1
|
Sone D, Young A, Shinagawa S, Tsugawa S, Iwata Y, Tarumi R, Ogyu K, Honda S, Ochi R, Matsushita K, Ueno F, Hondo N, Koreki A, Torres-Carmona E, Mar W, Chan N, Koizumi T, Kato H, Kusudo K, de Luca V, Gerretsen P, Remington G, Onaya M, Noda Y, Uchida H, Mimura M, Shigeta M, Graff-Guerrero A, Nakajima S. Disease Progression Patterns of Brain Morphology in Schizophrenia: More Progressed Stages in Treatment Resistance. Schizophr Bull 2024; 50:393-402. [PMID: 38007605 PMCID: PMC10919766 DOI: 10.1093/schbul/sbad164] [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] [Indexed: 11/27/2023]
Abstract
BACKGROUND AND HYPOTHESIS Given the heterogeneity and possible disease progression in schizophrenia, identifying the neurobiological subtypes and progression patterns in each patient may lead to novel biomarkers. Here, we adopted data-driven machine-learning techniques to identify the progression patterns of brain morphological changes in schizophrenia and investigate the association with treatment resistance. STUDY DESIGN In this cross-sectional multicenter study, we included 177 patients with schizophrenia, characterized by treatment response or resistance, with 3D T1-weighted magnetic resonance imaging. Cortical thickness and subcortical volumes calculated by FreeSurfer were converted into z scores using 73 healthy controls data. The Subtype and Stage Inference (SuStaIn) algorithm was used for unsupervised machine-learning analysis. STUDY RESULTS SuStaIn identified 3 different subtypes: (1) subcortical volume reduction (SC) type (73 patients), in which volume reduction of subcortical structures occurs first and moderate cortical thinning follows, (2) globus pallidus hypertrophy and cortical thinning (GP-CX) type (42 patients), in which globus pallidus hypertrophy initially occurs followed by progressive cortical thinning, and (3) cortical thinning (pure CX) type (39 patients), in which thinning of the insular and lateral temporal lobe cortices primarily happens. The remaining 23 patients were assigned to baseline stage of progression (no change). SuStaIn also found 84 stages of progression, and treatment-resistant schizophrenia showed significantly more progressed stages than treatment-responsive cases (P = .001). The GP-CX type presented earlier stages than the pure CX type (P = .009). CONCLUSIONS The brain morphological progressions in schizophrenia can be classified into 3 subtypes, and treatment resistance was associated with more progressed stages, which may suggest a novel biomarker.
Collapse
Affiliation(s)
- Daichi Sone
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
- Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, UK
| | - Alexandra Young
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Sakiko Tsugawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Iwata
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Ryosuke Tarumi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kamiyu Ogyu
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shiori Honda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Ochi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Karin Matsushita
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Fumihiko Ueno
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Nobuaki Hondo
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Akihiro Koreki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | | | - Wanna Mar
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Nathan Chan
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Teruki Koizumi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hideo Kato
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Keisuke Kusudo
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Vincenzo de Luca
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Philip Gerretsen
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Mitsumoto Onaya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Shigeta
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
| | | | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Pang TSW, Chun JSW, Wong TY, Chu ST, Ma CF, Honer WG, Chan SKW. A systematic review of neuroimaging studies of clozapine-resistant schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:65. [PMID: 37752161 PMCID: PMC10522657 DOI: 10.1038/s41537-023-00392-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023]
Abstract
This systematic review aimed to review neuroimaging studies comparing clozapine-resistant schizophrenia patients with clozapine-responding patients, and with first-line antipsychotic responding (FLR) patients. A total of 19 studies including 6 longitudinal studies were identified. Imaging techniques comprised computerized tomography (CT, n = 3), structural magnetic resonance imaging (MRI, n = 7), magnetic resonance spectroscopy (MRS, n = 5), functional MRI (n = 1), single-photon emission computerized tomography (SPECT, n = 3) and diffusion tensor imaging (DTI, n = 1). The most consistent finding was hypo-frontality in the clozapine-resistant group compared with the clozapine-responding group with possible differences in frontal-striatal-basal ganglia circuitry as well as the GABA level between the two treatment-resistant groups. Additional statistically significant findings were reported when comparing clozapine-resistant patients with the FLR group, including lower cortical thickness and brain volume of multiple brain regions as well as lower Glx/Cr level in the dorsolateral prefrontal cortex. Both treatment-resistant groups were found to have extensive differences in neurobiological features in comparison with the FLR group. Overall results suggested treatment-resistant schizophrenia is likely to be a neurobiological distinct type of the illness. Clozapine-resistant and clozapine-responding schizophrenia are likely to have both shared and distinct neurobiological features. However, conclusions from existing studies are limited, and future multi-center collaborative studies are required with a consensus clinical definition of patient samples, multimodal imaging tools, and longitudinal study designs.
Collapse
Affiliation(s)
- Tiffanie Sze Wing Pang
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Johnny Siu Wah Chun
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ting Yat Wong
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Sin Ting Chu
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chak Fai Ma
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - William G Honer
- Department of Psychiatry, The University of British Columbia, Vancouver, Canada
| | - Sherry Kit Wa Chan
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, HKSAR, Hong Kong SAR, China.
| |
Collapse
|
3
|
Wang C, Tishler TA, Nuechterlein KH, Ellingson BM. Cortical thickness, gray-white matter contrast, and intracortical myelin in first-episode schizophrenia patients treated with long-acting paliperidone palmitate versus oral antipsychotics. Psychiatry Res 2023; 326:115364. [PMID: 37494877 DOI: 10.1016/j.psychres.2023.115364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 07/28/2023]
Abstract
This longitudinal study evaluated the cortical thickness, gray-to-white matter contrast (GWC), and frontal lobe intracortical myelin (ICM) volume in first-episode schizophrenia (FES) patients treated with oral antipsychotics (OAP) versus a long-acting injectable antipsychotic, paliperidone palmitate (PP). 2D proton density and inversion recovery images, and 3D T1-weighted MPRAGE images were acquired at 3T from 68 FES patients in a randomized clinical trial with PP vs OAP. At baseline, no differences in GWC and ICM were observed between FES patients and HCs, but the thickness of the left precuneus, the right transverse temporal gyrus, and the bilateral superior temporal gyri was found to be thinner in FES patients relative to HCs. Following 9 months of antipsychotics, OAP treatment, compared to PP treatment, resulted in a more widespread cortical thickness reduction including the right lateral occipital and orbitofrontal gyri. No significant ICM and GWC changes were observed in the PP group, whereas OAP treatment led to a significant ICM volume decrease and GWC increase. A negative correlation was found between ICM changes and GWC changes within multiple frontal regions after 9 months of OAP treatment. These preliminary findings suggest that PP treatment might aid preservation of brain morphology.
Collapse
Affiliation(s)
- C Wang
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - T A Tishler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - K H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - B M Ellingson
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Neuroscience Interdisciplinary Graduate Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
4
|
Chen Y, Cao H, Liu S, Zhang B, Zhao G, Zhang Z, Li S, Li H, Yu X, Deng H. Brain Structure Measurements Predict Individualized Treatment Outcome of 12-Week Antipsychotic Monotherapies in First-episode Schizophrenia. Schizophr Bull 2023; 49:697-705. [PMID: 37010371 PMCID: PMC10154710 DOI: 10.1093/schbul/sbad043] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND AND HYPOTHESIS Early prediction of treatment response to antipsychotics in schizophrenia remains a challenge in clinical practice. This study aimed to investigate if brain morphometries including gray matter volume and cortical thickness could serve as potential predictive biomarkers in first-episode schizophrenia. STUDY DESIGN Sixty-eight drug-naïve first-episode patients underwent baseline structural MRI scans and were subsequently randomized to receive a single antipsychotic throughout the first 12 weeks. Assessments for symptoms and social functioning were conducted by eight "core symptoms" selected from the Positive and Negative Syndrome Scale (PANSS-8) and the Personal and Social performance scale (PSP) multiple times during follow-ups. Treatment outcome was evaluated as subject-specific slope coefficients for PANSS-8 and PSP scores using linear mixed model. LASSO regression model were conducted to examine the performance of baseline gray matter volume and cortical thickness in prediction of individualized treatment outcome. STUDY RESULTS The study showed that individual brain morphometries at baseline, especially the orbitofrontal, temporal and parietal cortex, pallidum and amygdala, significantly predicted 12-week treatment outcome of PANSS-8 (r[predicted vs observed] = 0.49, P = .001) and PSP (r[predicted vs observed] = 0.40, P = .003) in first-episode schizophrenia. Moreover, the gray matter volume performed better than cortical thickness in the prediction the symptom changes (P = .034), while cortical thickness outperformed gray matter volume in the prediction of outcome of social functioning (P = .029). CONCLUSIONS These findings provide initial evidence that brain morphometry have potential to be used as prognostic predictors for antipsychotic response in patients, encouraging the future investigation of the translational value of these measures in precision psychiatry.
Collapse
Affiliation(s)
- Ying Chen
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
- Hope Recovery and Rehabilitation Center, West China Hospital of Sichuan University, Chengdu, China
| | - Hengyi Cao
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Shanming Liu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Bo Zhang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | | | - Zhuoqiu Zhang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Shuiying Li
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Haiming Li
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xin Yu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Hong Deng
- Hope Recovery and Rehabilitation Center, West China Hospital of Sichuan University, Chengdu, China
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
5
|
Kim J, Song J, Kambari Y, Plitman E, Shah P, Iwata Y, Caravaggio F, Brown EE, Nakajima S, Chakravarty MM, De Luca V, Remington G, Graff-Guerrero A, Gerretsen P. Cortical thinning in relation to impaired insight into illness in patients with treatment resistant schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:27. [PMID: 37120642 PMCID: PMC10148890 DOI: 10.1038/s41537-023-00347-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/12/2023] [Indexed: 05/01/2023]
Abstract
Impaired insight into illness is a common element of schizophrenia that contributes to treatment nonadherence and negative clinical outcomes. Previous studies suggest that impaired insight may arise from brain abnormalities. However, interpretations of these findings are limited due to small sample sizes and inclusion of patients with a narrow range of illness severity and insight deficits. In a large sample of patients with schizophrenia, the majority of which were designated as treatment-resistant, we investigated the associations between impaired insight and cortical thickness and subcortical volumes. A total of 94 adult participants with a schizophrenia spectrum disorder were included. Fifty-six patients (60%) had treatment-resistant schizophrenia. The core domains of insight were assessed with the VAGUS insight into psychosis scale. We obtained 3T MRI T1-weighted images, which were analysed using CIVET and MAGeT-Brain. Whole-brain vertex-wise analyses revealed impaired insight, as measured by VAGUS average scores, was related to cortical thinning in left frontotemporoparietal regions. The same analysis in treatment-resistant patients showed thinning in the same regions, even after controlling for age, sex, illness severity, and chlorpromazine antipsychotic dose equivalents. No association was found in non-treatment-resistant patients. Region-of-interest analyses revealed impaired general illness awareness was associated with cortical thinning in the left supramarginal gyrus when controlling for covariates. Reduced right and left thalamic volumes were associated with VAGUS symptom attribution and awareness of negative consequences subscale scores, respectively, but not after correction for multiple testing. Our results suggest impaired insight into illness is related to cortical thinning in left frontotemporoparietal regions in patients with schizophrenia, particularly those with treatment resistance where insight deficits may be more chronic.
Collapse
Affiliation(s)
- Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jianmeng Song
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Yasaman Kambari
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Eric Plitman
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Yusuke Iwata
- University of Yamanashi, Faculty of Medicine, Department of Neuropsychiatry, Yamanashi, Japan
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eric E Brown
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
- Geriatric Mental Health Division, CAMH, Toronto, ON, Canada
| | - Shinichiro Nakajima
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Vincenzo De Luca
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Gary Remington
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
- Schizophrenia Division, CAMH, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Geriatric Mental Health Division, CAMH, Toronto, ON, Canada
- Schizophrenia Division, CAMH, Toronto, ON, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Geriatric Mental Health Division, CAMH, Toronto, ON, Canada.
