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Kaldewaij R, Salamone PC, Enmalm A, Östman L, Pietrzak M, Karlsson H, Löfberg A, Gauffin E, Samuelsson M, Gustavson S, Capusan AJ, Olausson H, Heilig M, Boehme R. Ketamine reduces the neural distinction between self- and other-produced affective touch: a randomized double-blind placebo-controlled study. Neuropsychopharmacology 2024:10.1038/s41386-024-01906-2. [PMID: 38918578 DOI: 10.1038/s41386-024-01906-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/07/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024]
Abstract
A coherent sense of self is crucial for social functioning and mental health. The N-methyl-D-aspartate antagonist ketamine induces short-term dissociative experiences and has therefore been used to model an altered state of self-perception. This randomized double-blind placebo-controlled cross-over study investigated the mechanisms for ketamine's effects on the bodily sense of self in the context of affective touch. Thirty healthy participants (15 females/15 males, age 19-39) received intravenous ketamine or placebo while performing self-touch and receiving touch by someone else during functional MRI - a previously established neural measure of tactile self-other-differentiation. Afterwards, tactile detection thresholds during self- and other-touch were assessed, as well as dissociative states, interoceptive awareness, and social touch attitudes. Compared to placebo, ketamine administration elicited dissociation and reduced neural activity associated with self-other-differentiation in the right temporoparietal cortex, which was most pronounced during other-touch. This reduction correlated with ketamine-induced reductions in interoceptive awareness. The temporoparietal cortex showed higher connectivity to somatosensory cortex and insula during other- compared to self-touch. This difference was augmented by ketamine, and correlated with dissociation strength for somatosensory cortex. These results demonstrate that disrupting the self-experience through ketamine administration affects neural activity associated with self-other-differentiation in a region involved in touch perception and social cognition, especially with regard to social touch by someone else. This process may be driven by ketamine-induced effects on top-down signaling, rendering the processing of predictable self-generated and unpredictable other-generated touch more similar. These findings provide further evidence for the intricate relationship of the bodily self with the tactile sense.
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Affiliation(s)
- Reinoud Kaldewaij
- Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
| | - Paula C Salamone
- Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - Adam Enmalm
- Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - Lars Östman
- Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - Michal Pietrzak
- Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - Hanna Karlsson
- Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - Andreas Löfberg
- Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - Emelie Gauffin
- Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - Martin Samuelsson
- Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - Sarah Gustavson
- Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - Andrea J Capusan
- Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - Håkan Olausson
- Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Rebecca Boehme
- Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
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Sapienza J, Pacchioni F, Spangaro M, Bosia M. Dysconnection in schizophrenia: Filling the dots from old to new evidence. Clin Neurophysiol 2024; 162:226-228. [PMID: 38555237 DOI: 10.1016/j.clinph.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Jacopo Sapienza
- Schizophrenia Research and Clinical Unit, IRCCS San Raffaele Hospital, Milan, Italy; Department of Humanities and Life Sciences, University School for Advanced Studies IUSS, Pavia, Italy.
| | - Federico Pacchioni
- Schizophrenia Research and Clinical Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marco Spangaro
- Schizophrenia Research and Clinical Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marta Bosia
- Schizophrenia Research and Clinical Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita -Salute San Raffaele University, Milan, Italy
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Rocca P, Brasso C, Montemagni C, Del Favero E, Bellino S, Bozzatello P, Giordano GM, Caporusso E, Fazio L, Pergola G, Blasi G, Amore M, Calcagno P, Rossi R, Rossi A, Bertolino A, Galderisi S, Maj M. The relationship between the resting state functional connectivity and social cognition in schizophrenia: Results from the Italian Network for Research on Psychoses. Schizophr Res 2024; 267:330-340. [PMID: 38613864 DOI: 10.1016/j.schres.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 03/24/2024] [Accepted: 04/04/2024] [Indexed: 04/15/2024]
Abstract
Deficits in social cognition (SC) interfere with recovery in schizophrenia (SZ) and may be related to resting state brain connectivity. This study aimed at assessing the alterations in the relationship between resting state functional connectivity and the social-cognitive abilities of patients with SZ compared to healthy subjects. We divided the brain into 246 regions of interest (ROI) following the Human Healthy Volunteers Brainnetome Atlas. For each participant, we calculated the resting-state functional connectivity (rsFC) in terms of degree centrality (DC), which evaluates the total strength of the most powerful coactivations of every ROI with all other ROIs during rest. The rs-DC of the ROIs was correlated with five measures of SC assessing emotion processing and mentalizing in 45 healthy volunteers (HVs) chosen as a normative sample. Then, controlling for symptoms severity, we verified whether these significant associations were altered, i.e., absent or of opposite sign, in 55 patients with SZ. We found five significant differences between SZ patients and HVs: in the patients' group, the correlations between emotion recognition tasks and rsFC of the right entorhinal cortex (R-EC), left superior parietal lobule (L-SPL), right caudal hippocampus (R-c-Hipp), and the right caudal (R-c) and left rostral (L-r) middle temporal gyri (MTG) were lost. An altered resting state functional connectivity of the L-SPL, R-EC, R-c-Hipp, and bilateral MTG in patients with SZ may be associated with impaired emotion recognition. If confirmed, these results may enhance the development of non-invasive brain stimulation interventions targeting those cerebral regions to reduce SC deficit in SZ.
