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Sehatpour P, Iosifescu DV, De Baun HM, Shope C, Mayer MR, Gangwisch J, Dias E, Sobeih T, Choo TH, Wall MM, Medalia A, Saperstein AM, Kegeles LS, Girgis RR, Carlson M, Kantrowitz JT. Dose-Dependent Augmentation of Neuroplasticity-Based Auditory Learning in Schizophrenia: A Double-Blind, Placebo-Controlled, Randomized, Target Engagement Clinical Trial of the NMDA Glutamate Receptor Agonist d-serine. Biol Psychiatry 2023; 94:164-173. [PMID: 36958998 PMCID: PMC10313776 DOI: 10.1016/j.biopsych.2023.01.015] [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: 08/10/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Patients with schizophrenia show reduced NMDA glutamate receptor-dependent auditory plasticity, which is rate limiting for auditory cognitive remediation (AudRem). We evaluate the utility of behavioral and neurophysiological pharmacodynamic target engagement biomarkers, using a d-serine+AudRem combination. METHODS Forty-five participants with schizophrenia or schizoaffective disorder were randomized to 3 once-weekly AudRem visits + double-blind d-serine (80, 100, or 120 mg/kg) or placebo in 3 dose cohorts of 12 d-serine and 3 placebo-treated participants each. In AudRem, participants indicated which paired tone was higher in pitch. The primary outcome was plasticity improvement, operationalized as change in pitch threshold between AudRem tones [(test tone Hz - reference tone Hz)/reference tone Hz] between the initial plateau pitch threshold (mean of trials 20-30 of treatment visit 1) to pitch threshold at the end of visit(s). Target engagement was assessed by electroencephalography outcomes, including mismatch negativity (pitch primary). RESULTS There was a significant overall treatment effect for plasticity improvement (p = .014). Plasticity improvement was largest within the 80 and 100 mg/kg groups (p < .001, d > 0.67), while 120 mg/kg and placebo-treated participants showed nonsignificant within-group changes. Plasticity improvement was seen after a single treatment and was sustained on subsequent treatments. Target engagement was demonstrated by significantly larger mismatch negativity (p = .049, d = 1.0) for the 100 mg/kg dose versus placebo. CONCLUSIONS Our results demonstrate sufficient proof of principle for continued development of both the d-serine+AudRem combination and our target engagement methodology. The ultimate utility is dependent on the results of an ongoing larger, longer study of the combination for clinically relevant outcomes.
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Affiliation(s)
- Pejman Sehatpour
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York; Nathan Kline Institute, Orangeburg, New York
| | - Dan V Iosifescu
- Nathan Kline Institute, Orangeburg, New York; Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Heloise M De Baun
- Area Psychosis, New York State Psychiatric Institute, New York, New York
| | | | - Megan R Mayer
- Area Psychosis, New York State Psychiatric Institute, New York, New York
| | - James Gangwisch
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Elisa Dias
- Nathan Kline Institute, Orangeburg, New York; Psychiatry, New York University Grossman School of Medicine, New York, New York
| | | | - Tse-Hwei Choo
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Melanie M Wall
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Alice Medalia
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Alice M Saperstein
- Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Lawrence S Kegeles
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Ragy R Girgis
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Marlene Carlson
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Joshua T Kantrowitz
- Area Psychosis, New York State Psychiatric Institute, New York, New York; Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York; Nathan Kline Institute, Orangeburg, New York.
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2
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Govani V, Shastry A, Iosifescu D, Govil P, Mayer M, Sobeih T, Choo T, Wall M, Sehatpour P, Kantrowitz J. Augmentation of learning in schizophrenia by D-serine is related to auditory and frontally-generated biomarkers: A randomized, double-blind, placebo-controlled study. RESEARCH SQUARE 2023:rs.3.rs-2943290. [PMID: 37293030 PMCID: PMC10246259 DOI: 10.21203/rs.3.rs-2943290/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Auditory cognition is impaired in schizophrenia, and typically engages a complex, distributed, hierarchical network, including both auditory and frontal input. We recently demonstrated proof of principle for the target engagement of an N-methyl-D-aspartate-type glutamate receptor (NMDAR) agonist + auditory targeted remediation (d-serine+AudRem) combination, showing significant improvement in auditory-learning induced plasticity and mismatch negativity. In this secondary analysis, we report on frontal EEG outcomes, assessing for both generalized effects and the mechanism of auditory plasticity. 21 schizophrenia or schizoaffective disorder participants were randomized to three 1x weekly AudRem + double-blind d-serine (100 mg/kg) visits. In AudRem, participants indicated which paired tone was higher in pitch. The focus of this secondary analysis was a frontally (premotor) mediated EEG outcome- event-related desynchronization in the b band (b-ERD), which was shown to be sensitive to AudRem in previous studies. d-Serine+AudRem led to significant improvement in b-ERD power across the retention and motor preparation intervals (F 1,18 =6.0, p=0.025) vs. AudRem alone. b-ERD was significantly related to baseline cognition, but not auditory-learning induced plasticity. The principal finding of this prespecified secondary analysis are that in addition to improving auditory based biomarkers, the d-serine+AudRem combination led to significant improvement in biomarkers thought to represent frontally mediated dysfunction, suggesting potential generalization of effects. Changes in auditory-learning induced plasticity were independent of these frontally mediated biomarkers. Ongoing work will assess whether d-serine+AudRem is sufficient to remediate cognition or whether targeting frontal NMDAR deficits with higher-level remediation may also be required. Trial Registration: NCT03711500.
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Dondé C, Kantrowitz JT, Medalia A, Saperstein AM, Balla A, Sehatpour P, Martinez A, O'Connell MN, Javitt DC. Early auditory processing dysfunction in schizophrenia: Mechanisms and implications. Neurosci Biobehav Rev 2023; 148:105098. [PMID: 36796472 PMCID: PMC10106448 DOI: 10.1016/j.neubiorev.2023.105098] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
Schizophrenia is a major mental disorder that affects approximately 1% of the population worldwide. Cognitive deficits are a key feature of the disorder and a primary cause of long-term disability. Over the past decades, significant literature has accumulated demonstrating impairments in early auditory perceptual processes in schizophrenia. In this review, we first describe early auditory dysfunction in schizophrenia from both a behavioral and neurophysiological perspective and examine their interrelationship with both higher order cognitive constructs and social cognitive processes. Then, we provide insights into underlying pathological processes, especially in relationship to glutamatergic and N-methyl-D-aspartate receptor (NMDAR) dysfunction models. Finally, we discuss the utility of early auditory measures as both treatment targets for precision intervention and as translational biomarkers for etiological investigation. Altogether, this review points out the crucial role of early auditory deficits in the pathophysiology of schizophrenia, in addition to major implications for early intervention and auditory-targeted approaches.
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Affiliation(s)
- Clément Dondé
- Univ. Grenoble Alpes, F-38000 Grenoble, France; INSERM, U1216, F-38000 Grenoble, France; Psychiatry Department, CHU Grenoble Alpes, F-38000 Grenoble, France; Psychiatry Department, CH Alpes-Isère, F-38000 Saint-Egrève, France.
| | - Joshua T Kantrowitz
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States; Schizophrenia Research Center, Nathan Kline Institute, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States
| | - 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, United States
| | - Alice M Saperstein
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, NY 10032, United States
| | - Andrea Balla
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States
| | - Pejman Sehatpour
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States; Division of Experimental Therapeutics, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Antigona Martinez
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States; Division of Experimental Therapeutics, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Monica N O'Connell
- Translational Neuroscience Division, Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States
| | - Daniel C Javitt
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, United States; Division of Experimental Therapeutics, College of Physicians and Surgeons, Columbia University, New York, NY, United States.
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Fivel L, Mondino M, Brunelin J, Haesebaert F. Basic auditory processing and its relationship with symptoms in patients with schizophrenia: A systematic review. Psychiatry Res 2023; 323:115144. [PMID: 36940586 DOI: 10.1016/j.psychres.2023.115144] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/09/2023] [Accepted: 03/01/2023] [Indexed: 03/23/2023]
Abstract
Processing of basic auditory features, one of the earliest stages of auditory perception, has been the focus of considerable investigations in schizophrenia. Although numerous studies have shown abnormalities in pitch perception in schizophrenia, other basic auditory features such as intensity, duration, and sound localization have been less explored. Additionally, the relationship between basic auditory features and symptom severity shows inconsistent results, preventing concrete conclusions. Our aim was to present a comprehensive overview of basic auditory processing in schizophrenia and its relationship with symptoms. We conducted a systematic review according to the PRISMA guidelines. PubMed, Embase, and PsycINFO databases were searched for studies exploring auditory perception in schizophrenia compared to controls, with at least one behavioral task investigating basic auditory processing using pure tones. Forty-one studies were included. The majority investigated pitch processing while the others investigated intensity, duration and sound localization. The results revealed that patients have a significant deficit in the processing of all basic auditory features. Although the search for a relationship with symptoms was limited, auditory hallucinations experience appears to have an impact on basic auditory processing. Further research may examine correlations with clinical symptoms to explore the performance of patient subgroups and possibly implement remediation strategies.
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Affiliation(s)
- Laure Fivel
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, PSYR2, Bron F-69500, France
| | - Marine Mondino
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, PSYR2, Bron F-69500, France; Centre Hospitalier Le Vinatier, 95 Boulevard Pinel, Bron F-69500, France.
| | - Jerome Brunelin
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, PSYR2, Bron F-69500, France; Centre Hospitalier Le Vinatier, 95 Boulevard Pinel, Bron F-69500, France
| | - Frédéric Haesebaert
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, PSYR2, Bron F-69500, France; Centre Hospitalier Le Vinatier, 95 Boulevard Pinel, Bron F-69500, France
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5
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Bailliard A, Lee B, Bennett J. Polysensoriality and Aesthetics: The Lived Sensory Experiences of Adults with Mental Illness. Can J Occup Ther 2023; 90:103-113. [PMID: 36632011 DOI: 10.1177/00084174221145811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background. Research in neuroscience shows that adults with schizophrenia or related psychotic disorders experience atypical sensory processing (e.g., deficits in sensory gating and mismatch negativity). Despite significant evidence proving these biomarkers are common among adults with serious mental illness, it is unclear how their sensory experiences impact their occupations in daily life (i.e., real-world implications of atypical sensory processing). Purpose. To explore how the lived sensory experiences of adults with psychotic disorders affect their occupations. Method. We used Walking with Video, photo-elicitation, and semi-structured interviews to study how the lived sensory experiences of adults with psychotic disorders (N = 6) relate to their occupations. Informed by a phenomenological perspective, we analysed data from semistructured interviews, and undertook analyses through iterative rounds of coding to develop themes and two cycles of group reflective practices to identify researcher biases and assumptions. Findings. Analyses revealed the following themes: polysensoriality, embodied aesthetics of everyday life, habits of sensing and sensory anchors, and active sensory beings. Implications. In clinical contexts, occupational therapists should carefully consider the situatedness of sensory experiences while avoiding assumptions that sensory preferences and aversions mechanistically generalize across contexts and occupations.