- Schizophrenia Division, CAMH, Toronto, ON, Canada.
| |
Collapse
|
6
|
Tuovinen N, Hofer A. Resting-state functional MRI in treatment-resistant schizophrenia. FRONTIERS IN NEUROIMAGING 2023; 2:1127508. [PMID: 37554635 PMCID: PMC10406237 DOI: 10.3389/fnimg.2023.1127508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/17/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Abnormalities in brain regions involved in the pathophysiology of schizophrenia (SCZ) may present insight into individual clinical symptoms. Specifically, functional connectivity irregularities may provide potential biomarkers for treatment response or treatment resistance, as such changes can occur before any structural changes are visible. We reviewed resting-state functional magnetic resonance imaging (rs-fMRI) findings from the last decade to provide an overview of the current knowledge on brain functional connectivity abnormalities and their associations to symptoms in treatment-resistant schizophrenia (TRS) and ultra-treatment-resistant schizophrenia (UTRS) and to look for support for the dysconnection hypothesis. METHODS PubMed database was searched for articles published in the last 10 years applying rs-fMRI in TRS patients, i.e., who had not responded to at least two adequate treatment trials with different antipsychotic drugs. RESULTS Eighteen articles were selected for this review involving 648 participants (TRS and control cohorts). The studies showed frontal hypoconnectivity before the initiation of treatment with CLZ or riluzole, an increase in frontal connectivity after riluzole treatment, fronto-temporal hypoconnectivity that may be specific for non-responders, widespread abnormal connectivity during mixed treatments, and ECT-induced effects on the limbic system. CONCLUSION Probably due to the heterogeneity in the patient cohorts concerning antipsychotic treatment and other clinical variables (e.g., treatment response, lifetime antipsychotic drug exposure, duration of illness, treatment adherence), widespread abnormalities in connectivity were noted. However, irregularities in frontal brain regions, especially in the prefrontal cortex, were noted which are consistent with previous SCZ literature and the dysconnectivity hypothesis. There were major limitations, as most studies did not differentiate between TRS and UTRS (i.e., CLZ-resistant schizophrenia) and investigated heterogeneous cohorts treated with mixed treatments (with or without CLZ). This is critical as in different subtypes of the disorder an interplay between dopaminergic and glutamatergic pathways involving frontal, striatal, and hippocampal brain regions in separate ways is likely. Better definitions of TRS and UTRS are necessary in future longitudinal studies to correctly differentiate brain regions underlying the pathophysiology of SCZ, which could serve as potential functional biomarkers for treatment resistance.
Collapse
Affiliation(s)
- Noora Tuovinen
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | | |
Collapse
|
7
|
Wang C, Tishler TA, Oughourlian T, Nuechterlein KH, de la Fuente-Sandoval C, Ellingson BM. Prospective, randomized, multicenter clinical trial evaluating longitudinal changes in brain function and microstructure in first-episode schizophrenia patients treated with long-acting injectable paliperidone palmitate versus oral antipsychotics. Schizophr Res 2023; 255:222-232. [PMID: 37019033 DOI: 10.1016/j.schres.2023.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 02/23/2023] [Accepted: 03/18/2023] [Indexed: 04/07/2023]
Abstract
Widespread anatomical alterations and abnormal functional connectivity have shown strong association with symptom severity in first-episode schizophrenia (FES) patients. Second-generation antipsychotic treatment might slow disease progression and possibly modify the cerebral plasticity in FES patients. However, whether a long-acting injectable antipsychotic (paliperidone palmitate [PP]), available in monthly and every-3-months formulations, is more effective than oral antipsychotics (OAP) in improving cerebral organization has been unclear. Therefore, in the current longitudinal study, we evaluated the differences in functional and microstructural changes of 68 FES patients in a randomized clinical trial of PP vs OAP. When compared to OAP treatment, PP treatment was more effective in decreasing abnormally high fronto-temporal and thalamo-temporal connectivity, as well as increasing fronto-sensorimotor and thalamo-insular connectivity. Consistent with previous studies, multiple white matter pathways showed larger changes in fractional anisotropy (FA) and mean diffusivity (MD) in response to PP compared with OAP treatment. These findings suggest that PP treatment might reduce regional abnormalities and improve cerebral connectivity networks compared with OAP treatment, and identified changes that may serve as reliable imaging biomarkers associated with medication treatment efficacy.
Collapse
Affiliation(s)
- Chencai Wang
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America.
| | - Todd A Tishler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Talia Oughourlian
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Camilo de la Fuente-Sandoval
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico; Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Benjamin M Ellingson
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Neuroscience Interdisciplinary Graduate Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| |
Collapse
|
8
|
Masumo Y, Kanahara N, Kogure M, Yamasaki F, Nakata Y, Iyo M. Dopamine supersensitivity psychosis and delay of clozapine treatment in patients with treatment-resistant schizophrenia. Int Clin Psychopharmacol 2023; 38:102-109. [PMID: 36719338 DOI: 10.1097/yic.0000000000000442] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Both the underutilization of clozapine and treatment resistance of patients to clozapine are serious problems worldwide. Identifying clinical markers predicting response to clozapine would help clinicians more effectively utilize clozapine treatment. The present study retrospectively assessed dopamine supersensitivity psychosis (DSP) in addition to other measures such as age at disease onset and delay of clozapine introduction for a total of 47 treatment-resistant schizophrenia (TRS) patients. The response to clozapine was judged with CGI-C at 1 and 2 years from clozapine introduction. Results revealed that the DSP group tended to have a longer delay between designation of TRS and introduction of clozapine and continued to have slightly more severe psychopathology after treatment with clozapine, showing only slight improvement. The logistic regression analysis showed that the age at disease onset was the only significant indicator, predicting responsiveness to clozapine: patients with an onset age <20 years had a significantly better response to clozapine than patients with an onset age ≥20 years. The present study suggests that DSP might be related to a longer delay in clozapine introduction and the persistence of refractory symptoms despite clozapine treatment, whereas early age of disease onset might be related to a better response to clozapine.
Collapse
Affiliation(s)
- Yuto Masumo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba
- Department of Psychiatry, Naoki-kai Isogaya Hospital, Ichihara
| | - Nobuhisa Kanahara
- Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, Chiba
- Shirayuri-kai Ichihara Tsuruoka Hospital, Ichihara, Japan
| | - Masanobu Kogure
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba
| | - Fumiaki Yamasaki
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba
| | - Yusuke Nakata
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba
| |
Collapse
|
9
|
de Bartolomeis A, Vellucci L, Barone A, Manchia M, De Luca V, Iasevoli F, Correll CU. Clozapine's multiple cellular mechanisms: What do we know after more than fifty years? A systematic review and critical assessment of translational mechanisms relevant for innovative strategies in treatment-resistant schizophrenia. Pharmacol Ther 2022; 236:108236. [PMID: 35764175 DOI: 10.1016/j.pharmthera.2022.108236] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 12/21/2022]
Abstract
Almost fifty years after its first introduction into clinical care, clozapine remains the only evidence-based pharmacological option for treatment-resistant schizophrenia (TRS), which affects approximately 30% of patients with schizophrenia. Despite the long-time experience with clozapine, the specific mechanism of action (MOA) responsible for its superior efficacy among antipsychotics is still elusive, both at the receptor and intracellular signaling level. This systematic review is aimed at critically assessing the role and specific relevance of clozapine's multimodal actions, dissecting those mechanisms that under a translational perspective could shed light on molecular targets worth to be considered for further innovative antipsychotic development. In vivo and in vitro preclinical findings, supported by innovative techniques and methods, together with pharmacogenomic and in vivo functional studies, point to multiple and possibly overlapping MOAs. To better explore this crucial issue, the specific affinity for 5-HT2R, D1R, α2c, and muscarinic receptors, the relatively low occupancy at dopamine D2R, the interaction with receptor dimers, as well as the potential confounder effects resulting in biased ligand action, and lastly, the role of the moiety responsible for lipophilic and alkaline features of clozapine are highlighted. Finally, the role of transcription and protein changes at the synaptic level, and the possibility that clozapine can directly impact synaptic architecture are addressed. Although clozapine's exact MOAs that contribute to its unique efficacy and some of its severe adverse effects have not been fully understood, relevant information can be gleaned from recent mechanistic understandings that may help design much needed additional therapeutic strategies for TRS.
Collapse
Affiliation(s)
- Andrea de Bartolomeis
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science and Dentistry, University Medical School of Naples "Federico II", Naples, Italy.
| | - Licia Vellucci
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science and Dentistry, University Medical School of Naples "Federico II", Naples, Italy
| | - Annarita Barone
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science and Dentistry, University Medical School of Naples "Federico II", Naples, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Felice Iasevoli
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science and Dentistry, University Medical School of Naples "Federico II", Naples, Italy
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| |
Collapse
|
10
|
Liu C, Kim WS, Shen J, Tsogt U, Kang NI, Lee KH, Chung YC. Altered Neuroanatomical Signatures of Patients With Treatment-Resistant Schizophrenia Compared to Patients With Early-Stage Schizophrenia and Healthy Controls. Front Psychiatry 2022; 13:802025. [PMID: 35664476 PMCID: PMC9158464 DOI: 10.3389/fpsyt.2022.802025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background The relationship between brain structural changes and cognitive dysfunction in schizophrenia is strong. However, few studies have investigated both neuroanatomical abnormalities and cognitive dysfunction in treatment-resistant schizophrenia (TRS). We examined neuroanatomical markers and cognitive function between patients with TRS or early-stage schizophrenia (ES-S) and healthy controls (HCs). Relationships between neuroanatomical markers and cognitive function in the patient groups were also investigated. Methods A total of 46 and 45 patients with TRS and ES-S and 61 HCs underwent structural magnetic resonance imaging (MRI) brain scanning and comprehensive cognitive tests. MRI scans were analyzed using the FreeSurfer to investigate differences in cortical surface area (CSA), cortical thickness (CT), cortical volume (CV), and subcortical volume (SCV) among the groups. Four cognitive domains (attention, verbal memory, executive function, and language) were assessed. Comparisons of neuroanatomical and cognitive function results among the three groups were performed. Results A widespread reduction in CT was observed in patients with TRS compared to HCs, but differences in cortical thinning between TRS and ES-S patients were mainly limited to the inferior frontal gyrus and insula. Several subcortical structures (accumbens, amygdala, hippocampus, putamen, thalamus and ventricles) were significantly altered in TRS patients compared to both ES-S patients and HCs. Performance in the verbal memory domain was significantly worse in TRS patients compared to ES-S patients. A positive relationship between the thickness of the left middle temporal gyrus and the composite score for language was identified in patients with ES-S. Conclusions Our findings suggest significant cognitive impairment and reductions in CT and SCV in individuals with TRS compared to those with ES-S and HCs. These abnormalities could act as biomarkers for earlier identification of TRS.
Collapse
Affiliation(s)
- Congcong Liu
- Department of Psychiatry, Medical School, Jeonbuk National University, Jeonju, South Korea
| | - Woo-Sung Kim
- Department of Psychiatry, Medical School, Jeonbuk National University, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Jie Shen
- Department of Psychiatry, Medical School, Jeonbuk National University, Jeonju, South Korea
| | - Uyanga Tsogt
- Department of Psychiatry, Medical School, Jeonbuk National University, Jeonju, South Korea
| | - Nam-In Kang
- Department of Psychiatry, Maeumsarang Hospital, Wanju, South Korea
| | - Keon-Hak Lee
- Department of Psychiatry, Maeumsarang Hospital, Wanju, South Korea
| | - Young-Chul Chung
- Department of Psychiatry, Medical School, Jeonbuk National University, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
- Department of Psychiatry, Jeonbuk National University Hospital, Jeonju, South Korea
| |
Collapse
|
11
|
Fountoulakis KN, Stahl SM. The effect of first- and second-generation antipsychotics on brain morphology in schizophrenia: A systematic review of longitudinal magnetic resonance studies with a randomized allocation to treatment arms. J Psychopharmacol 2022; 36:428-438. [PMID: 35395911 DOI: 10.1177/02698811221087645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Schizophrenia manifests as loss of brain volume in specific areas in a progressive nature and an important question concerns whether long-term treatment with medications contributes to this. The aim of the current PRISMA systematic review was to search for prospective studies involving randomization to treatment. PROSPERO ID: CRD42020197874. The MEDLINE/PUBMED was searched and it returned 2638 articles; 3 were fulfilling the inclusion criteria. A fourth was published later; they included 359 subjects, of whom 86 were healthy controls, while the rest were first-episode patients, with 91 under olanzapine, 93 under haloperidol, 48 under risperidone, 5 under paliperidone, 6 under ziprasidone, and 30 under placebo. Probably one-third of patients were suffering from a psychotic disorder other than schizophrenia. The consideration of their results suggested that there is no significant difference between these medications concerning their effects on brain structure and also in comparison to healthy subjects. There does not seem to be any strong support to the opinion that medications that treat psychosis cause loss of brain volume in patients with schizophrenia. On the contrary, the data might imply the possible presence of a protective effect for D2, 5-HT2, and NE alpha-2 antagonists (previously called SGAs). However, the literature is limited and focused research in large study samples is essential to clarify the issue, since important numerical differences do exist. The possibility of the results and their heterogeneity to be artifacts secondary to a modification of magnetic resonance imaging (MRI) signal by antipsychotics should not be easily rejected until relevant data are available.