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Affiliation(s)
- Paola Rocca
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Via Cherasco, 15, 10126 Turin, Italy
| | - Claudio Brasso
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Via Cherasco, 15, 10126 Turin, Italy.
| | - Cristiana Montemagni
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Via Cherasco, 15, 10126 Turin, Italy
| | - Elisa Del Favero
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Via Cherasco, 15, 10126 Turin, Italy
| | - Silvio Bellino
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Via Cherasco, 15, 10126 Turin, Italy
| | - Paola Bozzatello
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Via Cherasco, 15, 10126 Turin, Italy
| | - Giulia Maria Giordano
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Largo Madonna Delle Grazie, 1, 80138 Naples, Italy
| | - Edoardo Caporusso
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Largo Madonna Delle Grazie, 1, 80138 Naples, Italy
| | - Leonardo Fazio
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Policlinico, Piazza G. Cesare, 11, 70124 Bari, Italy; Department of Medicine and Surgery, LUM University, Strada Statale 100, 70010 Casamassima (BA), Italy
| | - Giulio Pergola
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Policlinico, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - Giuseppe Blasi
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Policlinico, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - Mario Amore
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Largo Paolo Daneo, 3, 16132 Genoa, Italy
| | - Pietro Calcagno
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Largo Paolo Daneo, 3, 16132 Genoa, Italy
| | - Rodolfo Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, via Vetoio - Coppito, 67100 L'Aquila, Italy; Policlinico Tor Vergata, Viale Oxford, 81, 00133 Rome, Italy
| | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, via Vetoio - Coppito, 67100 L'Aquila, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Policlinico, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Largo Madonna Delle Grazie, 1, 80138 Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Largo Madonna Delle Grazie, 1, 80138 Naples, Italy
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Lefebvre S, Gehrig G, Nadesalingam N, Nuoffer MG, Kyrou A, Wüthrich F, Walther S. The pathobiology of psychomotor slowing in psychosis: altered cortical excitability and connectivity. Brain 2024; 147:1423-1435. [PMID: 38537253 PMCID: PMC10994557 DOI: 10.1093/brain/awad395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/23/2023] [Accepted: 11/03/2023] [Indexed: 04/06/2024] Open
Abstract
Psychomotor slowing is a frequent symptom of schizophrenia. Short-interval intracortical inhibition assessed by transcranial magnetic stimulation demonstrated inhibitory dysfunction in schizophrenia. The inhibitory deficit results from additional noise during information processing in the motor system in psychosis. Here, we tested whether cortical inhibitory dysfunction was linked to psychomotor slowing and motor network alterations. In this cross-sectional study, we included 60 patients with schizophrenia and psychomotor slowing determined by the Salpêtrière Retardation Rating Scale, 23 patients without slowing and 40 healthy control participants. We acquired single and double-pulse transcranial magnetic stimulation effects from the left primary motor cortex, resting-state functional connectivity and diffusion imaging on the same day. Groups were compared on resting motor threshold, amplitude of the motor evoked potentials, as well as short-interval intracortical inhibition. Regression analyses calculated the association between motor evoked potential amplitudes or cortical inhibition with seed-based resting-state functional connectivity from the left primary motor cortex and fractional anisotropy at whole brain level and within major motor tracts. In patients with schizophrenia and psychomotor slowing, we observed lower amplitudes of motor evoked potentials, while the short-interval intracortical inhibition/motor evoked potentials amplitude ratio was higher than in healthy controls, suggesting lower cortical inhibition in these patients. Patients without slowing also had lower amplitudes of motor evoked potentials. Across the combined patient sample, cortical inhibition deficits were linked to more motor coordination impairments. In patients with schizophrenia and psychomotor slowing, lower amplitudes of motor evoked potentials were associated with lower fractional anisotropy in motor tracts. Moreover, resting-state functional connectivity between the primary motor cortex, the anterior cingulate cortex and the cerebellum increased with stronger cortical inhibition. In contrast, in healthy controls and patients without slowing, stronger cortical inhibition was linked to lower resting-state functional connectivity between the left primary motor cortex and premotor or parietal cortices. Psychomotor slowing in psychosis is linked to less cortical inhibition and aberrant functional connectivity of the primary motor cortex. Higher neural noise in the motor system may drive psychomotor slowing and thus may become a treatment target.