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Hoptman MJ, Tural U, Lim KO, Javitt DC, Oberlin LE. Relationships between Diffusion Tensor Imaging and Resting State Functional Connectivity in Patients with Schizophrenia and Healthy Controls: A Preliminary Study. Brain Sci 2022; 12:brainsci12020156. [PMID: 35203920 PMCID: PMC8870342 DOI: 10.3390/brainsci12020156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/02/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022] Open
Abstract
Schizophrenia is widely seen as a disorder of dysconnectivity. Neuroimaging studies have examined both structural and functional connectivity in the disorder, but these modalities have rarely been integrated directly. We scanned 29 patients with schizophrenia and 25 healthy control subjects, and we acquired resting state fMRI and diffusion tensor imaging. We used the Functional and Tractographic Connectivity Analysis Toolbox (FATCAT) to estimate functional and structural connectivity of the default mode network. Correlations between modalities were investigated, and multimodal connectivity scores (MCS) were created using principal component analysis. Of the 28 possible region pairs, 9 showed consistent (>80%) tracts across participants. Correlations between modalities were found among those with schizophrenia for the prefrontal cortex, posterior cingulate, and lateral temporal lobes, with frontal and parietal regions, consistent with frontotemporoparietal network involvement in the disorder. In patients, MCS correlated with several aspects of the Positive and Negative Syndrome Scale, with higher multimodal connectivity associated with outward-directed (externalizing) behavior and lower multimodal connectivity related to psychosis per se. In this preliminary sample, we found FATCAT to be a useful toolbox to directly integrate and examine connectivity between imaging modalities. A consideration of conjoint structural and functional connectivity can provide important information about the network mechanisms of schizophrenia.
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Affiliation(s)
- Matthew J. Hoptman
- Clinical Research Division, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA;
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY 10016, USA
- Correspondence: or ; Tel.: +1-845-398-6569
| | - Umit Tural
- Clinical Research Division, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA;
| | - Kelvin O. Lim
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA;
| | - Daniel C. Javitt
- Schizophrenia Research Division, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA; or
- Division of Experimental Therapeutics, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Lauren E. Oberlin
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA;
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7
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Ren X, Fribance SN, Coffman BA, Salisbury DF. Deficits in attentional modulation of auditory N100 in first-episode schizophrenia. Eur J Neurosci 2021; 53:2629-2638. [PMID: 33492765 DOI: 10.1111/ejn.15128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 12/16/2022]
Abstract
Reductions of the auditory N100 are present in schizophrenia, even at the first episode (FESz). Because most studies examine auditory N100 on active target detection oddball tasks, it remains unclear if the abnormality in FESz results from sensory deficits or impaired enhancement of N100 by selective attention, or both. N100 was recorded from 21 FESz and 22 matched healthy controls (HC) on a single-tone task and a two-tone oddball task. Overall, N100 was smaller in FESz (p = .036). Attention enhanced N100 amplitude (p < .001), but this differed between groups, with FESz impaired in N100 modulation (group x attention, p = .012). The oddball task showed greater N100 enhancement than the single-tone task (p < .001) in both groups. Group differences in N100 enhancement in the oddball task were large (Cohen's d = 0.85). Exploratory correlations showed that better N100 enhancement on the oddball task in FESz was associated with better MATRICS Overall Composite scores (cognitive tasks highly sensitive to psychosis), lower PANNS Negative factor and SANS scores, and better interpersonal (social) and role functioning in the last year. N100 during ignore conditions showed no significant difference between groups, albeit smaller in FESz, with small to medium effect sizes. Although sensory deficits in N100 are likely present, they are compounded by a failure to enhance N100 with attention. The failure of N100 enhancement by attentional gain control in FESz suggests functional dysconnection between cognitive control areas and the sensory cortex. N100 amplitude on active attention tasks may be a useful outcome biomarker for targeted enhancement of the cognitive control system.
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Affiliation(s)
- Xi Ren
- Clinical Neurophysiology Research Laboratory, Western Psychiatric Hospital, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sarah N Fribance
- Clinical Neurophysiology Research Laboratory, Western Psychiatric Hospital, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brian A Coffman
- Clinical Neurophysiology Research Laboratory, Western Psychiatric Hospital, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dean F Salisbury
- Clinical Neurophysiology Research Laboratory, Western Psychiatric Hospital, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Mentalization and Psychosis: A Rationale for the Use of Mentalization Theory to Understand and Treat Non-affective Psychotic Disorder. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2020. [DOI: 10.1007/s10879-019-09449-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractSocial functioning can be severely impaired in non-affective psychotic disorder (NAPD). Current models of psychosis pathogenesis do not tend to focus on social dysfunction and pharmacological treatment fails to ameliorate it. In this article, we propose that mentalization theory provides a valuable contribution to the understanding and treatment of NAPD. Impaired mentalizing may contribute to both positive and negatives symptoms as well as social dysfunction observed in NAPD. Furthermore, impaired mentalizing may help explain the relation between childhood abuse, insecure attachment and psychosis. Mentalization based treatment may contribute to the functional recovery of NAPD patients as it targets the social cognitive processes underlying social interaction. The article includes a description of the principles of MBT in general, specific characteristics of using MBT with patients with NAPD and a clinical vignette to illustrate these principles.
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9
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Lucarini V, Grice M, Cangemi F, Zimmermann JT, Marchesi C, Vogeley K, Tonna M. Speech Prosody as a Bridge Between Psychopathology and Linguistics: The Case of the Schizophrenia Spectrum. Front Psychiatry 2020; 11:531863. [PMID: 33101074 PMCID: PMC7522437 DOI: 10.3389/fpsyt.2020.531863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 08/25/2020] [Indexed: 12/04/2022] Open
Abstract
Patients with schizophrenia spectrum disorders experience severe difficulties in interpersonal communication, as described by traditional psychopathology and current research on social cognition. From a linguistic perspective, pragmatic abilities are crucial for successful communication. Empirical studies have shown that these abilities are significantly impaired in this group of patients. Prosody, the tone of voice with which words and sentences are pronounced, is one of the most important carriers of pragmatic meaning and can serve a range of functions from linguistic to emotional ones. Most of the existing literature on prosody of patients with schizophrenia spectrum disorders focuses on the expression of emotion, generally showing significant impairments. By contrast, the use of non-emotional prosody in these patients is scarcely investigated. In this paper, we first present a linguistic model to classify prosodic functions. Second, we discuss existing studies on the use of non-emotional prosody in these patients, providing an overview of the state of the art. Third, we delineate possible future lines of research in this field, also taking into account some classical psychopathological assumptions, for both diagnostic and therapeutic purposes.
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Affiliation(s)
- Valeria Lucarini
- Psychiatry Unit, Department of Medicine and Surgery, Medical Faculty, University of Parma, Parma, Italy
| | - Martine Grice
- IfL-Phonetics, University of Cologne, Cologne, Germany
| | | | - Juliane T Zimmermann
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Carlo Marchesi
- Psychiatry Unit, Department of Medicine and Surgery, Medical Faculty, University of Parma, Parma, Italy
| | - Kai Vogeley
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany.,Cognitive Neuroscience (INM-3), Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Matteo Tonna
- Department of Mental Health, Azienda Unità Sanitaria Locale di Parma, Parma, Italy
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10
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de la Garrigue N, Glasser J, Sehatpour P, Iosifescu DV, Dias E, Carlson M, Shope C, Sobeih T, Choo TH, Wall MM, Kegeles LS, Gangwisch J, Mayer M, Brazis S, De Baun HM, Wolfer S, Bermudez D, Arnold M, Rette D, Meftah AM, Conant M, Lieberman JA, Kantrowitz JT. Grant Report on d-Serine Augmentation of Neuroplasticity-Based Auditory Learning in Schizophrenia †. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2020; 5:e200018. [PMID: 32856005 PMCID: PMC7448686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We report on the rationale and design of an ongoing NIMH sponsored R61-R33 project in schizophrenia/schizoaffective disorder. This project studies augmenting the efficacy of auditory neuroplasticity cognitive remediation (AudRem) with d-serine, an N-methyl-d-aspartate-type glutamate receptor (NMDAR) glycine-site agonist. We operationalize improved (smaller) thresholds in pitch (frequency) between successive auditory stimuli after AudRem as improved plasticity, and mismatch negativity (MMN) and auditory θ as measures of functional target engagement of both NMDAR agonism and plasticity. Previous studies showed that AudRem alone produces significant, but small cognitive improvements, while d-serine alone improves symptoms and MMN. However, the strongest results for plasticity outcomes (improved pitch thresholds, auditory MMN and θ) were found when combining d-serine and AudRem. AudRem improvements correlated with reading and other auditory cognitive tasks, suggesting plasticity improvements are predictive of functionally relevant outcomes. While d-serine appears to be efficacious for acute AudRem enhancement, the optimal dose remains an open question, as does the ability of combined d-serine + AudRem to produce sustained improvement. In the ongoing R61, 45 schizophrenia patients will be randomized to receive three placebo-controlled, double-blind d-serine + AudRem sessions across three separate 15 subject dose cohorts (80/100/120 mg/kg). Successful completion of the R61 is defined by ≥moderate effect size changes in target engagement and correlation with function, without safety issues. During the three-year R33, we will assess the sustained effects of d-serine + AudRem. In addition to testing a potentially viable treatment, this project will develop a methodology to assess the efficacy of novel NMDAR modulators, using d-serine as a "gold-standard".
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Affiliation(s)
| | - Juliana Glasser
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Pejman Sehatpour
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA,Nathan Kline Institute, Orangeburg, NY 10962, USA
| | - Dan V. Iosifescu
- Nathan Kline Institute, Orangeburg, NY 10962, USA,NYU Langone Medical Center, New York, NY 10016, USA
| | - Elisa Dias
- Nathan Kline Institute, Orangeburg, NY 10962, USA,NYU Langone Medical Center, New York, NY 10016, USA
| | - Marlene Carlson
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | | | - Tarek Sobeih
- Nathan Kline Institute, Orangeburg, NY 10962, USA
| | - Tse-Hwei Choo
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Melanie M. Wall
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Lawrence S. Kegeles
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - James Gangwisch
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Megan Mayer
- New York State Psychiatric Institute, New York, NY 10032, USA
| | | | | | | | - Dalton Bermudez
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Molly Arnold
- Nathan Kline Institute, Orangeburg, NY 10962, USA
| | | | - Amir M. Meftah
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Melissa Conant
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Jeffrey A. Lieberman
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Joshua T. Kantrowitz
- New York State Psychiatric Institute, New York, NY 10032, USA,Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA,Nathan Kline Institute, Orangeburg, NY 10962, USA,Correspondence: Joshua T. Kantrowitz, ; Tel.: +1-646-774-6738
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11
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Dondé C, Martinez A, Sehatpour P, Patel GH, Kraut R, Kantrowitz JT, Javitt DC. Neural and functional correlates of impaired reading ability in schizophrenia. Sci Rep 2019; 9:16022. [PMID: 31690846 PMCID: PMC6831596 DOI: 10.1038/s41598-019-52669-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 10/22/2019] [Indexed: 01/14/2023] Open
Abstract
Deficits in early auditory processing (EAP) are a core component of schizophrenia (SZ) and contribute significantly to impaired overall function. Here, we evaluate the potential contributions of EAP-related impairments in reading to functional capacity and outcome, relative to effects of auditory social cognitive and general neurocognitive dysfunction. Participants included 30-SZ and 28-controls of similar age, sex, and educational achievement. EAP was assessed using an auditory working memory (tone-matching) task. Phonological processing and reading Fluency were assessed using the Comprehensive Test of Phonological Processing and Woodcock-Johnson reading batteries, respectively. Auditory-related social cognition was assessed using measures of emotion/sarcasm recognition. Functional capacity and outcome were assessed using the UCSD Performance-based Skills Assessment and Specific Level of Functioning scale, respectively. fMRI resting-state functional-connectivity (rsFC) was used to evaluate potential underlying substrates. As predicted, SZ patients showed significant and interrelated deficits in both phonological processing (d = 0.74, p = 0.009) and reading fluency (d = 1.24, p < 0.00005). By contrast, single word reading (d = 0.35, p = 0.31) was intact. In SZ, deficits in EAP and phonological reading ability significantly predicted reduced functional capacity, but not functional outcome. By contrast, deficits in reading fluency significantly predicted impairments in both functional capacity and functional outcome. Moreover, deficits in reading fluency correlated with rsFC alterations among auditory thalamus, early auditory and auditory association regions. These findings indicate significant contributions of EAP deficits and functional connectivity changes in subcortical and early auditory regions to reductions in reading fluency, and of impaired reading ability to impaired functional outcome in SZ.