Collapse
Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stephen M Stahl
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,Department of Psychiatry, Cambridge University, Cambridge, UK
| |
Collapse
|
12
|
Krajner F, Hadaya L, McQueen G, Sendt KV, Gillespie A, Avila A, Lally J, Hedges EP, Diederen K, Howes OD, Barker GJ, Lythgoe DJ, Kempton MJ, McGuire P, MacCabe JH, Egerton A. Subcortical volume reduction and cortical thinning 3 months after switching to clozapine in treatment resistant schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:13. [PMID: 35236831 PMCID: PMC8891256 DOI: 10.1038/s41537-022-00230-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
The neurobiological effects of clozapine are under characterised. We examined the effects clozapine treatment on subcortical volume and cortical thickness and investigated whether macrostructural changes were linked to alterations in glutamate or N-acetylaspartate (NAA). Data were acquired in 24 patients with treatment-resistant schizophrenia before and 12 weeks after switching to clozapine. During clozapine treatment we observed reductions in caudate and putamen volume, lateral ventricle enlargement (P < 0.001), and reductions in thickness of the left inferior temporal cortex, left caudal middle frontal cortex, and the right temporal pole. Reductions in right caudate volume were associated with local reductions in NAA (P = 0.002). None of the morphometric changes were associated with changes in glutamate levels. These results indicate that clozapine treatment is associated with subcortical volume loss and cortical thinning and that at least some of these effects are linked to changes in neuronal or metabolic integrity.
Collapse
Affiliation(s)
- Fanni Krajner
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Laila Hadaya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Grant McQueen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Kyra-Verena Sendt
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Amy Gillespie
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Alessia Avila
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emily P Hedges
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Kelly Diederen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Gareth J Barker
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - David J Lythgoe
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - James H MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.
| |
Collapse
|
13
|
Chen Y, Womer FY, Feng R, Zhang X, Zhang Y, Duan J, Chang M, Yin Z, Jiang X, Wei S, Wei Y, Tang Y, Wang F. A Real-World Observation of Antipsychotic Effects on Brain Volumes and Intrinsic Brain Activity in Schizophrenia. Front Neurosci 2022; 15:749316. [PMID: 35221884 PMCID: PMC8863862 DOI: 10.3389/fnins.2021.749316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe confounding effects of antipsychotics that led to the inconsistencies of neuroimaging findings have long been the barriers to understanding the pathophysiology of schizophrenia (SZ). Although it is widely accepted that antipsychotics can alleviate psychotic symptoms during the early most acute phase, the longer-term effects of antipsychotics on the brain have been unclear. This study aims to look at the susceptibility of different imaging measures to longer-term medicated status through real-world observation.MethodsWe compared gray matter volume (GMV) with amplitude of low-frequency fluctuations (ALFFs) in 89 medicated-schizophrenia (med-SZ), 81 unmedicated-schizophrenia (unmed-SZ), and 235 healthy controls (HC), and the differences were explored for relationships between imaging modalities and clinical variables. We also analyzed age-related effects on GMV and ALFF values in the two patient groups (med-SZ and unmed-SZ).ResultsMed-SZ demonstrated less GMV in the prefrontal cortex, temporal lobe, cingulate gyri, and left insula than unmed-SZ and HC (p < 0.05, family-wise error corrected). Additionally, GMV loss correlated with psychiatric symptom relief in all SZ. However, medicated status did not influence ALFF values: all SZ showed increased ALFF in the anterior cerebrum and decreased ALFF in posterior visual cortices compared with HC (p < 0.05, family-wise error corrected). Age-related GMV effects were seen in all regions, which showed group-level differences except fusiform gyrus. No significant correlation was found between ALFF values and psychiatric symptoms.ConclusionGMV loss appeared to be pronounced to longer-term antipsychotics, whereby imbalanced alterations in regional low-frequency fluctuations persisted unaffected by antipsychotic treatment. Our findings may help to understand the disease course of SZ and potentially identify a reliable neuroimaging feature for diagnosis.
Collapse
Affiliation(s)
- Yifan Chen
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Fay Y. Womer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Ruiqi Feng
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Xizhe Zhang
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Yanbo Zhang
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China
| | - Jia Duan
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Miao Chang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Zhiyang Yin
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaowei Jiang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shengnan Wei
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yange Wei
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Yanqing Tang,
| | - Fei Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
- Fei Wang,
| |
Collapse
|
14
|
Yang B, Zhang W, Lencer R, Tao B, Tang B, Yang J, Li S, Zeng J, Cao H, Sweeney JA, Gong Q, Lui S. Grey matter connectome abnormalities and age-related effects in antipsychotic-naive schizophrenia. EBioMedicine 2021; 74:103749. [PMID: 34906839 PMCID: PMC8671864 DOI: 10.1016/j.ebiom.2021.103749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/12/2021] [Accepted: 11/29/2021] [Indexed: 02/05/2023] Open
Abstract
Background Convergent evidence is increasing to indicate progressive brain abnormalities in schizophrenia. Knowing the brain network features over the illness course in schizophrenia, independent of effects of antipsychotic medications, would extend our sight on this question. Methods We recruited 237 antipsychotic-naive patients with schizophrenia range from 16 to 73 years old, and 254 healthy controls. High-resolution T1 weighted images were obtained with a 3.0T MR scanner. Grey matter networks were constructed individually based on the similarities of regional grey matter measurements. Network metrics were compared between patient groups and healthy controls, and regression analyses with age were conducted to determine potential differential rate of age-related changes between them. Findings Nodal centrality abnormalities were observed in patients with untreated schizophrenia, particularly in the central executive, default mode and salience networks. Accelerated age-related declines and illness duration-related declines were observed in global assortativity, and in nodal metrics of left superior temporal pole in schizophrenia patients. Although no significant intergroup differences in age-related regression were observed, the pattern of network metric alternation of left thalamus indicated higher nodal properties in early course patients, which decreased in long-term ill patients. Interpretations Global and nodal alterations in the grey matter connectome related to age and duration of illness in antipsychotic-naive patients, indicating potentially progressive network organizations mainly involving temporal regions and thalamus in schizophrenia independent from medication effects. Funding The National Natural Science Foundation of China, Sichuan Science and Technology Program, the Fundamental Research Funds for the Central Universities, Post-Doctor Research Project, West China Hospital, Sichuan University , the Science and Technology Project of the Health Planning Committee of Sichuan, Postdoctoral Interdisciplinary Research Project of Sichuan University and 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University.
Collapse
Affiliation(s)
- Beisheng Yang
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Wenjing Zhang
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Muenster, Germany
| | - Bo Tao
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Biqiu Tang
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Yang
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Siyi Li
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Jiaxin Zeng
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Hengyi Cao
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, United States
| | - John A Sweeney
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, OH, United States
| | - Qiyong Gong
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China.
| | - Su Lui
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China.
| |
Collapse
|
15
|
Vandevelde A, Métivier L, Dollfus S. Impact cérébral structurel et fonctionnel de la Clozapine chez les patients souffrant de schizophrénie : revue systématique des études longitudinales en neuroimagerie. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:683-700. [PMID: 33131322 PMCID: PMC8329901 DOI: 10.1177/0706743720966459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIF L'objectif de cette revue est d'identifier les corrélats anatomo-fonctionnels cérébraux lors d'un traitement par clozapine (CLZ) ainsi que les marqueurs anatomo-fonctionnels prédictifs de la réponse à la CLZ. MÉTHODES Nous avons réalisé une revue systématique de la littérature avec les bases de données MEDLINE et Web of Science afin d'identifier et d'examiner toutes les études longitudinales en neuroimagerie investiguant l'impact cérébral de la CLZ. RÉSULTATS 30 études ont été incluses et analysées. La CLZ induit une diminution du volume et de la perfusion dans les noyaux gris centraux chez les patients répondeurs. Un plus grand volume de substance grise et perfusion dans ces structures avant l'instauration de la CLZ étaient associés à une meilleure réponse au traitement. La diminution de volume et de perfusion au niveau du cortex préfrontal (CPF) est observée malgré l'instauration de CLZ mais de façon moins importante chez les patients sous CLZ que chez les patients sous antipsychotiques typiques. Un plus grand volume au niveau du CPF avant l'instauration de la CLZ est associé à une meilleure réponse clinique dans la majorité des études. Enfin, la CLZ semble induire une réduction des altérations au niveau de la substance blanche. CONCLUSION Les corrélats anatomo-fonctionnels de la CLZ différent de ceux des autres antipsychotiques avec une action spécifique de la CLZ au niveau des ganglions de la base et du CPF pouvant participer à sa supériorité en termes de réponse clinique. Plusieurs données cliniques et d'imagerie conduisent à l'hypothèse d'un meilleur pronostic associé à une instauration plus rapide de la CLZ.
Collapse
Affiliation(s)
- Anaïs Vandevelde
- Normandie Univ, UNICAEN, ISTS, EA 7466, GIP 55388Cyceron, boulevard Henri-Becquerel, 14000 Caen, France.,26962Normandie Univ, UNICAEN, UFR de médecine (Medical School), 14000 Caen, France.,Anaïs Vandevelde et Lucie Métivier ont participé de la même façon à ce travail et sont co-premier auteurs
| | - Lucie Métivier
- 26962Normandie Univ, UNICAEN, UFR de médecine (Medical School), 14000 Caen, France.,CHU de Caen, centre Esquirol, service de psychiatrie, 14000 Caen, France.,Anaïs Vandevelde et Lucie Métivier ont participé de la même façon à ce travail et sont co-premier auteurs
| | - Sonia Dollfus
- Normandie Univ, UNICAEN, ISTS, EA 7466, GIP 55388Cyceron, boulevard Henri-Becquerel, 14000 Caen, France.,26962Normandie Univ, UNICAEN, UFR de médecine (Medical School), 14000 Caen, France.,CHU de Caen, centre Esquirol, service de psychiatrie, 14000 Caen, France
| |
Collapse
|
16
|
Jiang Y, Wang Y, Huang H, He H, Tang Y, Su W, Xu L, Wei Y, Zhang T, Hu H, Wang J, Yao D, Wang J, Luo C. Antipsychotics Effects on Network-Level Reconfiguration of Cortical Morphometry in First-Episode Schizophrenia. Schizophr Bull 2021; 48:231-240. [PMID: 34313782 PMCID: PMC8781340 DOI: 10.1093/schbul/sbab082] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Cortical thickness reductions are evident in schizophrenia (SZ). Associations between antipsychotic medications (APMs) and cortical morphometry have been explored in SZ patients. This raises the question of whether the reconfiguration of morphological architecture by APM plays potential compensatory roles for abnormalities in the cerebral cortex. Structural magnetic resonance imaging was obtained from 127 medication-naive first-episode SZ patients and 133 matched healthy controls. Patients received 12 weeks of APM and were categorized as responders (n = 75) or nonresponders (NRs, n = 52) at follow-up. Using surface-based morphometry and structural covariance (SC) analysis, this study investigated the short-term effects of antipsychotics on cortical thickness and cortico-cortical covariance. Global efficiency was computed to characterize network integration of the large-scale structural connectome. The relationship between covariance and cortical thinning was examined by SC analysis among the top-n regions with thickness reduction. Widespread cortical thickness reductions were observed in pre-APM patients. Post-APM patients showed more reductions in cortical thickness, even in the frontotemporal regions without baseline reductions. Covariance analysis revealed strong cortico-cortical covariance and higher network integration in responders than in NRs. For the NRs, some of the prefrontal and temporal nodes were not covariant between the top-n regions with cortical thickness reduction. Antipsychotic effects are not restricted to a single brain region but rather exhibit a network-level covariance pattern. Neuroimaging connectomics highlights the positive effects of antipsychotics on the reconfiguration of brain architecture, suggesting that abnormalities in regional morphology may be compensated by increasing interregional covariance when symptoms are controlled by antipsychotics.