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Affiliation(s)
- Stephanie Lefebvre
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, 3000 Bern, Switzerland
| | - Gwendolyn Gehrig
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Niluja Nadesalingam
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, 3000 Bern, Switzerland
| | - Melanie G Nuoffer
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, 3000 Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, 3000 Bern, Switzerland
| | - Alexandra Kyrou
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Florian Wüthrich
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, 3000 Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, 3000 Bern, Switzerland
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Sapienza J, Agostoni G, Dall'Acqua S, Sut S, Nasini S, Martini F, Marchesi A, Bechi M, Buonocore M, Cocchi F, Cavallaro R, Spangaro M, Comai S, Bosia M. The kynurenine pathway in treatment-resistant schizophrenia at the crossroads between pathophysiology and pharmacotherapy. Schizophr Res 2024; 264:71-80. [PMID: 38101180 DOI: 10.1016/j.schres.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/28/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
Two cardinal elements in the complex and multifaceted pathophysiology of schizophrenia (SCZ) are neuroinflammation and dysregulation of glutamatergic neurotransmission, with the latter being especially involved in treatment-resistant schizophrenia (TRS). Interestingly, the Kynurenine (KYN) pathway (KP) is at the crossroad between them, constituting a potential causal link and a therapeutic target. Although there is preclinical and clinical evidence indicating a dysregulation of KP associated with the clinical phenotype of SCZ, clinical studies investigating the possible relationship between changes in biomarkers of the KP and response to pharmacotherapy are still limited. Therefore, we have studied possible differences in the circulating levels of biomarkers of the metabolism of tryptophan along the KP in 43 responders to first-line treatments (FLR) and 32 TRS patients treated with clozapine, and their possible associations with psychopathology in the two subgroups. Plasma levels of KYN were significantly higher in TRS patients than in FLR patients, indicating a greater activation of KP. Furthermore, the levels of quinolinic (NMDA receptor agonist) and kynurenic acid (NMDA negative allosteric modulator) showed a negative and a positive correlation with several dimensions and the overall symptomatology in the whole sample and in FLR, but not in TRS, suggesting a putative modulating effect of clozapine elicited through the NMDA receptors. Despite the cross-sectional design of the study that prevents us from demonstrating causation, these findings show a significant relationship among circulating KP biomarkers, psychopathology, and response to pharmacotherapy in SCZ. Therefore, plasma KP biomarkers should be further investigated for developing personalized medicine approaches in SCZ.
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Affiliation(s)
- Jacopo Sapienza
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Humanities and Life Sciences, University School for Advanced Studies IUSS, Pavia, Italy
| | - Giulia Agostoni
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Dall'Acqua
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Stefania Sut
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Sofia Nasini
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Francesca Martini
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Marchesi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Margherita Bechi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mariachiara Buonocore
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Cocchi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Cavallaro
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Spangaro
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Stefano Comai
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy; Division of Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Psychiatry, McGill University, Montreal, QC, Canada; Department of Biomedical Sciences, University of Padua, Padua, Italy.
| | - Marta Bosia
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Yakimov V, Falkai P, Wagner E. Pathogenese der Schizophrenie(n). FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:369-383. [PMID: 37725988 DOI: 10.1055/a-2099-7560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Schizophrenia is a mental disorder characterized by marked heterogeneity at both the phenomenological and neurobiological levels. Its diagnostic disentanglement would lead to more precise treatment and improved prognosis in people with schizophrenia. For this, a deeper understanding of the pathophysiological mechanisms of schizophrenia is needed.
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