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Affiliation(s)
- Clément Dondé
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon, F-69000, France. .,University Lyon 1, Villeurbanne, F-69000, France. .,Centre Hospitalier Le Vinatier, Bron, France. .,Nathan Kline Institute, Orangeburg, NY, USA. .,Dept. of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, USA.
| | - Antigona Martinez
- Nathan Kline Institute, Orangeburg, NY, USA.,Dept. of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, USA
| | - Pejman Sehatpour
- Nathan Kline Institute, Orangeburg, NY, USA.,Dept. of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, USA
| | - Gaurav H Patel
- Dept. of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, USA
| | - Rebecca Kraut
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Joshua T Kantrowitz
- Nathan Kline Institute, Orangeburg, NY, USA.,Dept. of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, USA
| | - Daniel C Javitt
- Nathan Kline Institute, Orangeburg, NY, USA. .,Dept. of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, USA.
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12
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Dondé C, Martínez A, Kantrowitz JT, Silipo G, Dias EC, Patel GH, Sanchez-Peña J, Corcoran CM, Medalia A, Saperstein A, Vail B, Javitt DC. Bimodal distribution of tone-matching deficits indicates discrete pathophysiological entities within the syndrome of schizophrenia. Transl Psychiatry 2019; 9:221. [PMID: 31492832 PMCID: PMC6731304 DOI: 10.1038/s41398-019-0557-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 06/03/2019] [Accepted: 06/20/2019] [Indexed: 12/11/2022] Open
Abstract
To date, no measures are available that permit differentiation of discrete, clinically distinct subtypes of schizophrenia (SZ) with potential differential underlying pathophysiologies. Over recent years, there has been increasing recognition that SZ is heterogeneously associated with deficits in early auditory processing (EAP), as demonstrated using clinically applicable tasks such as tone-matching task (TMT). Here, we pooled TMT performances across 310 SZ individuals and 219 healthy controls (HC), along with clinical, cognitive, and resting-state functional-connectivity MRI (rsFC-MRI) measures. In addition, TMT was measured in a group of 24 patients at symptomatic clinical high risk (CHR) for SZ and 24 age-matched HC (age range 7-27 years). We provide the first demonstration that the EAP deficits are bimodally distributed across SZ subjects (P < 0.0001 vs. unimodal distribution), with one group showing entirely unimpaired TMT performance (SZ-EAP+), and a second showing an extremely large TMT impairment (SZ-EAP-), relative to both controls (d = 2.1) and SZ-EAP+ patients (d = 3.4). The SZ-EAP- group predominated among samples drawn from inpatient sites, showed higher levels of cognitive symptoms (PANSS), worse social cognition and a differential deficit in neurocognition (MATRICS battery), and reduced functional capacity. rsFC-MRI analyses showed significant reduction in SZ-EAP- relative to controls between subcortical and cortical auditory regions. As opposed to SZ, CHR patients showed intact EAP function. In HC age-matched to CHR, EAP ability was shown to increase across the age range of vulnerability preceding SZ onset. These results indicate that EAP measure segregates between discrete SZ subgroups. As TMT can be readily implemented within routine clinical settings, its use may be critical to account for the heterogeneity of clinical outcomes currently observed across SZ patients, as well as for pre-clinical detection and efficacious treatment selection.
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Affiliation(s)
- Clément Dondé
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon, F-69000, France. .,University Lyon 1, Villeurbanne, F-69000, France. .,Centre Hospitalier Le Vinatier, Bron, France. .,Nathan Kline Institute, Orangeburg, NY, USA. .,Deppartment of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY, USA.
| | - Antigona Martínez
- 0000 0001 2189 4777grid.250263.0Nathan Kline Institute, Orangeburg, NY USA ,0000 0001 2285 2675grid.239585.0Deppartment of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY USA
| | - Joshua T. Kantrowitz
- 0000 0001 2189 4777grid.250263.0Nathan Kline Institute, Orangeburg, NY USA ,0000 0001 2285 2675grid.239585.0Deppartment of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY USA
| | - Gail Silipo
- 0000 0001 2189 4777grid.250263.0Nathan Kline Institute, Orangeburg, NY USA
| | - Elisa C. Dias
- 0000 0001 2189 4777grid.250263.0Nathan Kline Institute, Orangeburg, NY USA
| | - Gaurav H. Patel
- 0000 0001 2285 2675grid.239585.0Deppartment of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY USA
| | - Juan Sanchez-Peña
- 0000 0001 2285 2675grid.239585.0Deppartment of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY USA
| | - Cheryl M. Corcoran
- 0000 0001 2285 2675grid.239585.0Deppartment of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY USA ,0000 0001 0670 2351grid.59734.3cDepartment of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Alice Medalia
- 0000 0001 2285 2675grid.239585.0Deppartment of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY USA
| | - Alice Saperstein
- 0000 0001 2285 2675grid.239585.0Deppartment of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY USA
| | - Blair Vail
- 0000 0001 2285 2675grid.239585.0Deppartment of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY USA
| | - Daniel C. Javitt
- 0000 0001 2189 4777grid.250263.0Nathan Kline Institute, Orangeburg, NY USA ,0000 0001 2285 2675grid.239585.0Deppartment of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY USA
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13
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Dondé C, Mondino M, Leitman DI, Javitt DC, Suaud-Chagny MF, D'Amato T, Brunelin J, Haesebaert F. Are basic auditory processes involved in source-monitoring deficits in patients with schizophrenia? Schizophr Res 2019; 210:135-142. [PMID: 31176535 DOI: 10.1016/j.schres.2019.05.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/29/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Abstract
Patients with schizophrenia (SZ) display deficits in both basic non-verbal auditory processing and source-monitoring of speech. To date, the contributions of basic auditory deficits to higher-order cognitive impairments, such as source-monitoring, and to clinical symptoms have yet to be elucidated. The aim of this study was to investigate the deficits and relationships between basic auditory functions, source-monitoring performances, and clinical symptom severity in SZ. Auditory processing of 4 psychoacoustic features (pitch, intensity, amplitude, length) and 2 types of source-monitoring (internal and reality monitoring) performances were assessed in 29 SZ and 29 healthy controls. Clinical symptoms were evaluated in patients with the Positive And Negative Syndrome Scale. Compared to the controls, SZ individuals in showed significant reductions in both global basic auditory processing (p < .0005, d = 1.16) and source-monitoring (p < .0005, d = 1.24) abilities. Both deficits correlated significantly in patients and across groups (all p < .05). Pitch processing skills were negatively correlated with positive symptom severity (r = -0.4, p < .05). A step-wise regression analysis showed that pitch discrimination was a significant predictor of source-monitoring performance. These results suggest that cognitive mechanisms associated with the discrimination of basic auditory features are most compromised in patients with source-monitoring disability. Basic auditory processing may index pathophysiological processes that are critical for optimal source-monitoring in schizophrenia and that are involved in positive symptoms.
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Affiliation(s)
- Clément Dondé
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon F-69000, France; University Lyon 1, Villeurbanne F-69000, France; Centre Hospitalier Le Vinatier, Bron, France; Nathan Kline Institute, Orangeburg, NY, USA; Dept. of Psychiatry, Columbia University Medical Center, New York, NY, US.
| | - Marine Mondino
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon F-69000, France; University Lyon 1, Villeurbanne F-69000, France; Centre Hospitalier Le Vinatier, Bron, France
| | - David I Leitman
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon F-69000, France; University Lyon 1, Villeurbanne F-69000, France; Centre Hospitalier Le Vinatier, Bron, France
| | - Daniel C Javitt
- Nathan Kline Institute, Orangeburg, NY, USA; Dept. of Psychiatry, Columbia University Medical Center, New York, NY, US
| | - Marie-Françoise Suaud-Chagny
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon F-69000, France; University Lyon 1, Villeurbanne F-69000, France; Centre Hospitalier Le Vinatier, Bron, France
| | - Thierry D'Amato
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon F-69000, France; University Lyon 1, Villeurbanne F-69000, France; Centre Hospitalier Le Vinatier, Bron, France
| | - Jérôme Brunelin
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon F-69000, France; University Lyon 1, Villeurbanne F-69000, France; Centre Hospitalier Le Vinatier, Bron, France
| | - Frédéric Haesebaert
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon F-69000, France; University Lyon 1, Villeurbanne F-69000, France; Centre Hospitalier Le Vinatier, Bron, France
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14
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Rabagliati H, Delaney-Busch N, Snedeker J, Kuperberg G. Spared bottom-up but impaired top-down interactive effects during naturalistic language processing in schizophrenia: evidence from the visual-world paradigm. Psychol Med 2019; 49:1335-1345. [PMID: 30131083 PMCID: PMC6386628 DOI: 10.1017/s0033291718001952] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND People with schizophrenia process language in unusual ways, but the causes of these abnormalities are unclear. In particular, it has proven difficult to empirically disentangle explanations based on impairments in the top-down processing of higher level information from those based on the bottom-up processing of lower level information. METHODS To distinguish these accounts, we used visual-world eye tracking, a paradigm that measures spoken language processing during real-world interactions. Participants listened to and then acted out syntactically ambiguous spoken instructions (e.g. 'tickle the frog with the feather', which could either specify how to tickle a frog, or which frog to tickle). We contrasted how 24 people with schizophrenia and 24 demographically matched controls used two types of lower level information (prosody and lexical representations) and two types of higher level information (pragmatic and discourse-level representations) to resolve the ambiguous meanings of these instructions. Eye tracking allowed us to assess how participants arrived at their interpretation in real time, while recordings of participants' actions measured how they ultimately interpreted the instructions. RESULTS We found a striking dissociation in participants' eye movements: the two groups were similarly adept at using lower level information to immediately constrain their interpretations of the instructions, but only controls showed evidence of fast top-down use of higher level information. People with schizophrenia, nonetheless, did eventually reach the same interpretations as controls. CONCLUSIONS These data suggest that language abnormalities in schizophrenia partially result from a failure to use higher level information in a top-down fashion, to constrain the interpretation of language as it unfolds in real time.