Collapse
Affiliation(s)
- Yuchao Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, PR China,High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Yingchan Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Huan Huang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, PR China,High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Hui He
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Wenjun Su
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Lihua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yanyan Wei
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Tianhong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Hao Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jinhong Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, PR China,Research Unit of NeuroInformation (2019RU035), Chinese Academy of Medical Sciences, Chengdu, PR China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, PR China,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, PR China,High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, PR China,Research Unit of NeuroInformation (2019RU035), Chinese Academy of Medical Sciences, Chengdu, PR China,To whom correspondence should be addressed; University of Electronic Science and Technology of China, Second North Jianshe Road, Chengdu 610054, PR China; tel: 86-28-83201018, fax: 86-28-83208238, e-mail:
| |
Collapse
|
17
|
Tronchin G, McPhilemy G, Ahmed M, Kilmartin L, Costello L, Forde NJ, Nabulsi L, Akudjedu TN, Holleran L, Hallahan B, Cannon DM, McDonald C. White matter microstructure and structural networks in treatment-resistant schizophrenia patients after commencing clozapine treatment: A longitudinal diffusion imaging study. Psychiatry Res 2021; 298:113772. [PMID: 33556689 DOI: 10.1016/j.psychres.2021.113772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/26/2021] [Indexed: 02/08/2023]
Abstract
This study investigates changes on white matter microstructure and neural networks after 6 months of switching to clozapine in schizophrenia patients compared to controls, and whether any changes are related to clinical variables. T1 and diffusion-weighted MRI images were acquired at baseline before commencing clozapine and after 6 months of treatment for 22 patients with treatment-resistant schizophrenia and 23 controls. The Tract-based spatial statistics approach was used to compare changes over time between groups in fractional anisotropy (FA). Changes in structural network organisation weighted by FA and number of streamlines were assessed using graph theory. Patients displayed a significant reduction of FA over time (p<0.05) compared to controls in the genu and body of the corpus callosum and bilaterally in the anterior and superior corona radiata. There was no correlation between FA change in patients and changes in clinical variables or serum level of clozapine. There was no changes in structural network organisation between groups (F(7,280)=2.80;p = 0.187). This longitudinal study demonstrated progressive focal FA abnormalities in key anterior tracts, but preserved brain structural network organisation in patients. The FA reduction was independent of any clinical measures and may reflect progression of the underlying pathophysiology of this malignant form of schizophrenia illness.
Collapse
Affiliation(s)
- Giulia Tronchin
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33 Galway, Ireland.
| | - Genevieve McPhilemy
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33 Galway, Ireland
| | - Mohamed Ahmed
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33 Galway, Ireland
| | - Liam Kilmartin
- College of Science and Engineering, National University of Ireland Galway, Galway, Republic of Ireland
| | - Laura Costello
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33 Galway, Ireland
| | - Natalie J Forde
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Leila Nabulsi
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33 Galway, Ireland; Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, University of Southern California, Marina del Rey, CA 90292, USA
| | - Theophilus N Akudjedu
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33 Galway, Ireland; Institute of Medical Imaging & Visualisation, Faculty of Health & Social Science, Bournemouth University, Bournemouth, United Kingdom
| | - Laurena Holleran
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33 Galway, Ireland
| | - Brian Hallahan
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33 Galway, Ireland
| | - Dara M Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33 Galway, Ireland
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91TK33 Galway, Ireland
| |
Collapse
|
18
|
Sungura R, Onyambu C, Mpolya E, Sauli E, Vianney JM. The extended scope of neuroimaging and prospects in brain atrophy mitigation: A systematic review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
19
|
Caseras X, Kirov G, Kendall KM, Rees E, Legge SE, Bracher-Smith M, Escott-Price V, Murphy K. Effects of genomic copy number variants penetrant for schizophrenia on cortical thickness and surface area in healthy individuals: analysis of the UK Biobank. Br J Psychiatry 2021; 218:104-111. [PMID: 32792019 PMCID: PMC7844611 DOI: 10.1192/bjp.2020.139] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Schizophrenia is a highly heritable disorder with undetermined neurobiological causes. Understanding the impact on brain anatomy of carrying genetic risk for the disorder will contribute to uncovering its neurobiological underpinnings. AIMS To examine the effect of rare copy number variants (CNVs) associated with schizophrenia on brain cortical anatomy in a sample of unaffected participants from the UK Biobank. METHOD We used regression analyses to compare cortical thickness and surface area (total and across gyri) between 120 unaffected carriers of rare CNVs associated with schizophrenia and 16 670 participants without any pathogenic CNV. A measure of cortical thickness and surface area covariance across gyri was also compared between groups. RESULTS Carrier status was associated with reduced surface area (β = -0.020 mm2, P < 0.001) and less robustly with increased cortical thickness (β = 0.015 mm, P = 0.035), and with increased covariance in thickness (carriers z = 0.31 v. non-carriers z = 0.22, P < 0.0005). Associations were mainly present in frontal and parietal areas and driven by a limited number of rare risk alleles included in our analyses (mainly 15q11.2 deletion for surface area and 16p13.11 duplication for thickness covariance). CONCLUSIONS Results for surface area conformed with previous clinical findings, supporting surface area reductions as an indicator of genetic liability for schizophrenia. Results for cortical thickness, though, argued against its validity as a potential risk marker. Increased structural thickness covariance across gyri also appears related to risk for schizophrenia. The heterogeneity found across the effects of rare risk alleles suggests potential different neurobiological gateways into schizophrenia's phenotype.
Collapse
Affiliation(s)
- Xavier Caseras
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - George Kirov
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Kimberley M. Kendall
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Elliott Rees
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Sophie E. Legge
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Matthew Bracher-Smith
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Valentina Escott-Price
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University; and UK Dementia Research Institute, Cardiff University, UK
| | - Kevin Murphy
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Physics and Astronomy, Cardiff University, UK
| |
Collapse
|
20
|
Identifying and validating subtypes within major psychiatric disorders based on frontal-posterior functional imbalance via deep learning. Mol Psychiatry 2021; 26:2991-3002. [PMID: 33005028 PMCID: PMC8505253 DOI: 10.1038/s41380-020-00892-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/27/2020] [Accepted: 09/15/2020] [Indexed: 12/31/2022]
Abstract
Converging evidence increasingly implicates shared etiologic and pathophysiological characteristics among major psychiatric disorders (MPDs), such as schizophrenia (SZ), bipolar disorder (BD), and major depressive disorder (MDD). Examining the neurobiology of the psychotic-affective spectrum may greatly advance biological determination of psychiatric diagnosis, which is critical for the development of more effective treatments. In this study, ensemble clustering was developed to identify subtypes within a trans-diagnostic sample of MPDs. Whole brain amplitude of low-frequency fluctuations (ALFF) was used to extract the low-dimensional features for clustering in a total of 944 participants: 581 psychiatric patients (193 with SZ, 171 with BD, and 217 with MDD) and 363 healthy controls (HC). We identified two subtypes with differentiating patterns of functional imbalance between frontal and posterior brain regions, as compared to HC: (1) Archetypal MPDs (60% of MPDs) had increased frontal and decreased posterior ALFF, and decreased cortical thickness and white matter integrity in multiple brain regions that were associated with increased polygenic risk scores and enriched risk gene expression in brain tissues; (2) Atypical MPDs (40% of MPDs) had decreased frontal and increased posterior ALFF with no associated alterations in validity measures. Medicated Archetypal MPDs had lower symptom severity than their unmedicated counterparts; whereas medicated and unmedicated Atypical MPDs had no differences in symptom scores. Our findings suggest that frontal versus posterior functional imbalance as measured by ALFF is a novel putative trans-diagnostic biomarker differentiating subtypes of MPDs that could have implications for precision medicine.
Collapse
|
21
|
Feng R, Womer FY, Edmiston EK, Chen Y, Wang Y, Chang M, Yin Z, Wei Y, Duan J, Ren S, Li C, Liu Z, Jiang X, Wei S, Li S, Zhang X, Zuo XN, Tang Y, Wang F. Antipsychotic Effects on Cortical Morphology in Schizophrenia and Bipolar Disorders. Front Neurosci 2020; 14:579139. [PMID: 33362453 PMCID: PMC7758211 DOI: 10.3389/fnins.2020.579139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/10/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Previous studies of atypical antipsychotic effects on cortical structures in schizophrenia (SZ) and bipolar disorder (BD) have findings that vary between the short and long term. In particular, there has not been a study exploring the effects of atypical antipsychotics on age-related cortical structural changes in SZ and BD. This study aimed to determine whether mid- to long-term atypical antipsychotic treatment (mean duration = 20 months) is associated with cortical structural changes and whether age-related cortical structural changes are affected by atypical antipsychotics. Methods: Structural magnetic resonance imaging images were obtained from 445 participants consisting of 88 medicated patients (67 with SZ, 21 with BD), 84 unmedicated patients (50 with SZ, 34 with BD), and 273 healthy controls (HC). Surface-based analyses were employed to detect differences in thickness and area among the three groups. We examined the age-related effects of atypical antipsychotics after excluding the potential effects of illness duration. Results: Significant differences in cortical thickness were observed in the frontal, temporal, parietal, and insular areas and the isthmus of the cingulate gyrus. The medicated group showed greater cortical thinning in these regions than the unmediated group and HC; furthermore, there were age-related differences in the effects of atypical antipsychotics, and these effects did not relate to illness duration. Moreover, cortical thinning was significantly correlated with lower symptom scores and Wisconsin Card Sorting Test (WCST) deficits in patients. After false discovery rate correction, cortical thinning in the right middle temporal gyrus in patients was significantly positively correlated with lower HAMD scores. The unmedicated group showed only greater frontotemporal thickness than the HC group. Conclusion: Mid- to long-term atypical antipsychotic use may adversely affect cortical thickness over the course of treatment and ageing and may also result in worsening cognitive function.
Collapse
Affiliation(s)
- Ruiqi Feng
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Fay Y. Womer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - E. Kale Edmiston
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yifan Chen
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yinshan Wang
- CAS Key Laboratory of Behavioral Science and Research Center for Lifespan Development of Mind and Brain (CLIMB), Institute of Psychology, Beijing, China
| | - Miao Chang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhiyang Yin
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yange Wei
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jia Duan
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Sihua Ren
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Chao Li
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhuang Liu
- School of Public Health, China Medical University, Shenyang, China
| | - Xiaowei Jiang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shengnan Wei
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Songbai Li
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xizhe Zhang
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Xi-Nian Zuo
- Key Laboratory of Brain and Education Sciences, School of Education Sciences, Nanning Normal University, Nanning, China
| | - Yanqing Tang
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Fei Wang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| |
Collapse
|
22
|
Palaniyappan L, Sukumar N. Reconsidering brain tissue changes as a mechanistic focus for early intervention in psychiatry. J Psychiatry Neurosci 2020; 44:373-378. [PMID: 33119489 PMCID: PMC7595740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2024] Open
Affiliation(s)
- Lena Palaniyappan
- From the Robarts Research Institute, Western University (Palaniyappan); the Department of Psychiatry, Western University (Palaniyappan, Sukumar); the Lawson Health Research Institute, Imaging Division (Palaniyappan); and the Department of Medical Biophysics, Western University (Palaniyappan), London, Ont., Canada
| | - Niron Sukumar
- From the Robarts Research Institute, Western University (Palaniyappan); the Department of Psychiatry, Western University (Palaniyappan, Sukumar); the Lawson Health Research Institute, Imaging Division (Palaniyappan); and the Department of Medical Biophysics, Western University (Palaniyappan), London, Ont., Canada
| |
Collapse
|
23
|
Palaniyappan L, Sukumar N. Reconsidering brain tissue changes as a mechanistic focus for early intervention in psychiatry. J Psychiatry Neurosci 2020; 45. [PMID: 33119489 PMCID: PMC7595740 DOI: 10.1503/jpn.200172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Lena Palaniyappan
- From the Robarts Research Institute, Western University (Palaniyappan); the Department of Psychiatry, Western University (Palaniyappan, Sukumar); the Lawson Health Research Institute, Imaging Division (Palaniyappan); and the Department of Medical Biophysics, Western University (Palaniyappan), London, Ont., Canada
| | - Niron Sukumar
- From the Robarts Research Institute, Western University (Palaniyappan); the Department of Psychiatry, Western University (Palaniyappan, Sukumar); the Lawson Health Research Institute, Imaging Division (Palaniyappan); and the Department of Medical Biophysics, Western University (Palaniyappan), London, Ont., Canada
| |
Collapse
|
24
|
Tronchin G, Akudjedu TN, Kenney JP, McInerney S, Scanlon C, McFarland J, McCarthy P, Cannon DM, Hallahan B, McDonald C. Cognitive and Clinical Predictors of Prefrontal Cortical Thickness Change Following First-Episode of Psychosis. Psychiatry Res Neuroimaging 2020; 302:111100. [PMID: 32464535 DOI: 10.1016/j.pscychresns.2020.111100] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022]
Abstract
The association of neuroanatomical progression with cognitive and clinical deterioration after first-episode of psychosis remains uncertain. This longitudinal study aims to assess whether i)impaired executive functioning and emotional intelligence at first presentation are associated with progressive prefrontal and orbitofrontal cortical thinning ii)negative symptom severity is linked to progressive prefrontal cortical thinning. 1.5T MRI images were acquired at baseline and after 3.5 years for 20 individuals with first-episode psychosis and 18 controls. The longitudinal pipeline of Freesurfer was employed to parcellate prefrontal cortex at two time points. Baseline cognitive performance was compared between diagnostic groups using MANCOVA. Partial correlations investigated relationships between cognition and negative symptoms at baseline and cortical thickness change over time. Patients displayed poorer performance than controls at baseline in working memory, reasoning/problem solving and emotional intelligence. In patients, loss of prefrontal and orbitofrontal thickness over time was predicted by impaired working memory and emotional intelligence respectively at baseline. Moreover, exploratory analyses revealed that the worsening of negative symptoms over time was significantly related to prefrontal cortical thinning. Results indicate that specific cognitive deficits at the onset of psychotic illness are markers of progressive neuroanatomical deficits and that worsening of negative symptoms occurs with prefrontal thickness reduction as the illness progresses.
