculum, the inverse of recent clinical imaging findings in prodromal and SCZ patients. GLS1 het mice were less sensitive to the behavioral stimulating effects of amphetamine, showed a reduction in amphetamine-induced striatal dopamine release and in ketamine-induced frontal cortical activation, suggesting that GLS1 het mice are resistant to the effects of these pro-psychotic challenges. Moreover, GLS1 het mice showed clozapine-like potentiation of latent inhibition, suggesting that reduction in glutaminase has antipsychotic-like properties. These observations provide further support for the pivotal role of altered glutamatergic synaptic transmission in the pathophysiology of SCZ, and suggest that presynaptic modulation of the glutamine-glutamate pathway through glutaminase inhibition may provide a new direction for the pharmacotherapy of SCZ.
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