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Affiliation(s)
- Hugh Rabagliati
- Department of Psychology, Tufts University, Medford, MA 02155, U.S.A
- Department of Psychology, Harvard University
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh
| | | | | | - Gina Kuperberg
- Department of Psychology, Tufts University, Medford, MA 02155, U.S.A
- Department of Psychiatry and the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, U.S.A
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15
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Voss P, Thomas ME, Guercio GD, de Villers-Sidani E. Dysregulation of auditory neuroplasticity in schizophrenia. Schizophr Res 2019; 207:3-11. [PMID: 29703662 DOI: 10.1016/j.schres.2018.04.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/10/2018] [Accepted: 04/13/2018] [Indexed: 12/16/2022]
Abstract
Schizophrenia is a complex brain syndrome characterized by an array of positive symptoms (delusions, hallucinations, disorganized speech), negative symptoms (alogia, apathy, avolition) and cognitive impairments (memory, executive functions). Although investigations of the cognitive deficits in schizophrenia have primarily concentrated on disturbances affecting higher-order cognitive processes, there is an increasing realization that schizophrenia also affects early sensory processing, which might, in fact, play a significant role in the development of higher-order cognitive impairments. Recent evidence suggests that many of these early sensory processing impairments possibly arise from a dysregulation of plasticity regulators in schizophrenia, resulting in either reduced plasticity or excessive unregulated plasticity. The purpose of the present manuscript is to provide a concise overview of how the dysregulation of cortical plasticity mechanisms contributes to schizophrenia symptoms with an emphasis on auditory dysplasticity and to discuss its relevance for treatment outcomes. The idea that plasticity mechanisms are not constrained only within sensitive periods suggests that many functional properties of sensory neurons can be altered throughout the lifetime.
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Affiliation(s)
- Patrice Voss
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada.
| | - Maryse E Thomas
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
| | - Gerson D Guercio
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
| | - Etienne de Villers-Sidani
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada.
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16
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Kantrowitz JT. N-methyl-d-aspartate-type glutamate receptor modulators and related medications for the enhancement of auditory system plasticity in schizophrenia. Schizophr Res 2019; 207:70-79. [PMID: 29459050 DOI: 10.1016/j.schres.2018.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/30/2018] [Accepted: 02/02/2018] [Indexed: 12/14/2022]
Abstract
Deficits in N-methyl-d-aspartate-type (NMDAR) function contribute to cognitive deficits in schizophrenia, particularly dysfunction in neuroplasticity, defined as reduced learning during training on exercises that place implicit, increasing demands on early sensory (auditory and visual) information processing. Auditory mismatch negativity (MMN) can be both a target engagement biomarker for the NMDAR and a proxy measure of neurophysiological plasticity. This review covers the evidence for using NMDAR modulator and related compounds for enhancement of cognition, with a particular focus on early auditory processing/plasticity. Compounds covered include glycine site agonists, glycine and system A-type transporter inhibitors, d-amino acid oxidase inhibitors, memantine and nicotinic alpha-7 acetylcholine receptor agonists. As opposed to daily treatment studies focusing on schizophrenia in general, intermittent, non-daily treatment combining NMDAR modulators with neuroplasticity-based paradigms, using MMN as target-engagement biomarkers show promise as treatments to both remediate plasticity deficits and overall functional deficits.
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Affiliation(s)
- Joshua T Kantrowitz
- Schizophrenia Research Center, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA; Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, New York, NY 10032, USA.
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17
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Dondé C, Silipo G, Dias EC, Javitt DC. Hierarchical deficits in auditory information processing in schizophrenia. Schizophr Res 2019; 206:135-141. [PMID: 30551982 PMCID: PMC6526044 DOI: 10.1016/j.schres.2018.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/11/2018] [Accepted: 12/04/2018] [Indexed: 01/31/2023]
Abstract
Deficits in auditory processing contribute significantly to impaired functional outcome in schizophrenia (SZ), but mediating factors remain under investigation. Here we evaluated two hierarchical components of early auditory processing: pitch-change detection (i.e. identifying if 2 tones have "same" or "different" pitch), which is preferentially associated with early auditory cortex, and serial pitch-pattern detection (i.e. identifying if 3 tones have "same" or "different" pitch, and, if "different", which one differed from the others), which depends also on auditory association regions. Deficits in pitch-change detection deficits in SZ have been widely reported and correlated with higher auditory disturbances such as Auditory Emotion Recognition (AER). Deficits in serial pitch-pattern discrimination have been less studied. Here, we investigated both pitch perception components, along with integrity of AER in SZ patients vs. controls using behavioral paradigms. We hypothesized that the deficits could be viewed as hierarchically organized in SZ, with deficits in low-level function propagating sequentially through subsequent levels of processing. Participants included 27 SZ and 40 controls. The magnitude of the deficits in SZ participants was large in both the pitch-change (d = 1.15) and serial pitch-pattern tasks (d = 1.21) with no significant differential task effect. The effect size of the AER deficits was extremely large (d = 2.82). In the SZ group, performance in both pitch tasks correlated significantly with impaired AER performance. However, a mediation analysis showed that serial pitch-pattern detection mediated the relationship between simpler pitch-change detection and AER in patients. Findings are consistent with hierarchical models of cognitive dysfunction in SZ with deficits in early information processing contributing to higher level impairments. Furthermore, findings are consistent with recent neurophysiological results suggesting similar level impairments for processing of simple vs. more complex tonal dysfunction in SZ.
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Affiliation(s)
- Clément Dondé
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon F-69000, France; University Lyon 1, Villeurbanne F-69000, France; Centre Hospitalier Le Vinatier, Bron, France; Nathan Kline Institute, Orangeburg, NY, USA; Dept. of Psychiatry, Columbia University Medical Center, New York, NY, USA.
| | - Gail Silipo
- Nathan Kline Institute, Orangeburg, NY, USA.
| | | | - Daniel C. Javitt
- Nathan Kline Institute, Orangeburg, NY USA,Dept. of Psychiatry, Columbia University Medical Center, New York, NY USA
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18
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Moschopoulos NP, Nimatoudis I, Kaprinis S, Iliadou V. Behavioral assessment of auditory processing deficits in schizophrenia: Literature review and suggestions for future research. Scand J Psychol 2018; 60:116-127. [DOI: 10.1111/sjop.12514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/12/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Nikolaos P. Moschopoulos
- Clinical Psychoacoustics Lab; 3rd Psychiatry Department; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Ioannis Nimatoudis
- Clinical Psychoacoustics Lab; 3rd Psychiatry Department; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Stergios Kaprinis
- 2nd Psychiatry Department; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Vasiliki Iliadou
- Clinical Psychoacoustics Lab; 3rd Psychiatry Department; Aristotle University of Thessaloniki; Thessaloniki Greece
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19
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Lin Y, Ding H, Zhang Y. Emotional Prosody Processing in Schizophrenic Patients: A Selective Review and Meta-Analysis. J Clin Med 2018; 7:jcm7100363. [PMID: 30336573 PMCID: PMC6210777 DOI: 10.3390/jcm7100363] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/10/2018] [Accepted: 10/14/2018] [Indexed: 12/11/2022] Open
Abstract
Emotional prosody (EP) has been increasingly recognized as an important area of schizophrenic patients’ dysfunctions in their language use and social communication. The present review aims to provide an updated synopsis on emotional prosody processing (EPP) in schizophrenic disorders, with a specific focus on performance characteristics, the influential factors and underlying neural mechanisms. A literature search up to 2018 was conducted with online databases, and final selections were limited to empirical studies which investigated the prosodic processing of at least one of the six basic emotions in patients with a clear diagnosis of schizophrenia without co-morbid diseases. A narrative synthesis was performed, covering the range of research topics, task paradigms, stimulus presentation, study populations and statistical power with a quantitative meta-analytic approach in Comprehensive Meta-Analysis Version 2.0. Study outcomes indicated that schizophrenic patients’ EPP deficits were consistently observed across studies (d = −0.92, 95% CI = −1.06 < δ < −0.78), with identification tasks (d = −0.95, 95% CI = −1.11 < δ < −0.80) being more difficult to process than discrimination tasks (d = −0.74, 95% CI = −1.03 < δ < −0.44) and emotional stimuli being more difficult than neutral stimuli. Patients’ performance was influenced by both participant- and experiment-related factors. Their social cognitive deficits in EP could be further explained by right-lateralized impairments and abnormalities in primary auditory cortex, medial prefrontal cortex and auditory-insula connectivity. The data pointed to impaired pre-attentive and attentive processes, both of which played important roles in the abnormal EPP in the schizophrenic population. The current selective review and meta-analysis support the clinical advocacy of including EP in early diagnosis and rehabilitation in the general framework of social cognition and neurocognition deficits in schizophrenic disorders. Future cross-sectional and longitudinal studies are further suggested to investigate schizophrenic patients’ perception and production of EP in different languages and cultures, modality forms and neuro-cognitive domains.
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Affiliation(s)
- Yi Lin
- Institute of Cross-Linguistic Processing and Cognition, School of Foreign Languages, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Hongwei Ding
- Institute of Cross-Linguistic Processing and Cognition, School of Foreign Languages, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Yang Zhang
- Department of Speech-Language-Hearing Sciences & Center for Neurobehavioral Development, University of Minnesota, Twin Cities, MN 55455, USA.
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20
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Kantrowitz JT, Swerdlow NR, Dunn W, Vinogradov S. Auditory System Target Engagement During Plasticity-Based Interventions in Schizophrenia: A Focus on Modulation of N-Methyl-D-Aspartate-Type Glutamate Receptor Function. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 3:581-590. [PMID: 29656951 PMCID: PMC6062454 DOI: 10.1016/j.bpsc.2018.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/24/2018] [Accepted: 02/12/2018] [Indexed: 12/31/2022]
Abstract
Cognitive deficits are predictive of long-term social and occupational functional deficits in schizophrenia but are currently without gold-standard treatments. In particular, augmentation of auditory cortical neuroplasticity may represent a rate-limiting first step before addressing higher-order cognitive deficits. We review the rationale for N-methyl-d-aspartate-type glutamate receptor (NMDAR) modulators as treatments for auditory plasticity deficits in schizophrenia, along with potential serum and electroencephalographic target engagement biomarkers for NMDAR function. Several recently published NMDAR-modulating treatment studies are covered, involving D-serine, memantine, and transcranial direct current stimulation. While all three interventions appear to modulate auditory plasticity, direct agonists (D-serine) appear to have the largest and most consistent effects on plasticity, at least acutely. We hypothesize that there may be synergistic effects of combining procognitive NMDAR-modulating approaches with auditory cortical neuroplasticity cognitive training interventions. Future studies should assess biomarkers for target engagement and patient stratification, along with head-to-head studies comparing putative interventions and potential long-term versus acute effects.