Collapse
Affiliation(s)
- Giulia Tronchin
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland.
| | - Theophilus N Akudjedu
- Faculty of Health & Social Science, Institute of Medical Imaging & Visualisation, Bournemouth University, Bournemouth, United Kingdom
| | - Joanne Pm Kenney
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Shane McInerney
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland
| | - Cathy Scanlon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland
| | - John McFarland
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland
| | - Peter McCarthy
- Department of Radiology, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Dara M Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland
| | - Brian Hallahan
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, School of Medicine, National University of Ireland Galway, H91TK33 Galway, Ireland
| |
Collapse
|
25
|
Luo C, Lencer R, Hu N, Xiao Y, Zhang W, Li S, Lui S, Gong Q. Characteristics of White Matter Structural Networks in Chronic Schizophrenia Treated With Clozapine or Risperidone and Those Never Treated. Int J Neuropsychopharmacol 2020; 23:799-810. [PMID: 32808036 PMCID: PMC7770521 DOI: 10.1093/ijnp/pyaa061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/24/2020] [Accepted: 08/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Despite its benefits, a major concern regarding antipsychotic treatment is its possible impact on the brain's structure and function. This study sought to explore the characteristics of white matter structural networks in chronic never-treated schizophrenia and those treated with clozapine or risperidone, and its potential association with cognitive function. METHODS Diffusion tensor imaging was performed on a unique sample of 34 schizophrenia patients treated with antipsychotic monotherapy for over 5 years (17 treated with clozapine and 17 treated with risperidone), 17 never-treated schizophrenia patients with illness duration over 5 years, and 27 healthy control participants. Graph theory and network-based statistic approaches were employed. RESULTS We observed a disrupted organization of white matter structural networks as well as decreased nodal and connectivity characteristics across the schizophrenia groups, mainly involving thalamus, prefrontal, and occipital regions. Alterations in nodal and connectivity characteristics were relatively milder in risperidone-treated patients than clozapine-treated patients and never-treated patients. Altered global network measures were significantly associated with cognitive performance levels. Structural connectivity as reflected by network-based statistic mediated the difference in cognitive performance levels between clozapine-treated and risperidone-treated patients. LIMITATIONS These results are constrained by the lack of random assignment to different types of antipsychotic treatment. CONCLUSION These findings provide insight into the white matter structural network deficits in patients with chronic schizophrenia, either being treated or untreated, and suggest white matter structural networks supporting cognitive function may benefit from antipsychotic treatment, especially in those treated with risperidone.
Collapse
Affiliation(s)
- Chunyan Luo
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Na Hu
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| | - Yuan Xiao
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| | - Wenjing Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| | - Siyi Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| | - Su Lui
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China,Correspondence: Dr Su Lui, MD, Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Chengdu 610041, China ()
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
26
|
Barth C, Jørgensen KN, Wortinger LA, Nerland S, Jönsson EG, Agartz I. Trajectories of brain volume change over 13 years in chronic schizophrenia. Schizophr Res 2020; 222:525-527. [PMID: 32507379 DOI: 10.1016/j.schres.2020.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Claudia Barth
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Kjetil N Jørgensen
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Laura A Wortinger
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Stener Nerland
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Erik G Jönsson
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| |
Collapse
|
27
|
Tronchin G, Akudjedu TN, Ahmed M, Holleran L, Hallahan B, Cannon DM, McDonald C. Progressive subcortical volume loss in treatment-resistant schizophrenia patients after commencing clozapine treatment. Neuropsychopharmacology 2020; 45:1353-1361. [PMID: 32268345 PMCID: PMC7298040 DOI: 10.1038/s41386-020-0665-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 02/07/2023]
Abstract
The association of antipsychotic medication with abnormal brain morphometry in schizophrenia remains uncertain. This study investigated subcortical morphometric changes 6 months after switching treatment to clozapine in patients with treatment-resistant schizophrenia compared with healthy volunteers, and the relationships between longitudinal volume changes and clinical variables. In total, 1.5T MRI images were acquired at baseline before commencing clozapine and again after 6 months of treatment for 33 patients with treatment-resistant schizophrenia and 31 controls, and processed using the longitudinal pipeline of Freesurfer v.5.3.0. Two-way repeated MANCOVA was used to assess group differences in subcortical volumes over time and partial correlations to determine association with clinical variables. Whereas no significant subcortical volume differences were found between patients and controls at baseline (F(8,52) = 1.79; p = 0.101), there was a significant interaction between time, group and structure (F(7,143) = 52.54; p < 0.001). Corrected post-hoc analyses demonstrated that patients had significant enlargement of lateral ventricles (F(1,59) = 48.89; p < 0.001) and reduction of thalamus (F(1,59) = 34.85; p < 0.001), caudate (F(1,59) = 59.35; p < 0.001), putamen (F(1,59) = 87.20; p < 0.001) and hippocampus (F(1,59) = 14.49; p < 0.001) volumes. Thalamus and putamen volume reduction was associated with improvement in PANSS (r = 0.42; p = 0.021, r = 0.39; p = 0.033), SANS (r = 0.36; p = 0.049, r = 0.40; p = 0.027) and GAF (r = -0.39; p = 0.038, r = -0.42; p = 0.024) scores. Reduced thalamic volume over time was associated with increased serum clozapine level at follow-up (r = -0.44; p = 0.010). Patients with treatment-resistant schizophrenia display progressive subcortical volume deficits after switching to clozapine despite experiencing symptomatic improvement. Thalamo-striatal progressive volumetric deficit associated with symptomatic improvement after clozapine exposure may reflect an adaptive response related to improved outcome rather than a harmful process.
Collapse
Affiliation(s)
- Giulia Tronchin
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland.
| | - Theophilus N Akudjedu
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
- Institute of Medical Imaging & Visualisation, Faculty of Health & Social Science, Department of Medical Science & Public Science, Bournemouth University, Bournemouth, UK
| | - Mohamed Ahmed
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Laurena Holleran
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Brian Hallahan
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Dara M Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| |
Collapse
|
28
|
Fountoulakis KN, Moeller HJ, Kasper S, Tamminga C, Yamawaki S, Kahn R, Tandon R, Correll CU, Javed A. The report of the joint WPA/CINP workgroup on the use and usefulness of antipsychotic medication in the treatment of schizophrenia. CNS Spectr 2020; 26:1-25. [PMID: 32594935 DOI: 10.1017/s1092852920001546] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This is a report of a joint World Psychiatric Association/International College of Neuropsychopharmacology (WPA/CINP) workgroup concerning the risk/benefit ratio of antipsychotics in the treatment of schizophrenia. It utilized a selective but, within topic, comprehensive review of the literature, taking into consideration all the recently discussed arguments on the matter and avoiding taking sides when the results in the literature were equivocal. The workgroup's conclusions suggested that antipsychotics are efficacious both during the acute and the maintenance phase, and that the current data do not support the existence of a supersensitivity rebound psychosis. Long-term treated patients have better overall outcome and lower mortality than those not taking antipsychotics. Longer duration of untreated psychosis and relapses are modestly related to worse outcome. Loss of brain volume is evident already at first episode and concerns loss of neuropil volume rather than cell loss. Progression of volume loss probably happens in a subgroup of patients with worse prognosis. In humans, antipsychotic treatment neither causes nor worsens volume loss, while there are some data in favor for a protective effect. Schizophrenia manifests 2 to 3 times higher mortality vs the general population, and treatment with antipsychotics includes a number of dangers, including tardive dyskinesia and metabolic syndrome; however, antipsychotic treatment is related to lower mortality, including cardiovascular mortality. In conclusion, the literature strongly supports the use of antipsychotics both during the acute and the maintenance phase without suggesting that it is wise to discontinue antipsychotics after a certain period of time. Antipsychotic treatment improves long-term outcomes and lowers overall and specific-cause mortality.
Collapse
Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Hans-Jurgen Moeller
- Department of Psychiatry, Ludwig Maximilian University of Munich, Munich, Germany
| | - Siegfried Kasper
- Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Vienna, Austria
| | - Carol Tamminga
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Shigeto Yamawaki
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Hiroshima, Japan
| | - Rene Kahn
- Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rajiv Tandon
- Department of Psychiatry, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| | - Christoph U Correll
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Afzal Javed
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| |
Collapse
|
29
|
Shah P, Plitman E, Iwata Y, Kim J, Nakajima S, Chan N, Brown EE, Caravaggio F, Torres E, Hahn M, Chakravarty MM, Remington G, Gerretsen P, Graff-Guerrero A. Glutamatergic neurometabolites and cortical thickness in treatment-resistant schizophrenia: Implications for glutamate-mediated excitotoxicity. J Psychiatr Res 2020; 124:151-158. [PMID: 32169688 DOI: 10.1016/j.jpsychires.2020.02.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 12/21/2022]
Abstract
Treatment-resistant schizophrenia may be related to structural brain alterations. However, the mechanisms underlying these changes remain unclear. The present study had two main aims: (1) to explore differences in cortical thickness between patients with treatment-resistant schizophrenia non-responsive to clozapine (ultra-treatment-resistant schizophrenia, UTRS), patients with treatment-resistant schizophrenia responsive to clozapine (Cloz-Resp), patients responsive to first-line non-clozapine antipsychotics (FL-Resp), and healthy controls (HCs); and (2) to test our hypothesis of structural compromise as a manifestation of neurotoxic effects from elevated glutamate (Glu) (i.e. glutamate-mediated excitotoxicity) by examining the relationships between glutamatergic neurometabolite levels (Glu and glutamate + glutamine (Glx)) in the dorsal anterior cingulate cortex (dACC) and cortical thickness. T1-weighted images and 1H-MRS data were obtained from UTRS (n = 24), Cloz-Resp (n = 25), FL-Resp (n = 19), and HCs (n = 26). Vertex-wise analyses showed that patients with UTRS had widespread cortical thinning in the bilateral frontal, temporal, parietal, and occipital gyri compared to HCs and FL-Resp patients. In the patient group, negative associations were found between dACC Glx levels and cortical thickness in the right dorsolateral prefrontal cortex after correcting for multiple comparisons and controlling for age, sex, antipsychotic dose, and illness severity. In conclusion, glutamate-mediated excitotoxicity may be one of the mechanisms underlying structural compromise seen in treatment-resistant schizophrenia. Future studies should longitudinally examine the associations between glutamatergic neurometabolite levels and cortical thickness in the context of treatment and illness progression.