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Affiliation(s)
- Joshua T Kantrowitz
- Schizophrenia Research Center, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York; Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, New York, New York.
| | - Neal R Swerdlow
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Walter Dunn
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, California
| | - Sophia Vinogradov
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota
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21
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Eddy CM. Social cognition and self-other distinctions in neuropsychiatry: Insights from schizophrenia and Tourette syndrome. Prog Neuropsychopharmacol Biol Psychiatry 2018; 82:69-85. [PMID: 29195921 DOI: 10.1016/j.pnpbp.2017.11.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 02/08/2023]
Abstract
Impairments in social cognition may reflect dysfunction of disorder specific or disorder general mechanisms. Although cross-disorder comparison may prove insightful, few studies have compared social cognition in different neuropsychiatric disorders. Parallel investigation of schizophrenia and Tourette syndrome (TS) is encouraged by similarities including the presence of problematic social behavior, echophenomena, emotional dysregulation and dopamine dysfunction. Focusing on tests of social cognition administered in both disorders, this review aims to summarize behavioral, neurophysiological and neuroimaging findings, before exploring how these may contribute to clinical symptoms. Studies investigating social cognition (imitation, emotion recognition, and understanding of beliefs or intentions) in patients with schizophrenia or TS were identified through Web of Science and PubMed searches. Although findings indicate that social cognitive deficits are more apparent in schizophrenia, adults with TS can exhibit similar task performance to patients with paranoia. In both disorders, behavioral and neuroimaging findings raise the possibility of increased internal simulation of others' actions and emotions, in combination with a relative under-application of mentalizing. More specifically, dysfunction in neurobiological substrates such as temporo-parietal junction and inferior frontal gyrus may underlie problems with self-other distinctions in both schizophrenia and TS. Difficulties in distinguishing between actions and mental states linked to the self and other may contribute to a range of psychiatric symptoms, including emotional dysregulation, paranoia, social anhedonia and socially disruptive urges. Comparing different patient populations could therefore reveal common neuro-cognitive risk factors for the development of problematic social behaviors, in addition to markers of resilience, coping strategies and potential neuro-compensation mechanisms.
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Affiliation(s)
- Clare M Eddy
- BSMHFT National Centre for Mental Health, Birmingham, and College of Medical and Dental Sciences, University of Birmingham, UK.
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22
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Parker EM, Sweet RA. Stereological Assessments of Neuronal Pathology in Auditory Cortex in Schizophrenia. Front Neuroanat 2018; 11:131. [PMID: 29375326 PMCID: PMC5767177 DOI: 10.3389/fnana.2017.00131] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/18/2017] [Indexed: 12/21/2022] Open
Abstract
It has long been known that auditory processing is disrupted in schizophrenia. More recently, postmortem studies have provided direct evidence that morphological alterations to neurons in auditory cortex are implicated in the pathophysiology of this illness, confirming previous predictions. Potential neural substrates for auditory impairment and gray matter loss in auditory cortex in schizophrenia have been identified, described, and are the focus of this review article. Pyramidal cell somal volume is reduced in auditory cortex, as are dendritic spine density and number in schizophrenia. Pyramidal cells are not lost in this region in schizophrenia, indicating that dendritic spine reductions reflect fewer spines per pyramidal cell, consistent with the reduced neuropil hypothesis of schizophrenia. Stereological methods have aided in the proper collection, reporting and interpretation of this data. Mechanistic studies exploring relationships between genetic risk for schizophrenia and altered dendrite morphology represent an important avenue for future research in order to further elucidate cellular pathology in auditory cortex in schizophrenia.
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Affiliation(s)
- Emily M Parker
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Robert A Sweet
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States.,VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
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23
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Kantrowitz JT, Epstein ML, Lee M, Lehrfeld N, Nolan KA, Shope C, Petkova E, Silipo G, Javitt DC. Improvement in mismatch negativity generation during d-serine treatment in schizophrenia: Correlation with symptoms. Schizophr Res 2018; 191:70-79. [PMID: 28318835 DOI: 10.1016/j.schres.2017.02.027] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Deficits in N-methyl-d-aspartate-type (NMDAR) function contribute to symptoms and cognitive dysfunction in schizophrenia. The efficacy of NMDAR agonists in the treatment of persistent symptoms of schizophrenia has been variable, potentially reflecting limitations in functional target engagement. We recently demonstrated significant improvement in auditory mismatch negativity (MMN) with once-weekly treatment with d-serine, a naturally occurring NMDAR glycine-site agonist. This study investigates effects of continuous (daily) NMDAR agonists in schizophrenia/schizoaffective disorder. METHODS Primary analysis was on MMN after double-blind crossover (60mg/kg/d, n=16, 6weeks) treatment with d-serine/placebo. Secondary measures included clinical symptoms, neurocognition, and the effects of open-label (30-120mg/kg/d, n=21) d-serine and bitopertin/placebo (10mg, n=29), a glycine transport inhibitor. RESULTS Double-blind d-serine treatment led to significant improvement in MMN frequency (p=0.001, d=2.3) generation and clinical symptoms (p=0.023, d=0.80). MMN frequency correlated significantly with change in symptoms (r=-0.63, p=0.002) following co-variation for treatment type. d-Serine treatment led to a significant, large effect size increase vs. placebo in evoked α-power in response to standards (p=0.036, d=0.81), appearing to normalize evoked α power relative to previous findings with controls. While similar results were seen with open-label d-serine, no significant effects of bitopertin were observed for symptoms or MMN. CONCLUSIONS These findings represent the first randomized double-blind placebo-controlled study with 60mg/kg d-serine in schizophrenia, and are consistent with meta-analyses showing significant effects of d-serine in schizophrenia. Results overall support suggest that MMN may have negative, as well as positive, predictive value in predicting efficacy of novel compounds. CLINICAL TRIALS REGISTRATION Clinicaltrials.gov: NCT00322023/NCT00817336 (d-serine); NCT01116830 (bitopertin).
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Affiliation(s)
- Joshua T Kantrowitz
- Schizophrenia Research Center, Nathan Kline Institute, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States; Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States.
| | - Michael L Epstein
- Schizophrenia Research Center, Nathan Kline Institute, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States; Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States; Graduate Center, City University of New York, 365 5th Ave, New York, NY, United States
| | - Migyung Lee
- Schizophrenia Research Center, Nathan Kline Institute, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States; Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States
| | - Nayla Lehrfeld
- Schizophrenia Research Center, Nathan Kline Institute, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States
| | - Karen A Nolan
- Schizophrenia Research Center, Nathan Kline Institute, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States; Department of Psychiatry, New York University School of Medicine, 1 Park Ave, New York, NY, United States
| | - Constance Shope
- Schizophrenia Research Center, Nathan Kline Institute, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States
| | - Eva Petkova
- Schizophrenia Research Center, Nathan Kline Institute, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States; Department of Child and Adolescent Psychiatry, New York University School of Medicine, 1 Park Ave, New York, NY, United States
| | - Gail Silipo
- Schizophrenia Research Center, Nathan Kline Institute, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States
| | - Daniel C Javitt
- Schizophrenia Research Center, Nathan Kline Institute, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States; Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States
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24
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Perrin MA, Kantrowitz JT, Silipo G, Dias E, Jabado O, Javitt DC. Mismatch negativity (MMN) to spatial deviants and behavioral spatial discrimination ability in the etiology of auditory verbal hallucinations and thought disorder in schizophrenia. Schizophr Res 2018; 191:140-147. [PMID: 28532686 DOI: 10.1016/j.schres.2017.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 05/08/2017] [Accepted: 05/10/2017] [Indexed: 02/02/2023]
Abstract
UNLABELLED Persistent auditory verbal hallucinations (AVH) in schizophrenia are increasingly tied to dysfunction at the level of auditory cortex. AVH may reflect in part misattribution of internally generated thoughts to external spatial locations. Here, we investigated the association between persistent AVH and spatial localization abilities assessed both behaviorally and by mismatch negativity (MMN) to location deviants. METHODS Spatial- and tonal- discrimination abilities were assessed in patients (n=20) and controls (n=20) using free-field tones. MMN was assessed to spatial-location-, pitch- and duration-deviants. AVH and thought disorder were assessed using clinical evaluation. RESULTS As predicted, patients showed significant reductions in behavioral spatial-discrimination (p<0.0001) and tone-matching (p<0.001) ability, along with impaired MMN generation to location (p<0.03) and pitch (p<0.05) deviants. Hallucinating (AVH+) and non-hallucinating (AVH-) subjects showed similar deficits in location MMN to left-hemifield stimuli (p<0.0001 vs. control). By contrast, AVH- patients differed significantly from controls (p=0.009) and AVH+ patients (p=0.018) for MMN to right-lateral hemifield (left auditory cortex) stimuli, whereas AVH+ patients showed paradoxically preserved MMN generation (p=0.99 vs. controls). Severity of thought disorder correlated with impaired spatial discrimination, especially to right-hemifield stimuli (p=0.013), but did not correlate significantly with MMN or tone matching deficits. CONCLUSION These findings demonstrate a significant relationship between auditory cortical spatial localization abilities and AVH susceptibility, with relatively preserved function of left vs. right auditory cortex predisposing to more severe AVH, and support models that attribute persistent AVH to impaired source-monitoring. The findings suggest new approaches for therapeutic intervention for both AVH and thought disorder in schizophrenia.
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Affiliation(s)
- Megan A Perrin
- Schizophrenia Research Center, Nathan Kline Institute for Psychiatric Research, United States; Department of Clinical Neuropsychology, Queens College, United States; The Graduate Center, City University of New York, United States
| | - Joshua T Kantrowitz
- Schizophrenia Research Center, Nathan Kline Institute for Psychiatric Research, United States; Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, United States
| | - Gail Silipo
- Schizophrenia Research Center, Nathan Kline Institute for Psychiatric Research, United States
| | - Elisa Dias
- Schizophrenia Research Center, Nathan Kline Institute for Psychiatric Research, United States
| | - Omar Jabado
- Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, United States
| | - Daniel C Javitt
- Schizophrenia Research Center, Nathan Kline Institute for Psychiatric Research, United States; Department of Psychiatry, Columbia College of Physicians and Surgeons, United States.
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25
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Kantrowitz JT, Epstein ML, Beggel O, Rohrig S, Lehrfeld JM, Revheim N, Lehrfeld NP, Reep J, Parker E, Silipo G, Ahissar M, Javitt DC. Neurophysiological mechanisms of cortical plasticity impairments in schizophrenia and modulation by the NMDA receptor agonist D-serine. Brain 2017; 139:3281-3295. [PMID: 27913408 DOI: 10.1093/brain/aww262] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/20/2016] [Accepted: 08/29/2016] [Indexed: 11/12/2022] Open
Abstract
Schizophrenia is associated with deficits in cortical plasticity that affect sensory brain regions and lead to impaired cognitive performance. Here we examined underlying neural mechanisms of auditory plasticity deficits using combined behavioural and neurophysiological assessment, along with neuropharmacological manipulation targeted at the N-methyl-D-aspartate type glutamate receptor (NMDAR). Cortical plasticity was assessed in a cohort of 40 schizophrenia/schizoaffective patients relative to 42 healthy control subjects using a fixed reference tone auditory plasticity task. In a second cohort (n = 21 schizophrenia/schizoaffective patients, n = 13 healthy controls), event-related potential and event-related time-frequency measures of auditory dysfunction were assessed during administration of the NMDAR agonist d-serine. Mismatch negativity was used as a functional read-out of auditory-level function. Clinical trials registration numbers were NCT01474395/NCT02156908 Schizophrenia/schizoaffective patients showed significantly reduced auditory plasticity versus healthy controls (P = 0.001) that correlated with measures of cognitive, occupational and social dysfunction. In event-related potential/time-frequency analyses, patients showed highly significant reductions in sensory N1 that reflected underlying impairments in θ responses (P < 0.001), along with reduced θ and β-power modulation during retention and motor-preparation intervals. Repeated administration of d-serine led to intercorrelated improvements in (i) auditory plasticity (P < 0.001); (ii) θ-frequency response (P < 0.05); and (iii) mismatch negativity generation to trained versus untrained tones (P = 0.02). Schizophrenia/schizoaffective patients show highly significant deficits in auditory plasticity that contribute to cognitive, occupational and social dysfunction. d-serine studies suggest first that NMDAR dysfunction may contribute to underlying cortical plasticity deficits and, second, that repeated NMDAR agonist administration may enhance cortical plasticity in schizophrenia.
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Affiliation(s)
- Joshua T Kantrowitz
- 1 Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA .,2 Division of Experimental Therapeutics, Departments of Psychiatry and Neuroscience, Columbia University, New York, NY, USA
| | - Michael L Epstein
- 1 Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA.,3 Graduate Center, City University of New York, New York, NY, USA
| | - Odeta Beggel
- 1 Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA
| | - Stephanie Rohrig
- 1 Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA
| | - Jonathan M Lehrfeld
- 1 Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA
| | - Nadine Revheim
- 1 Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA
| | - Nayla P Lehrfeld
- 1 Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA
| | - Jacob Reep
- 1 Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA
| | - Emily Parker
- 1 Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA
| | - Gail Silipo
- 1 Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA
| | - Merav Ahissar
- 4 Edmond and Lily Safra Center for Brain Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Daniel C Javitt
- 1 Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA.,2 Division of Experimental Therapeutics, Departments of Psychiatry and Neuroscience, Columbia University, New York, NY, USA
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26
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Abstract
The specific efficacy of antipsychotics on negative symptoms is questionable, suggesting an urgent need for specific treatments for negative symptoms. This review includes studies published since 2014 with a primary or secondary focus on treating negative symptoms in schizophrenia. Special emphasis is given to recently published meta-analyses. Topics include novel pharmacological approaches, including glutamatergic-based and nicotinic-acetylcholinergic treatments, treatments approved for other indications by the US FDA (or other regulatory bodies) (antipsychotics, antidepressants, and mood stabilizers), brain stimulation, and behavioral- and activity-based approaches, including physical exercise. Potential complications regarding the design of current negative symptom trials are discussed and include inconsistent placebo effects, lack of reliable biomarkers, negative symptom scale and inclusion criteria variability, attempts to distinguish between primary and secondary negative symptoms, lack of focus on early psychosis, and the potential iatrogenic bias of clinical trials.
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Affiliation(s)
- Joshua T Kantrowitz
- Schizophrenia Research Center, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA. .,Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, New York, NY, 10032, USA. .,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10023, USA.
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27
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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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28
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Debbané M, Salaminios G, Luyten P, Badoud D, Armando M, Solida Tozzi A, Fonagy P, Brent BK. Attachment, Neurobiology, and Mentalizing along the Psychosis Continuum. Front Hum Neurosci 2016; 10:406. [PMID: 27597820 PMCID: PMC4992687 DOI: 10.3389/fnhum.2016.00406] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 08/02/2016] [Indexed: 11/22/2022] Open
Abstract
In this review article, we outline the evidence linking attachment adversity to psychosis, from the premorbid stages of the disorder to its clinical forms. To better understand the neurobiological mechanisms through which insecure attachment may contribute to psychosis, we identify at least five neurobiological pathways linking attachment to risk for developing psychosis. Besides its well documented influence on the hypothalamic-pituary-adrenal (HPA) axis, insecure attachment may also contribute to neurodevelopmental risk through the dopaminergic and oxytonergic systems, as well as bear influence on neuroinflammation and oxidative stress responses. We further consider the neuroscientific and behavioral studies that underpin mentalization as a suite of processes potentially moderating the risk to transition to psychotic disorders. In particular, mentalization may help the individual compensate for endophenotypical impairments in the integration of sensory and metacognitive information. We propose a model where embodied mentalization would lie at the core of a protective, resilience response mitigating the adverse and potentially pathological influence of the neurodevelopmental cascade of risk for psychosis.
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Affiliation(s)
- Martin Debbané
- Faculty of Psychology and Educational Sciences, University of GenevaGeneva, Switzerland
- Research Department of Clinical, Educational and Health Psychology, University College LondonLondon, UK
- Office Médico-PédagogiqueGeneva, Switzerland
| | - George Salaminios
- Research Department of Clinical, Educational and Health Psychology, University College LondonLondon, UK
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College LondonLondon, UK
- Faculty of Psychology and Educational Sciences, University of LeuvenLeuven, Belgium
| | - Deborah Badoud
- Faculty of Psychology and Educational Sciences, University of GenevaGeneva, Switzerland
| | | | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College LondonLondon, UK
| | - Benjamin K. Brent
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, USA
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29
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Tobe RH, Corcoran CM, Breland M, MacKay-Brandt A, Klim C, Colcombe SJ, Leventhal BL, Javitt DC. Differential profiles in auditory social cognition deficits between adults with autism and schizophrenia spectrum disorders: A preliminary analysis. J Psychiatr Res 2016; 79:21-27. [PMID: 27131617 PMCID: PMC7314624 DOI: 10.1016/j.jpsychires.2016.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/09/2016] [Accepted: 04/14/2016] [Indexed: 11/20/2022]
Abstract
Impairment in social cognition, including emotion recognition, has been extensively studied in both Autism Spectrum Disorders (ASD) and Schizophrenia (SZ). However, the relative patterns of deficit between disorders have been studied to a lesser degree. Here, we applied a social cognition battery incorporating both auditory (AER) and visual (VER) emotion recognition measures to a group of 19 high-functioning individuals with ASD relative to 92 individuals with SZ, and 73 healthy control adult participants. We examined group differences and correlates of basic auditory processing and processing speed. Individuals with SZ were impaired in both AER and VER while ASD individuals were impaired in VER only. In contrast to SZ participants, those with ASD showed intact basic auditory function. Our finding of a dissociation between AER and VER deficits in ASD relative to Sz support modality-specific theories of emotion recognition dysfunction. Future studies should focus on visual system-specific contributions to social cognitive impairment in ASD.
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Affiliation(s)
- Russell H Tobe
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Columbia University, Department of Psychiatry, New York, NY, USA
| | - Cheryl M Corcoran
- Columbia University, Department of Psychiatry, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Melissa Breland
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Anna MacKay-Brandt
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Columbia University, Department of Neurology, Cognitive Neuroscience Division, New York, NY, USA
| | - Casimir Klim
- Columbia University, Department of Psychiatry, New York, NY, USA
| | | | - Bennett L Leventhal
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; University of California San Francisco, Department of Psychiatry, San Francisco, CA, USA
| | - Daniel C Javitt
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Columbia University, Department of Psychiatry, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
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30
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Chen FZ, Wang Y, Sun XR, Yao YH, Zhang N, Qiao HF, Zhang L, Li ZJ, Lin H, Lu Z, Li J, Chan RCK, Zhao XD. Emotional Experiences Predict the Conversion of Individuals with Attenuated Psychosis Syndrome to Psychosis: A 6-Month Follow up Study. Front Psychol 2016; 7:818. [PMID: 27313553 PMCID: PMC4888623 DOI: 10.3389/fpsyg.2016.00818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/17/2016] [Indexed: 02/05/2023] Open
Abstract
The present study explored the conversion rate in individuals with Attenuated Psychosis Syndrome (APS) and potential predictor for transition in mainland China. Sixty-three participants identified as APS were followed up 6 months later. The results showed that 17% of individuals with APS converted to full-blown psychosis. The converters exhibited significantly poorer emotional experience and expression than the non-converters at baseline. A further binary logistic regression analysis showed that emotional experience could predict the transition (Wald = 4.18, p = 0.041, 95% CI = 1.04~6.82). The present study suggests an important role of emotional processing in the prediction of the development of full-blown psychosis.
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Affiliation(s)
- Fa Zhan Chen
- Pudong New Area Mental Health Center, Tongji University School of MedicineShanghai, China; Department of Psychosomatic Medicine, East Hospital, Tongji University School of MedicineShanghai, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences Beijing, China
| | - Xi Rong Sun
- Pudong New Area Mental Health Center, Tongji University School of Medicine Shanghai, China
| | - Yu Hong Yao
- Psychological Health Education and Counseling Center, Tongji University Shanghai, China
| | - Ning Zhang
- Department of Clinical Psychology, Nanjing Brain Hospital, Nanjing Medical University Nanjing, China
| | - Hui Fen Qiao
- Department of Clinical Psychology, Nanjing Brain Hospital, Nanjing Medical University Nanjing, China
| | - Lan Zhang
- Mental Health Center, West China Hospital, Sichuan University Chengdu, China
| | - Zhan Jiang Li
- Department of Clinical Psychology, Beijing Anding Hospital, Capital Medical University Beijing, China
| | - Hong Lin
- Department of Clinical Psychology, Peking University Sixth Hospital Beijing, China
| | - Zheng Lu
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine Shanghai, China
| | - Jing Li
- Department of Psychiatry, First Affiliated Hospital of Chongqing Medical University Chongqing, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences Beijing, China
| | - Xu Dong Zhao
- Pudong New Area Mental Health Center, Tongji University School of MedicineShanghai, China; Department of Psychosomatic Medicine, East Hospital, Tongji University School of MedicineShanghai, China
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31
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Faget-Agius C, Boyer L, Richieri R, Auquier P, Lançon C, Guedj E. Functional brain substrate of quality of life in patients with schizophrenia: A brain SPECT multidimensional analysis. Psychiatry Res Neuroimaging 2016; 249:67-75. [PMID: 27000309 DOI: 10.1016/j.pscychresns.2016.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 01/16/2016] [Accepted: 02/11/2016] [Indexed: 12/20/2022]
Abstract
The aim of this study was to investigate the functional brain substrate of quality of life (QoL) in patients with schizophrenia. Participants comprised 130 right-handed patients with schizophrenia who underwent whole-brain single photon emission computed tomography (SPECT) with (99m)Tc-labeled ethylcysteinate dimer ((99m)Tc-ECD) for exploring correlations of regional cerebral blood flow (rCBF) with the eight dimensions score of the Schizophrenia Quality of Life questionnaire (S-QoL 18). A significant positive correlation was found between the global index of the S-QoL 18 and rCBF in the right superior temporal sulcus and between psychological well-being dimension and rCBF in Brodmann area (BA)6, BA8, BA9, and BA10 and between self-esteem dimension and rCBF in striatum and between family relationship dimension and rCBF in BA1, BA2, BA3, BA4, BA8, BA22, BA40, BA42 and BA44 and between relationship with friends dimension and rCBF in BA44 and between physical well-being dimension and rCBF in parahippocampal gyrus, and finally between autonomy dimension and rCBF in cuneus and precuneus. A significant negative correlation was found between resilience dimension and rCBF in precuneus and between sentimental life dimension and rCBF in BA10. Our findings provide neural correlates of QoL. Brain regions involved in cognitions, emotional information processing and social cognition underlie the different QoL dimensions.