Collapse
Affiliation(s)
- Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Eric Plitman
- Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Shinichiro Nakajima
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Nathan Chan
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Eric E Brown
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Edgardo Torres
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Margaret Hahn
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - M Mallar Chakravarty
- Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Gary Remington
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
30
|
Robertson OD, Coronado NG, Sethi R, Berk M, Dodd S. Putative neuroprotective pharmacotherapies to target the staged progression of mental illness. Early Interv Psychiatry 2019; 13:1032-1049. [PMID: 30690898 DOI: 10.1111/eip.12775] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/26/2018] [Indexed: 12/22/2022]
Abstract
AIM Neuropsychiatric disorders including depression, bipolar and schizophrenia frequently exhibit a neuroprogressive course from prodrome to chronicity. There are a range of agents exhibiting capacity to attenuate biological mechanisms associated with neuroprogression. This review will update the evidence for putative neuroprotective agents including clinical efficacy, mechanisms of action and limitations in current assessment tools, and identify novel agents with neuroprotective potential. METHOD Data for this review were sourced from online databases PUBMED, Embase and Web of Science. Only data published since 2012 were included in this review, no data were excluded based on language or publication origin. RESULTS Each of the agents reviewed inhibit one or multiple pathways of neuroprogression including: inflammatory gene expression and cytokine release, oxidative and nitrosative stress, mitochondrial dysfunction, neurotrophin dysregulation and apoptotic signalling. Some demonstrate clinical efficacy in preventing neural damage or loss, relapse or cognitive/functional decline. Agents include: the psychotropic medications lithium, second generation antipsychotics and antidepressants; other pharmacological agents such as minocycline, aspirin, cyclooxygenase-2 inhibitors, statins, ketamine and alpha-2-delta ligands; and others such as erythropoietin, oestrogen, leptin, N-acetylcysteine, curcumin, melatonin and ebselen. CONCLUSIONS Signals of evidence of clinical neuroprotection are evident for a number of candidate agents. Adjunctive use of multiple agents may present a viable avenue to clinical realization of neuroprotection. Definitive prospective studies of neuroprotection with multimodal assessment tools are required.
Collapse
Affiliation(s)
- Oliver D Robertson
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia.,Mental Health, Drugs and Alcohol Services, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Nieves G Coronado
- Unidad de Gestión Clinica Salud Mental, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Rickinder Sethi
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia.,Mental Health, Drugs and Alcohol Services, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia.,Mood Disorders Research Program, Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Seetal Dodd
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia.,Mental Health, Drugs and Alcohol Services, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia.,Mood Disorders Research Program, Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| |
Collapse
|
31
|
Wannan CMJ, Cropley VL, Chakravarty MM, Bousman C, Ganella EP, Bruggemann JM, Weickert TW, Weickert CS, Everall I, McGorry P, Velakoulis D, Wood SJ, Bartholomeusz CF, Pantelis C, Zalesky A. Evidence for Network-Based Cortical Thickness Reductions in Schizophrenia. Am J Psychiatry 2019; 176:552-563. [PMID: 31164006 DOI: 10.1176/appi.ajp.2019.18040380] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Cortical thickness reductions in schizophrenia are irregularly distributed across multiple loci. The authors hypothesized that cortical connectivity networks would explain the distribution of cortical thickness reductions across the cortex, and, specifically, that cortico-cortical connectivity between loci with these reductions would be exceptionally strong and form an interconnected network. This hypothesis was tested in three cross-sectional schizophrenia cohorts: first-episode psychosis, chronic schizophrenia, and treatment-resistant schizophrenia. METHODS Structural brain images were acquired for 70 patients with first-episode psychosis, 153 patients with chronic schizophrenia, and 47 patients with treatment-resistant schizophrenia and in matching healthy control groups (N=57, N=168, and N=54, respectively). Cortical thickness was compared between the patient and respective control groups at 148 regions spanning the cortex. Structural connectivity strength between pairs of cortical regions was quantified with structural covariance analysis. Connectivity strength between regions with cortical thickness reductions was compared with connectivity strength between 5,000 sets of randomly chosen regions to establish whether regions with reductions were interconnected more strongly than would be expected by chance. RESULTS Significant (false discovery rate corrected) and widespread cortical thickness reductions were found in the chronic schizophrenia (79 regions) and treatment-resistant schizophrenia (106 regions) groups, with more circumscribed reductions in the first-episode psychosis group (34 regions). Cortical thickness reductions with the largest effect sizes were found in frontal, temporal, cingulate, and insular regions. In all cohorts, both the patient and healthy control groups showed significantly increased structural covariance between regions with cortical thickness reductions compared with randomly selected regions. CONCLUSIONS Brain network architecture can explain the irregular topographic distribution of cortical thickness reductions in schizophrenia. This finding, replicated in three distinct schizophrenia cohorts, suggests that the effect is robust and independent of illness stage.
Collapse
Affiliation(s)
- Cassandra M J Wannan
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Vanessa L Cropley
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - M Mallar Chakravarty
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Chad Bousman
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Eleni P Ganella
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Jason M Bruggemann
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Thomas W Weickert
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Cynthia Shannon Weickert
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Ian Everall
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Patrick McGorry
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Dennis Velakoulis
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Stephen J Wood
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Cali F Bartholomeusz
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Christos Pantelis
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| | - Andrew Zalesky
- The Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia (Wannan, Cropley, Bousman, Ganella, T.W. Weickert, C.S. Weickert, McGorry, Velakoulis, Bartholomeusz, Pantelis, Zalesky); Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia (Wannan, Ganella, McGorry, Wood, Bartholomeusz); the Cooperative Research Centre for Mental Health, Victoria, Australia (Wannan, Bousman, Ganella, Everall, Pantelis); North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia (Wannan, Ganella, Everall, Pantelis); Faculty of Health, Arts, and Design, the Brain and Psychological Sciences Research Centre, Swinburne University, Victoria, Australia (Cropley); the Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia (Bousman, Everall, Pantelis); the Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, Carlton South, Victoria, Australia (Everall, Pantelis); the Melbourne School of Engineering, University of Melbourne, Parkville, Victoria, Australia (Everall, Pantelis, Zalesky); Alberta Children's Hospital Research Institute, University of Calgary, Alberta (Bousman); Hotchkiss Brain Institute, University of Calgary, Alberta (Bousman); the Departments of Medical Genetics, Psychiatry, and Physiology and Pharmacology, University of Calgary, Alberta (Bousman); the Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal (Chakravarty); the Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal (Chakravarty); the School of Psychiatry, University of New South Wales, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); Neuroscience Research Australia, Sydney, Australia (Bruggemann, T.W. Weickert, C.S. Weickert); the Schizophrenia Research Laboratory, Neuroscience Research Australia, Randwick, New South Wales, Australia (T.W. Weickert, C.S. Weickert); the School of Psychology, University of Birmingham, Edgbaston, U.K. (Wood); the Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, N.Y. (T.W. Weickert, C.S. Weickert); and the Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Everall)
| |
Collapse
|
32
|
Vita A, Minelli A, Barlati S, Deste G, Giacopuzzi E, Valsecchi P, Turrina C, Gennarelli M. Treatment-Resistant Schizophrenia: Genetic and Neuroimaging Correlates. Front Pharmacol 2019; 10:402. [PMID: 31040787 PMCID: PMC6476957 DOI: 10.3389/fphar.2019.00402] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/01/2019] [Indexed: 12/11/2022] Open
Abstract
Schizophrenia is a severe neuropsychiatric disorder that affects approximately 0.5–1% of the population. Response to antipsychotic therapy is highly variable, and it is not currently possible to predict those patients who will or will not respond to antipsychotic medication. Furthermore, a high percentage of patients, approximately 30%, are classified as treatment-resistant (treatment-resistant schizophrenia; TRS). TRS is defined as a non-response to at least two trials of antipsychotic medication of adequate dose and duration. These patients are usually treated with clozapine, the only evidence-based pharmacotherapy for TRS. However, clozapine is associated with severe adverse events. For these reasons, there is an increasing interest to identify better targets for drug development of new compounds and to establish better biomarkers for existing medications. The ability of antipsychotics to improve psychotic symptoms is dependent on their antagonist and reverse agonist activities at different neuroreceptors, and some genetic association studies of TRS have focused on different pharmacodynamic factors. Some genetic studies have shown an association between antipsychotic response or TRS and neurodevelopment candidate genes, antipsychotic mechanisms of action (such as dopaminergic, serotonergic, GABAergic, and glutamatergic) or pharmacokinetic factors (i.e., differences in the cytochrome families). Moreover, there is a growing body of literature on the structural and functional neuroimaging research into TRS. Neuroimaging studies can help to uncover the underlying neurobiological reasons for such resistance and identify resistant patients earlier. Studies examining the neuropharmacological mechanisms of antipsychotics, including clozapine, can help to improve our knowledge of their action on the central nervous system, with further implications for the discovery of biomarkers and the development of new treatments. The identification of the underlying mechanisms of TRS is a major challenge for developing personalized medicine in the psychiatric field for schizophrenia treatment. The main goal of precision medicine is to use genetic and brain-imaging information to improve the safety, effectiveness, and health outcomes of patients via more efficiently targeted risk stratification, prevention, and tailored medication and treatment management approaches. The aim of this review is to summarize the state of art of pharmacogenetic, pharmacogenomic and neuroimaging studies in TRS.
Collapse
Affiliation(s)
- Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alessandra Minelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy
| | - Edoardo Giacopuzzi
- Genetic Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Paolo Valsecchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cesare Turrina
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Massimo Gennarelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Genetic Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| |
Collapse
|
33
|
Brain structure, cognition, and brain age in schizophrenia, bipolar disorder, and healthy controls. Neuropsychopharmacology 2019; 44:898-906. [PMID: 30635616 PMCID: PMC6461913 DOI: 10.1038/s41386-018-0298-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/09/2018] [Accepted: 12/13/2018] [Indexed: 12/24/2022]
Abstract
Schizophrenia and bipolar disorder (BD) may be disorders of accelerated aging. Direct comparison of healthy aging populations with schizophrenia and BD patients across the adult lifespan may help inform this theory. In total, 225 individuals (91 healthy controls, 81 schizophrenia, 53 euthymic BD) underwent 3T T1-weighted magnetic resonance imaging, diffusion tensor imaging, and cognitive testing. We analyzed associations among age, diagnosis, and cognition with cortical thickness and fractional anisotropy (FA) using general linear models. We then assessed "brain age" using a random forest algorithm, which was also assessed in an independent sample (n = 147). Participants with schizophrenia had lower cortical thickness and FA compared with the other two groups, most prominently in fronto-temporal circuitry. These brain changes were more evident in younger participants than in older ones, yet were associated with cognitive performance independent of diagnosis. Predicted age was 8 years greater than chronological age in individuals with schizophrenia in the first sample and 6 years greater in the second sample. Predicted and chronological age were not different in BD. Differences in brain circuitry are present from illness onset most prominently in schizophrenia and to a lesser extent in BD. These results support a non-progressive "early hit" hypothesis/etiology of illness in the major psychoses. Brain age differences support the hypothesized early aging mechanism in schizophrenia but not in BD.
Collapse
|
34
|
Kuo SS, Pogue-Geile MF. Variation in fourteen brain structure volumes in schizophrenia: A comprehensive meta-analysis of 246 studies. Neurosci Biobehav Rev 2019; 98:85-94. [PMID: 30615934 PMCID: PMC6401304 DOI: 10.1016/j.neubiorev.2018.12.030] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 11/21/2018] [Accepted: 12/31/2018] [Indexed: 12/24/2022]
Abstract
Despite hundreds of structural MRI studies documenting smaller brain volumes on average in schizophrenia compared to controls, little attention has been paid to group differences in the variability of brain volumes. Examination of variability may help interpret mean group differences in brain volumes and aid in better understanding the heterogeneity of schizophrenia. Variability in 246 MRI studies was meta-analyzed for 13 structures that have shown medium to large mean effect sizes (Cohen's d≥0.4): intracranial volume, total brain volume, lateral ventricles, third ventricle, total gray matter, frontal gray matter, prefrontal gray matter, temporal gray matter, superior temporal gyrus gray matter, planum temporale, hippocampus, fusiform gyrus, insula; and a control structure, caudate nucleus. No significant differences in variability in cortical/subcortical volumes were detected in schizophrenia relative to controls. In contrast, increased variability was found in schizophrenia compared to controls for intracranial and especially lateral and third ventricle volumes. These findings highlight the need for more attention to ventricles and detailed analyses of brain volume distributions to better elucidate the pathophysiology of schizophrenia.