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Affiliation(s)
- Catherine Faget-Agius
- Aix-Marseille University, EA 3279, 13005 Marseille, France; Department of Psychiatry, Conception University Hospital, 13005 Marseille, France; EA 3279-Public Health, Chronic Diseases and Quality of Life, School of Medicine, Timone University, 13005 Marseille, France.
| | - Laurent Boyer
- Aix-Marseille University, EA 3279, 13005 Marseille, France; Department of Public Health, La Timone University Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France; EA 3279-Public Health, Chronic Diseases and Quality of Life, School of Medicine, Timone University, 13005 Marseille, France
| | - Raphaëlle Richieri
- Aix-Marseille University, EA 3279, 13005 Marseille, France; Department of Psychiatry, Conception University Hospital, 13005 Marseille, France; EA 3279-Public Health, Chronic Diseases and Quality of Life, School of Medicine, Timone University, 13005 Marseille, France
| | - Pascal Auquier
- Aix-Marseille University, EA 3279, 13005 Marseille, France; Department of Public Health, La Timone University Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France; EA 3279-Public Health, Chronic Diseases and Quality of Life, School of Medicine, Timone University, 13005 Marseille, France
| | - Christophe Lançon
- Aix-Marseille University, EA 3279, 13005 Marseille, France; Department of Psychiatry, Conception University Hospital, 13005 Marseille, France; EA 3279-Public Health, Chronic Diseases and Quality of Life, School of Medicine, Timone University, 13005 Marseille, France
| | - Eric Guedj
- Service Central de Biophysique et Médecine Nucléaire, La Timone University Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France; Centre Européen de Recherche en Imagerie Médicale (CERIMED), Aix-Marseille University, Marseille 13005, France
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Abstract
UNLABELLED Deficits in auditory emotion recognition (AER) are a core feature of schizophrenia and a key component of social cognitive impairment. AER deficits are tied behaviorally to impaired ability to interpret tonal ("prosodic") features of speech that normally convey emotion, such as modulations in base pitch (F0M) and pitch variability (F0SD). These modulations can be recreated using synthetic frequency modulated (FM) tones that mimic the prosodic contours of specific emotional stimuli. The present study investigates neural mechanisms underlying impaired AER using a combined event-related potential/resting-state functional connectivity (rsfMRI) approach in 84 schizophrenia/schizoaffective disorder patients and 66 healthy comparison subjects. Mismatch negativity (MMN) to FM tones was assessed in 43 patients/36 controls. rsfMRI between auditory cortex and medial temporal (insula) regions was assessed in 55 patients/51 controls. The relationship between AER, MMN to FM tones, and rsfMRI was assessed in the subset who performed all assessments (14 patients, 21 controls). As predicted, patients showed robust reductions in MMN across FM stimulus type (p = 0.005), particularly to modulations in F0M, along with impairments in AER and FM tone discrimination. MMN source analysis indicated dipoles in both auditory cortex and anterior insula, whereas rsfMRI analyses showed reduced auditory-insula connectivity. MMN to FM tones and functional connectivity together accounted for ∼50% of the variance in AER performance across individuals. These findings demonstrate that impaired preattentive processing of tonal information and reduced auditory-insula connectivity are critical determinants of social cognitive dysfunction in schizophrenia, and thus represent key targets for future research and clinical intervention. SIGNIFICANCE STATEMENT Schizophrenia patients show deficits in the ability to infer emotion based upon tone of voice [auditory emotion recognition (AER)] that drive impairments in social cognition and global functional outcome. This study evaluated neural substrates of impaired AER in schizophrenia using a combined event-related potential/resting-state fMRI approach. Patients showed impaired mismatch negativity response to emotionally relevant frequency modulated tones along with impaired functional connectivity between auditory and medial temporal (anterior insula) cortex. These deficits contributed in parallel to impaired AER and accounted for ∼50% of variance in AER performance. Overall, these findings demonstrate the importance of both auditory-level dysfunction and impaired auditory/insula connectivity in the pathophysiology of social cognitive dysfunction in schizophrenia.
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Gill KE, Cressman V, Poe SL, Steinfeld S, Ben-David S, Keilp JG, Moore H, Turkstra LS, Corcoran C. Social inference in individuals at clinical high risk for psychosis. Early Interv Psychiatry 2016; 10:77-80. [PMID: 25203733 DOI: 10.1111/eip.12182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 07/22/2014] [Indexed: 11/30/2022]
Abstract
AIM Social cognition impairment is a hallmark of schizophrenia and contains multiple domains. The domain of social inference has been relatively understudied in schizophrenia and its risk states. METHODS Social inference was assessed in 60 clinical high-risk (CHR) patients and 28 healthy control subjects, using the video social inference task. We hypothesized a deficit in social inference in CHR participants and examined predictive value for psychosis transition. RESULTS Social inference was positively associated with increasing age. Social inference did not differ significantly between CHR patients and controls, or predict transition to psychosis. CONCLUSIONS Few studies have examined social inference of individuals at clinical high risk for psychosis, and findings have been inconclusive. Additional studies using a variety of measures of social inference in CHR participants are recommended.
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Affiliation(s)
- Kelly E Gill
- Department of Psychiatry, Columbia University, New York, New York, USA.,Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Victoria Cressman
- Department of Psychiatry, New York Harbor Healthcare System, New York University School of Medicine, New York, New York, USA
| | - Sarah Lucy Poe
- Department of Psychiatry, Columbia University, New York, New York, USA.,Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Sara Steinfeld
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Shelly Ben-David
- Department of Psychiatry, Columbia University, New York, New York, USA.,School of Social Work, New York University, New York, New York, USA
| | - John G Keilp
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Holly Moore
- Department of Psychiatry, Columbia University, New York, New York, USA.,Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Lyn S Turkstra
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Cheryl Corcoran
- Department of Psychiatry, Columbia University, New York, New York, USA.,Psychiatry, New York State Psychiatric Institute, New York, New York, USA
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Brown M, Kuperberg GR. A Hierarchical Generative Framework of Language Processing: Linking Language Perception, Interpretation, and Production Abnormalities in Schizophrenia. Front Hum Neurosci 2015; 9:643. [PMID: 26640435 PMCID: PMC4661240 DOI: 10.3389/fnhum.2015.00643] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 11/12/2015] [Indexed: 12/27/2022] Open
Abstract
Language and thought dysfunction are central to the schizophrenia syndrome. They are evident in the major symptoms of psychosis itself, particularly as disorganized language output (positive thought disorder) and auditory verbal hallucinations (AVHs), and they also manifest as abnormalities in both high-level semantic and contextual processing and low-level perception. However, the literatures characterizing these abnormalities have largely been separate and have sometimes provided mutually exclusive accounts of aberrant language in schizophrenia. In this review, we propose that recent generative probabilistic frameworks of language processing can provide crucial insights that link these four lines of research. We first outline neural and cognitive evidence that real-time language comprehension and production normally involve internal generative circuits that propagate probabilistic predictions to perceptual cortices - predictions that are incrementally updated based on prediction error signals as new inputs are encountered. We then explain how disruptions to these circuits may compromise communicative abilities in schizophrenia by reducing the efficiency and robustness of both high-level language processing and low-level speech perception. We also argue that such disruptions may contribute to the phenomenology of thought-disordered speech and false perceptual inferences in the language system (i.e., AVHs). This perspective suggests a number of productive avenues for future research that may elucidate not only the mechanisms of language abnormalities in schizophrenia, but also promising directions for cognitive rehabilitation.
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Affiliation(s)
- Meredith Brown
- Department of Psychiatry–Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, CharlestownMA, USA
- Department of Psychology, Tufts University, MedfordMA, USA
| | - Gina R. Kuperberg
- Department of Psychiatry–Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, CharlestownMA, USA
- Department of Psychology, Tufts University, MedfordMA, USA
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35
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Corcoran CM, Keilp JG, Kayser J, Klim C, Butler PD, Bruder GE, Gur RC, Javitt DC. Emotion recognition deficits as predictors of transition in individuals at clinical high risk for schizophrenia: a neurodevelopmental perspective. Psychol Med 2015; 45:2959-2973. [PMID: 26040537 PMCID: PMC5080982 DOI: 10.1017/s0033291715000902] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Schizophrenia is characterized by profound and disabling deficits in the ability to recognize emotion in facial expression and tone of voice. Although these deficits are well documented in established schizophrenia using recently validated tasks, their predictive utility in at-risk populations has not been formally evaluated. METHOD The Penn Emotion Recognition and Discrimination tasks, and recently developed measures of auditory emotion recognition, were administered to 49 clinical high-risk subjects prospectively followed for 2 years for schizophrenia outcome, and 31 healthy controls, and a developmental cohort of 43 individuals aged 7-26 years. Deficit in emotion recognition in at-risk subjects was compared with deficit in established schizophrenia, and with normal neurocognitive growth curves from childhood to early adulthood. RESULTS Deficits in emotion recognition significantly distinguished at-risk patients who transitioned to schizophrenia. By contrast, more general neurocognitive measures, such as attention vigilance or processing speed, were non-predictive. The best classification model for schizophrenia onset included both face emotion processing and negative symptoms, with accuracy of 96%, and area under the receiver-operating characteristic curve of 0.99. In a parallel developmental study, emotion recognition abilities were found to reach maturity prior to traditional age of risk for schizophrenia, suggesting they may serve as objective markers of early developmental insult. CONCLUSIONS Profound deficits in emotion recognition exist in at-risk patients prior to schizophrenia onset. They may serve as an index of early developmental insult, and represent an effective target for early identification and remediation. Future studies investigating emotion recognition deficits at both mechanistic and predictive levels are strongly encouraged.
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Affiliation(s)
- C. M. Corcoran
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - J. G. Keilp
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - J. Kayser
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - C. Klim
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - P. D. Butler
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
- Department of Psychiatry, New York University, New York, NY, USA
| | - G. E. Bruder
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - R. C. Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - D. C. Javitt
- Department of Psychiatry, Columbia University, New York, NY, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
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36
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Javitt DC, Sweet RA. Auditory dysfunction in schizophrenia: integrating clinical and basic features. Nat Rev Neurosci 2015; 16:535-50. [PMID: 26289573 PMCID: PMC4692466 DOI: 10.1038/nrn4002] [Citation(s) in RCA: 252] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Schizophrenia is a complex neuropsychiatric disorder that is associated with persistent psychosocial disability in affected individuals. Although studies of schizophrenia have traditionally focused on deficits in higher-order processes such as working memory and executive function, there is an increasing realization that, in this disorder, deficits can be found throughout the cortex and are manifest even at the level of early sensory processing. These deficits are highly amenable to translational investigation and represent potential novel targets for clinical intervention. Deficits, moreover, have been linked to specific structural abnormalities in post-mortem auditory cortex tissue from individuals with schizophrenia, providing unique insights into underlying pathophysiological mechanisms.
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Affiliation(s)
- Daniel C Javitt
- Division of Experimental Therapeutics, Departments of Psychiatry and Neuroscience, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, Unit 21, New York, New York 10032, USA
- Program in Cognitive Neuroscience and Schizophrenia, Nathan S. Kline Institute, 140 Old Orangeburg Rd, Orangeburg, New York 10962, USA
| | - Robert A Sweet
- Departments of Psychiatry and Neurology, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, Pennsylvania 15213, USA
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Research Office Building (151R), University Drive C, Pittsburgh, Pennsylvania 15240, USA
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37
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Javitt DC, Freedman R. Sensory processing dysfunction in the personal experience and neuronal machinery of schizophrenia. Am J Psychiatry 2015; 172:17-31. [PMID: 25553496 PMCID: PMC4501403 DOI: 10.1176/appi.ajp.2014.13121691] [Citation(s) in RCA: 263] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sensory processing deficits, first investigated by Kraepelin and Bleuler as possible pathophysiological mechanisms in schizophrenia, are now being recharacterized in the context of our current understanding of the molecular and neurobiological brain mechanisms involved. The National Institute of Mental Health Research Domain Criteria position these deficits as intermediaries between molecular and cellular mechanisms and clinical symptoms of schizophrenia, such as hallucinations. The prepulse inhibition of startle responses by a weaker preceding tone, the inhibitory gating of response to paired sensory stimuli characterized using the auditory P50 evoked response, and the detection of slight deviations in patterns of sensory stimulation eliciting the cortical mismatch negativity potential demonstrate deficits in early sensory processing mechanisms, whose molecular and neurobiological bases are increasingly well understood. Deficits in sensory processing underlie more complex cognitive dysfunction and are in turn affected by higher-level cognitive difficulties. These deficits are now being used to identify genes involved in familial transmission of schizophrenia and to monitor potentially therapeutic drug effects for both treatment and prevention. This research also provides a clinical reminder that patients' sensory perception of the surrounding world, even during treatment sessions, may differ considerably from others' perceptions. A person's ability to understand and interact effectively with the surrounding world ultimately depends on an underlying sensory experience of it.
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Affiliation(s)
- Daniel C. Javitt
- Division of Experimental Therapeutics, Department of Psychiatry, Program in Cognitive Neuroscience and Schizophrenia, Nathan Kline Institute for Psychiatric Research/Columbia University Medical Center, New York, NY 10032, USA
| | - Robert Freedman
- Department of Psychiatry, University of Colorado Denver School of Medicine, Mail Stop F546, Aurora, CO, 80045, USA
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Smith MJ, Schroeder MP, Abram SV, Goldman MB, Parrish TB, Wang X, Derntl B, Habel U, Decety J, Reilly JL, Csernansky JG, Breiter HC. Alterations in brain activation during cognitive empathy are related to social functioning in schizophrenia. Schizophr Bull 2015; 41:211-22. [PMID: 24583906 PMCID: PMC4266286 DOI: 10.1093/schbul/sbu023] [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] [Indexed: 12/30/2022]
Abstract
Impaired cognitive empathy (ie, understanding the emotional experiences of others) is associated with poor social functioning in schizophrenia. However, it is unclear whether the neural activity underlying cognitive empathy relates to social functioning. This study examined the neural activation supporting cognitive empathy performance and whether empathy-related activation during correctly performed trials was associated with self-reported cognitive empathy and measures of social functioning. Thirty schizophrenia outpatients and 24 controls completed a cognitive empathy paradigm during functional magnetic resonance imaging. Neural activity corresponding to correct judgments about the expected emotional expression in a social interaction was compared in schizophrenia subjects relative to control subjects. Participants also completed a self-report measure of empathy and 2 social functioning measures (social competence and social attainment). Schizophrenia subjects demonstrated significantly lower accuracy in task performance and were characterized by hypoactivation in empathy-related frontal, temporal, and parietal regions as well as hyperactivation in occipital regions compared with control subjects during accurate cognitive empathy trials. A cluster with peak activation in the supplementary motor area (SMA) extending to the anterior midcingulate cortex (aMCC) correlated with social competence and social attainment in schizophrenia subjects but not controls. These results suggest that neural correlates of cognitive empathy may be promising targets for interventions aiming to improve social functioning and that brain activation in the SMA/aMCC region could be used as a biomarker for monitoring treatment response.
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Affiliation(s)
- Matthew J. Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; ,Department of Psychiatry, Warren Wright Adolescent Center at Stone Institute of Psychiatry, Northwestern Memorial Hospital, Chicago, IL; ,*To whom correspondence should be addressed; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N. Lakeshore Dr, Abbott Hall 13th floor, Chicago, IL 60611, US; tel: 1-312-503-2542, fax: 1-312-503-0527, e-mail:
| | - Matthew P. Schroeder
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Morris B. Goldman
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Todd B. Parrish
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Xue Wang
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Birgit Derntl
- Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen University (Germany), Aachen, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen University (Germany), Aachen, Germany
| | - Jean Decety
- Department of Psychology, University of Chicago, Chicago, IL; ,Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL
| | - James L. Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; ,Department of Psychiatry, Warren Wright Adolescent Center at Stone Institute of Psychiatry, Northwestern Memorial Hospital, Chicago, IL; , These authors shared senior authorship
| | - John G. Csernansky
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; , These authors shared senior authorship
| | - Hans C. Breiter
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; ,Department of Psychiatry, Warren Wright Adolescent Center at Stone Institute of Psychiatry, Northwestern Memorial Hospital, Chicago, IL; , These authors shared senior authorship
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39
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Mitchell RLC, Rossell SL. Perception of emotion-related conflict in human communications: what are the effects of schizophrenia? Psychiatry Res 2014; 220:135-44. [PMID: 25149130 DOI: 10.1016/j.psychres.2014.07.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 07/29/2014] [Accepted: 07/31/2014] [Indexed: 11/18/2022]
Abstract
Our ability to make sense of emotional cues is of paramount importance for understanding state of mind and communicative intent. However, emotional cues often conflict with each other; this presents a significant challenge for people with schizophrenia. We conducted a theoretical review to determine the extent and types of impaired processing of emotion-related conflict in schizophrenia; we evaluated the relationship with medication and symptoms, and considered possible mediatory mechanisms. The literature established that people with schizophrenia demonstrated impaired function: (i) when passively exposed to emotion cues whilst performing an unrelated task, (ii) when selectively attending to one source of emotion cues whilst trying to ignore interference from another source, and (iii) when trying to resolve conflicting emotion cues and judge meta-communicative intent. These deficits showed associations with both negative and positive symptoms. There was limited evidence for antipsychotic medications attenuating impaired emotion perception when there are conflicting cues, with further direct research needed. Impaired attentional control and context processing may underlie some of the observed impairments. Neuroanatomical correlates are likely to involve interhemispheric transfer via the corpus callosum, limbic regions such as the amygdala, and possibly dorsolateral prefrontal and anterior cingulate cortex through their role in conflict processing.
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Affiliation(s)
- Rachel L C Mitchell
- Centre for Affective (PO Box 72), Department of Psychological Medicine, Institute of Psychiatry, 16 De Crespigny Park, London SE5 8AF, UK.
| | - Susan L Rossell
- Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Victoria, Australia
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Petkova E, Lu F, Kantrowitz J, Sanchez JL, Lehrfeld J, Scaramello N, Silipo G, DiCostanza J, Ross M, Su Z, Javitt DC, Butler PD. Auditory tasks for assessment of sensory function and affective prosody in schizophrenia. Compr Psychiatry 2014; 55:1862-74. [PMID: 25214372 PMCID: PMC4691012 DOI: 10.1016/j.comppsych.2014.08.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 08/11/2014] [Accepted: 08/14/2014] [Indexed: 01/05/2023] Open
Abstract
Schizophrenia patients exhibit impairments in auditory-based social cognition, indicated by deficits in detection of prosody, such as affective prosody and basic pitch perception. However, little is known about the psychometric properties of behavioral tests used to assess these functions. The goal of this paper is to characterize the properties of prosody and pitch perception tasks and to investigate whether they can be shortened. The pitch perception test evaluated is a tone-matching task developed by Javitt and colleagues (J-TMT). The prosody test evaluated is the auditory emotion recognition task developed by Juslin and Laukka (JL-AER). The sample includes 124 schizophrenia patients (SZ) and 131 healthy controls (HC). Properties, including facility and discrimination, of each item were assessed. Effects of item characteristics (e.g., emotion) were also evaluated. Shortened versions of the tests are proposed based on facility, discrimination, and/or ability of item characteristics to discriminate between patients and controls. Test-retest reliability is high for patients and controls for both the original and short forms of the J-TMT and JL-AER. Thus, the original as well as short forms of the J-TMT and JL-AER are suggested for inclusion in clinical trials of social cognitive and perceptual treatments. The development of short forms further increases the utility of these auditory tasks in clinical trials and clinical practice. The large SZ vs. HC differences reported here also highlight the profound nature of auditory deficits and a need for remediation.
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Affiliation(s)
- Eva Petkova
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, New York, NY 10016, USA; Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA.
| | - Feihan Lu
- Department of Statistics, Columbia University, New York, NY 10027
| | - Joshua Kantrowitz
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10027
| | - Jamie L. Sanchez
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962
| | - Jonathan Lehrfeld
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962
| | - Nayla Scaramello
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962
| | - Gail Silipo
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962
| | - Joanna DiCostanza
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962
| | - Marina Ross
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962
| | - Zhe Su
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, New York, NY 10016
| | - Daniel C. Javitt
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10027
| | - Pamela D. Butler
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962,Department of Psychiatry, New York University School of Medicine, New York, NY 10016
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41
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Kantrowitz JT, Scaramello N, Jakubovitz A, Lehrfeld JM, Laukka P, Elfenbein HA, Silipo G, Javitt DC. Amusia and protolanguage impairments in schizophrenia. Psychol Med 2014; 44:2739-2748. [PMID: 25066878 PMCID: PMC5373691 DOI: 10.1017/s0033291714000373] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Both language and music are thought to have evolved from a musical protolanguage that communicated social information, including emotion. Individuals with perceptual music disorders (amusia) show deficits in auditory emotion recognition (AER). Although auditory perceptual deficits have been studied in schizophrenia, their relationship with musical/protolinguistic competence has not previously been assessed. METHOD Musical ability was assessed in 31 schizophrenia/schizo-affective patients and 44 healthy controls using the Montreal Battery for Evaluation of Amusia (MBEA). AER was assessed using a novel battery in which actors provided portrayals of five separate emotions. The Disorganization factor of the Positive and Negative Syndrome Scale (PANSS) was used as a proxy for language/thought disorder and the MATRICS Consensus Cognitive Battery (MCCB) was used to assess cognition. RESULTS Highly significant deficits were seen between patients and controls across auditory tasks (p < 0.001). Moreover, significant differences were seen in AER between the amusia and intact music-perceiving groups, which remained significant after controlling for group status and education. Correlations with AER were specific to the melody domain, and correlations between protolanguage (melody domain) and language were independent of overall cognition. DISCUSSION This is the first study to document a specific relationship between amusia, AER and thought disorder, suggesting a shared linguistic/protolinguistic impairment. Once amusia was considered, other cognitive factors were no longer significant predictors of AER, suggesting that musical ability in general and melodic discrimination ability in particular may be crucial targets for treatment development and cognitive remediation in schizophrenia.
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Affiliation(s)
- J. T. Kantrowitz
- Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - N. Scaramello
- Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA
| | - A. Jakubovitz
- Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA
| | - J. M. Lehrfeld
- Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA
| | - P. Laukka
- Department of Psychology, Stockholm University, Sweden
| | - H. A. Elfenbein
- Olin Business School, Washington University, St Louis, MO, USA
| | - G. Silipo
- Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA
| | - D. C. Javitt
- Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
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