Collapse
Affiliation(s)
- Susan S Kuo
- Department of Psychology, University of Pittsburgh, 4209 Sennott Square, 210 South Bouquet St., Pittsburgh PA 15260, USA.
| | - Michael F Pogue-Geile
- Department of Psychology, University of Pittsburgh, 4209 Sennott Square, 210 South Bouquet St., Pittsburgh PA 15260, USA; Department of Psychology and Department of Psychiatry, University of Pittsburgh, 4207 Sennott Square, 210 South Bouquet St., Pittsburgh PA 15260, USA.
| |
Collapse
|
35
|
Development of Neuroimaging-Based Biomarkers in Psychiatry. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1192:159-195. [PMID: 31705495 DOI: 10.1007/978-981-32-9721-0_9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This chapter presents an overview of accumulating neuroimaging data with emphasis on translational potential. The subject will be described in the context of three disease states, i.e., schizophrenia, bipolar disorder, and major depressive disorder, and for three clinical goals, i.e., disease risk assessment, subtyping, and treatment decision.
Collapse
|
36
|
Young CR, Adler S, Eary JF, Lindenberg ML, Jacobs PM, Collins J, Kummar S, Kurdziel KA, Choyke PL, Mena E. Biodistribution, Tumor Detection, and Radiation Dosimetry of 18F-5-Fluoro-2'-Deoxycytidine with Tetrahydrouridine in Solid Tumors. J Nucl Med 2018; 60:492-496. [PMID: 30389817 DOI: 10.2967/jnumed.118.216994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/12/2018] [Indexed: 01/27/2023] Open
Abstract
In preclinical studies, 5-fluoro-2'-deoxycytidine (FdCyd), an inhibitor of DNA methyltransferase and DNA hypermethylation, has shown treatment efficacy against multiple malignancies by suppressing epigenetic hypermethylation in tumor cells. Several ongoing clinical trials are using FdCyd, and although some patients may respond to this drug, in most patients it is ineffective. Thus, establishing a noninvasive imaging modality to evaluate the distribution of the drug may provide insight into the variable responses. A novel experimental radiopharmaceutical, 18F-labeled FdCyd, was developed as a companion imaging agent to the nonradioactive form of the drug, FdCyd. We present the first-in-humans radiation dosimetry results and biodistribution of 18F-FdCyd, administered along with tetrahydrouridine, an inhibitor of cytidine/deoxycytidine deaminase, in patients with a variety of solid tumors undergoing FdCyd therapy. Methods: This phase 0 imaging trial examined the 18F-FdCyd biodistribution and radiation dosimetry in 5 human subjects enrolled in companion therapy trials. In each subject, 4 sequential PET scans were acquired to estimate whole-body and individual organ effective dose, using OLINDA/EXM, version 1.0. Tumor-to-background ratios were also calculated for the tumor sites visualized on PET/CT imaging. Results: The average whole-body effective dose for the experimental radiopharmaceutical 18F-FdCyd administered in conjunction with tetrahydrouridine was 2.12E-02 ± 4.15E-03 mSv/MBq. This is similar to the radiation dose estimates for 18F-FDG PET. The critical organ, with the highest absorbed radiation dose, was the urinary bladder wall at 7.96E-02 mSv/MBq. Other organ doses of note were the liver (6.02E-02mSv/MBq), kidneys (5.26E-02 mSv/MBq), and gallbladder (4.05E-02 mSv/MBq). Tumor target-to-background ratios ranged from 2.4 to 1.4, which potentially enable tumor visualization in static PET images. Conclusion: This phase 0 imaging clinical trial provides evidence that 18F-FdCyd administered in conjunction with tetrahydrouridine yields acceptable individual organ and whole-body effective doses, as well as modest tumor-to-background ratios that potentially enable tumor visualization. Dose estimates for 18F-FdCyd are comparable to those for other PET radiopharmaceuticals, such as 18F-FDG. Further studies with larger study populations are warranted to assess 18F-FdCyd imaging as a predictor of FdCyd treatment effectiveness.
Collapse
Affiliation(s)
- Colin R Young
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Stephen Adler
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., National Cancer Institute, Frederick, Maryland
| | - Janet F Eary
- Cancer Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - M Liza Lindenberg
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Paula M Jacobs
- Cancer Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jerry Collins
- Developmental Therapeutics Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; and
| | - Shivaani Kummar
- Stanford University School of Medicine, Palo Alto, California
| | - Karen A Kurdziel
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Esther Mena
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
37
|
Samanaite R, Gillespie A, Sendt KV, McQueen G, MacCabe JH, Egerton A. Biological Predictors of Clozapine Response: A Systematic Review. Front Psychiatry 2018; 9:327. [PMID: 30093869 PMCID: PMC6070624 DOI: 10.3389/fpsyt.2018.00327] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/29/2018] [Indexed: 01/04/2023] Open
Abstract
Background: Clozapine is the recommended antipsychotic for treatment-resistant schizophrenia (TRS) but there is significant variability between patients in the degree to which clozapine will improve symptoms. The biological basis of this variability is unknown. Although clozapine has efficacy in TRS, it can elicit adverse effects and initiation is often delayed. Identification of predictive biomarkers of clozapine response may aid initiation of clozapine treatment, as well as understanding of its mechanism of action. In this article we systematically review prospective or genetic studies of biological predictors of response to clozapine. Methods: We searched the PubMed database until 20th January 2018 for studies investigating "clozapine" AND ("response" OR "outcome") AND "schizophrenia." Inclusion required that studies examined a biological variable in relation to symptomatic response to clozapine. For all studies except genetic-studies, inclusion required that biological variables were measured before clozapine initiation. Results: Ninety-eight studies met the eligibility criteria and were included in the review, including neuroimaging, blood-based, cerebrospinal fluid (CSF)-based, and genetic predictors. The majority (70) are genetic studies, collectively investigating 379 different gene variants, however only three genetic variants (DRD3 Ser9Gly, HTR2A His452Tyr, and C825T GNB3) have independently replicated significant findings. Of the non-genetic variables, the most consistent predictors of a good response to clozapine are higher prefrontal cortical structural integrity and activity, and a lower ratio of the dopamine and serotonin metabolites, homovanillic acid (HVA): 5-hydroxyindoleacetic acid (5-HIAA) in CSF. Conclusions: Recommendations include that future studies should ensure adequate clozapine trial length and clozapine plasma concentrations, and may include multivariate models to increase predictive accuracy.
Collapse
Affiliation(s)
- Ruta Samanaite
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Amy Gillespie
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Kyra-Verena Sendt
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Grant McQueen
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - James H. MacCabe
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Alice Egerton
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
38
|
Correll CU, Rubio JM, Kane JM. What is the risk-benefit ratio of long-term antipsychotic treatment in people with schizophrenia? World Psychiatry 2018; 17:149-160. [PMID: 29856543 PMCID: PMC5980517 DOI: 10.1002/wps.20516] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The long-term benefit-to-risk ratio of sustained antipsychotic treatment for schizophrenia has recently been questioned. In this paper, we critically examine the literature on the long-term efficacy and effectiveness of this treatment. We also review the evidence on the undesired effects, the impact on physical morbidity and mortality, as well as the neurobiological correlates of chronic exposure to antipsychotics. Finally, we summarize factors that affect the risk-benefit ratio. There is consistent evidence supporting the efficacy of antipsychotics in the short term and mid term following stabilization of acute psychotic symptoms. There is insufficient evidence supporting the notion that this effect changes in the long term. Most, but not all, of the long-term cohort studies find a decrease in efficacy during chronic treatment with antipsychotics. However, these results are inconclusive, given the extensive risk of bias, including increasing non-adherence. On the other hand, long-term studies based on national registries, which have lower risk of bias, find an advantage in terms of effectiveness during sustained antipsychotic treatment. Sustained antipsychotic treatment has been also consistently associated with lower mortality in people with schizophrenia compared to no antipsychotic treatment. Nevertheless, chronic antipsychotic use is associated with metabolic disturbance and tardive dyskinesia. The latter is the clearest undesired clinical consequence of brain functioning as a potential result of chronic antipsychotic exposure, likely from dopaminergic hypersensitivity, without otherwise clear evidence of other irreversible neurobiological changes. Adjunctive psychosocial interventions seem critical for achieving recovery. However, overall, the current literature does not support the safe reduction of antipsychotic dosages by 50% or more in stabilized individuals receiving adjunctive psychosocial interventions. In conclusion, the critical appraisal of the literature indicates that, although chronic antipsychotic use can be associated with undesirable neurologic and metabolic side effects, the evidence supporting its long-term efficacy and effectiveness, including impact on life expectancy, outweighs the evidence against this practice, overall indicating a favorable benefit-to-risk ratio. However, the finding that a minority of individuals diagnosed initially with schizophrenia appear to be relapse free for long periods, despite absence of sustained antipsychotic treatment, calls for further research on patient-level predictors of positive outcomes in people with an initial psychotic presentation.
Collapse
Affiliation(s)
- Christoph U Correll
- Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jose M Rubio
- Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - John M Kane
- Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| |
Collapse
|
39
|
Omega-3 fatty acid supplementation may prevent loss of gray matter thickness in the left parieto-occipital cortex in first episode schizophrenia: A secondary outcome analysis of the OFFER randomized controlled study. Schizophr Res 2018; 195:168-175. [PMID: 29079060 DOI: 10.1016/j.schres.2017.10.013] [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: 06/13/2017] [Revised: 07/28/2017] [Accepted: 10/08/2017] [Indexed: 11/22/2022]
Abstract
The aim of the study was to assess changes in cortical thickness related to the use of n-3 polyunsaturated fatty acids (PUFA) as add-on therapy in patients with first episode schizophrenia. A double-blind randomized controlled study was conducted using a 26-week intervention composed of concentrated fish oil containing 2.2g/d of eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) or placebo (olive oil). Participants underwent MRI scanning twice to assess changes in cortical thickness: at the beginning and at the end of intervention. Data of suitable quality was obtained from 29 participants. The T1-weighted images for each participant were analyzed using FreeSurfer methodology for longitudinal pipeline. Significant differences in cortical thickness loss were observed between the groups in the parieto-occipital regions of Brodmann areas 7 and 19 of the left hemisphere, dysfunctions in which may be involved in schizophrenia symptomatology. The results of the study support the previous observations carried out in older individuals and patients with mild cognitive impairment, indicating that n-3 PUFA may have neuroprotective properties, especially at early stages of neurodegenerative diseases, such as schizophrenia. If replicated, the results of the present study may encourage clinicians to consider n-3 PUFA as a promising addition to antipsychotics for long-term treatment of schizophrenia.
Collapse
|
40
|
Akudjedu TN, Nabulsi L, Makelyte M, Scanlon C, Hehir S, Casey H, Ambati S, Kenney J, O’Donoghue S, McDermott E, Kilmartin L, Dockery P, McDonald C, Hallahan B, Cannon DM. A comparative study of segmentation techniques for the quantification of brain subcortical volume. Brain Imaging Behav 2018; 12:1678-1695. [DOI: 10.1007/s11682-018-9835-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
41
|
Dieleman N, Koek HL, Hendrikse J. Short-term mechanisms influencing volumetric brain dynamics. NEUROIMAGE-CLINICAL 2017; 16:507-513. [PMID: 28971004 PMCID: PMC5609861 DOI: 10.1016/j.nicl.2017.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/28/2017] [Accepted: 09/04/2017] [Indexed: 12/14/2022]
Abstract
With the use of magnetic resonance imaging (MRI) and brain analysis tools, it has become possible to measure brain volume changes up to around 0.5%. Besides long-term brain changes caused by atrophy in aging or neurodegenerative disease, short-term mechanisms that influence brain volume may exist. When we focus on short-term changes of the brain, changes may be either physiological or pathological. As such determining the cause of volumetric dynamics of the brain is essential. Additionally for an accurate interpretation of longitudinal brain volume measures by means of neurodegeneration, knowledge about the short-term changes is needed. Therefore, in this review, we discuss the possible mechanisms influencing brain volumes on a short-term basis and set-out a framework of MRI techniques to be used for volumetric changes as well as the used analysis tools. 3D T1-weighted images are the images of choice when it comes to MRI of brain volume. These images are excellent to determine brain volume and can be used together with an analysis tool to determine the degree of volume change. Mechanisms that decrease global brain volume are: fluid restriction, evening MRI measurements, corticosteroids, antipsychotics and short-term effects of pathological processes like Alzheimer's disease, hypertension and Diabetes mellitus type II. Mechanisms increasing the brain volume include fluid intake, morning MRI measurements, surgical revascularization and probably medications like anti-inflammatory drugs and anti-hypertensive medication. Exercise was found to have no effect on brain volume on a short-term basis, which may imply that dehydration caused by exercise differs from dehydration by fluid restriction. In the upcoming years, attention should be directed towards studies investigating physiological short-term changes within the light of long-term pathological changes. Ultimately this may lead to a better understanding of the physiological short-term effects of pathological processes and may aid in early detection of these diseases. Fluid-restriction, evening MRI, corticosteroids, & antipsychotics decrease volume Fluid-intake, morning MRI, surgical revascularization & medications increase volume Short-term changes within the light of long-term pathological changes should be investigated Short-term changes may introduce bias in longitudinal data
Collapse
Affiliation(s)
- Nikki Dieleman
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Huiberdina L Koek
- Department of Geriatrics, University Medical Center Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| |
Collapse
|
42
|
Progressive cortical reorganisation: A framework for investigating structural changes in schizophrenia. Neurosci Biobehav Rev 2017; 79:1-13. [DOI: 10.1016/j.neubiorev.2017.04.028] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/26/2017] [Accepted: 04/26/2017] [Indexed: 12/27/2022]
|
43
|
ENIGMA and the individual: Predicting factors that affect the brain in 35 countries worldwide. Neuroimage 2017; 145:389-408. [PMID: 26658930 PMCID: PMC4893347 DOI: 10.1016/j.neuroimage.2015.11.057] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/16/2015] [Accepted: 11/23/2015] [Indexed: 11/22/2022] Open
Abstract
In this review, we discuss recent work by the ENIGMA Consortium (http://enigma.ini.usc.edu) - a global alliance of over 500 scientists spread across 200 institutions in 35 countries collectively analyzing brain imaging, clinical, and genetic data. Initially formed to detect genetic influences on brain measures, ENIGMA has grown to over 30 working groups studying 12 major brain diseases by pooling and comparing brain data. In some of the largest neuroimaging studies to date - of schizophrenia and major depression - ENIGMA has found replicable disease effects on the brain that are consistent worldwide, as well as factors that modulate disease effects. In partnership with other consortia including ADNI, CHARGE, IMAGEN and others1, ENIGMA's genomic screens - now numbering over 30,000 MRI scans - have revealed at least 8 genetic loci that affect brain volumes. Downstream of gene findings, ENIGMA has revealed how these individual variants - and genetic variants in general - may affect both the brain and risk for a range of diseases. The ENIGMA consortium is discovering factors that consistently affect brain structure and function that will serve as future predictors linking individual brain scans and genomic data. It is generating vast pools of normative data on brain measures - from tens of thousands of people - that may help detect deviations from normal development or aging in specific groups of subjects. We discuss challenges and opportunities in applying these predictors to individual subjects and new cohorts, as well as lessons we have learned in ENIGMA's efforts so far.
Collapse
|
44
|
Sun Y, Dai Z, Li J, Collinson SL, Sim K. Modular-level alterations of structure-function coupling in schizophrenia connectome. Hum Brain Mapp 2016; 38:2008-2025. [PMID: 28032370 DOI: 10.1002/hbm.23501] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/07/2016] [Accepted: 12/14/2016] [Indexed: 12/29/2022] Open
Abstract
Convergent evidences have revealed that schizophrenia is associated with brain dysconnectivity, which leads to abnormal network organization. However, discrepancies were apparent between the structural connectivity (SC) and functional connectivity (FC) studies, and the relationship between structural and functional deficits in schizophrenia remains largely unknown. In this study, resting-state functional magnetic resonance imaging and structural diffusion tensor imaging were performed in 20 patients with schizophrenia and 20 matched healthy volunteers (patients/controls = 19/17 after head motion rejection). Functional and structural brain networks were obtained for each participant. Graph theoretical approaches were employed to parcellate the FC networks into functional modules. The relationships between the entries of SC and FC were estimated within each module to identify group differences and their correlations with clinical symptoms. Although five common functional modules (including the default mode, occipital, subcortical, frontoparietal, and central modules) were identified in both groups, the patients showed a significantly reduced modularity in comparison with healthy participants. Furthermore, we found that schizophrenia-related aberrations of SC-FC coupling exhibited complex patterns among modules. Compared with controls, patients showed an increased SC-FC coupling in the default mode and the central modules. Moreover, significant SC-FC decoupling was demonstrated in the occipital and the subcortical modules, which was associated with longer duration of illness and more severe clinical manifestations of schizophrenia. Taken together, these findings demonstrated that altered module-dependent SC-FC coupling may underlie abnormal brain function and clinical symptoms observed in schizophrenia and highlighted the potential for using new multimodal neuroimaging biomarkers for diagnosis and severity evaluation of schizophrenia. Hum Brain Mapp 38:2008-2025, 2017. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Yu Sun
- Singapore Institute for Neurotechnology (SINAPSE), Centre for Life Science, National University of Singapore, Singapore
| | - Zhongxiang Dai
- Singapore Institute for Neurotechnology (SINAPSE), Centre for Life Science, National University of Singapore, Singapore
| | - Junhua Li
- Singapore Institute for Neurotechnology (SINAPSE), Centre for Life Science, National University of Singapore, Singapore
| | - Simon L Collinson
- Department of Psychology, National University of Singapore, Singapore
| | - Kang Sim
- Department of General Psychiatry, Institute of Mental Health (IMH), Singapore.,Department of Research, Institute of Mental Health (IMH), Singapore
| |
Collapse
|
45
|
Riederer F, Schaer M, Gantenbein AR, Luechinger R, Michels L, Kaya M, Kollias S, Sándor PS. Cortical Alterations in Medication-Overuse Headache. Headache 2016; 57:255-265. [DOI: 10.1111/head.12993] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 09/20/2016] [Accepted: 10/09/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Franz Riederer
- Neurological Center Rosenhuegel and Karl Landsteiner Institute for Epilepsy Research and Cognitive Neurology; Vienna Austria
- Department of Neurology; University Hospital Zurich; Frauenklinikstrasse 26 Zurich CH-8091 Switzerland
| | - Marie Schaer
- Stanford Cognitive & Systems Neuroscience Laboratory; Stanford, Palo Alto CA USA
- Office Médico-Pédagogique; University of Geneva; Switzerland
| | - Andreas R. Gantenbein
- Department of Neurology; University Hospital Zurich; Frauenklinikstrasse 26 Zurich CH-8091 Switzerland
- Rehaclinic Bad Zurzach; Zurzach Switzerland
| | - Roger Luechinger
- Institute for Biomedical Engineering; Swiss Federal Institute of Technology and the University of Zurich; Zurich Switzerland
| | - Lars Michels
- Institute of Neuroradiology; University Hospital Zurich; Zurich Switzerland
| | - Marihan Kaya
- Department of Childhood and Adolescent Psychiatry; Medical University of Vienna; Währinger Vienna
| | - Spyridon Kollias
- Institute of Neuroradiology; University Hospital Zurich; Zurich Switzerland
| | | |
Collapse
|
46
|
Harvey PD, Rosenthal JB. Treatment resistant schizophrenia: Course of brain structure and function. Prog Neuropsychopharmacol Biol Psychiatry 2016; 70:111-6. [PMID: 26925705 DOI: 10.1016/j.pnpbp.2016.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/08/2016] [Accepted: 02/21/2016] [Indexed: 01/21/2023]
Abstract
Approximately 30% of people with schizophrenia manifest a minimal response to conventional and atypical antipsychotic medications and manifest continuous symptoms of psychosis, with this condition referred to as "treatment resistant schizophrenia (TRS)". There are several neurobiological consequences of continuous psychosis, including regional cortical atrophy and ventricular enlargement. Pharmacological treatments are available for TRS, with at least 1/3 of patients responding to treatment with clozapine. In this paper we review the evidence regarding the course of treatment resistant schizophrenia, as well as changes in brain structure and function in psychosis and on the possible role of clozapine treatment in altering cortical deterioration in patients with TRS.
Collapse
Affiliation(s)
- Philip D Harvey
- University of Miami Miller School of Medicine, United States; Research Service, Bruce W. Carter VA Medical Center, Miami, FL, United States.
| | | |
Collapse
|
47
|
Mouchlianitis E, McCutcheon R, Howes OD. Brain-imaging studies of treatment-resistant schizophrenia: a systematic review. Lancet Psychiatry 2016; 3:451-63. [PMID: 26948188 PMCID: PMC5796640 DOI: 10.1016/s2215-0366(15)00540-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 02/05/2023]
Abstract
Around 30% of patients with schizophrenia show an inadequate response to antipsychotics-ie, treatment resistance. Neuroimaging studies can help to uncover the underlying neurobiological reasons for such resistance and identify these patients earlier. Additionally, studies examining the effect of clozapine on the brain can help to identify aspects of clozapine that make it uniquely effective in patients with treatment resistance. We did a systematic search of PubMed between Jan 1, 1980, and April 13, 2015, to identify all neuroimaging studies that examined treatment-resistant patients or longitudinally assessed the effects of clozapine treatment. We identified 330 articles, of which 61 met the inclusion criteria. Replicated differences between treatment-resistant and treatment-responsive patients include reductions in grey matter and perfusion of frontotemporal regions, and increases in white matter and basal ganglia perfusion, with effect sizes ranging from 0·4 to greater than 1. Clozapine treatment led to reductions in caudate nucleus volume in three separate studies. The available evidence supports the hypothesis that some of the neurobiological changes seen in treatment-resistant schizophrenia lie along a continuum with treatment-responsive schizophrenia, whereas other differences are categorical in nature and have potential to be used as biomarkers. However, further replication is needed, and for neuroimaging findings to be clinically translatable, future studies need to focus on a-priori hypotheses and be adequately powered.
Collapse
Affiliation(s)
- Elias Mouchlianitis
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Robert McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; Psychiatric Imaging Group, Medical Research Council Clinical Sciences Centre, Institute of Clinical Science, Imperial College London, London, UK.
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; Psychiatric Imaging Group, Medical Research Council Clinical Sciences Centre, Institute of Clinical Science, Imperial College London, London, UK
| |
Collapse
|
48
|
Halene TB, Kozlenkov A, Jiang Y, Mitchell A, Javidfar B, Dincer A, Park R, Wiseman J, Croxson P, Giannaris EL, Hof PR, Roussos P, Dracheva S, Hemby SE, Akbarian S. NeuN+ neuronal nuclei in non-human primate prefrontal cortex and subcortical white matter after clozapine exposure. Schizophr Res 2016; 170:235-44. [PMID: 26776227 PMCID: PMC4740223 DOI: 10.1016/j.schres.2015.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/24/2015] [Accepted: 12/28/2015] [Indexed: 12/01/2022]
Abstract
Increased neuronal densities in subcortical white matter have been reported for some cases with schizophrenia. The underlying cellular and molecular mechanisms remain unresolved. We exposed 26 young adult macaque monkeys for 6 months to either clozapine, haloperidol or placebo and measured by structural MRI frontal gray and white matter volumes before and after treatment, followed by observer-independent, flow-cytometry-based quantification of neuronal and non-neuronal nuclei and molecular fingerprinting of cell-type specific transcripts. After clozapine exposure, the proportion of nuclei expressing the neuronal marker NeuN increased by approximately 50% in subcortical white matter, in conjunction with a more subtle and non-significant increase in overlying gray matter. Numbers and proportions of nuclei expressing the oligodendrocyte lineage marker, OLIG2, and cell-type specific RNA expression patterns, were maintained after antipsychotic drug exposure. Frontal lobe gray and white matter volumes remained indistinguishable between antipsychotic-drug-exposed and control groups. Chronic clozapine exposure increases the proportion of NeuN+ nuclei in frontal subcortical white matter, without alterations in frontal lobe volumes or cell type-specific gene expression. Further exploration of neurochemical plasticity in non-human primate brain exposed to antipsychotic drugs is warranted.
Collapse
Affiliation(s)
- Tobias B. Halene
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Corresponding author: Tobias B. Halene, MD PhD, Icahn School of Medicine at Mount Sinai, Department of Psychiatry, 1470 Madison Ave, Hess 9-105, New York, NY 10029, Tel: 646 627 5529, Fax: 646-537-9583,
| | - Alexey Kozlenkov
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yan Jiang
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amanda Mitchell
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Behnam Javidfar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aslihan Dincer
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Royce Park
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer Wiseman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paula Croxson
- Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eustathia Lela Giannaris
- Department of Cell and Developmental Biology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Patrick R. Hof
- Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Panos Roussos
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Genetics and Genomic Science and Institute for Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stella Dracheva
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scott E. Hemby
- Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, NC, USA
| | - Schahram Akbarian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|