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Tsapakis EM, Treiber M, Mitkani C, Drakaki Z, Cholevas A, Spanaki C, Fountoulakis KN. Pharmacological Treatments of Negative Symptoms in Schizophrenia-An Update. J Clin Med 2024; 13:5637. [PMID: 39337126 PMCID: PMC11432821 DOI: 10.3390/jcm13185637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 09/21/2024] [Indexed: 09/30/2024] Open
Abstract
Schizophrenia is a chronic psychotic disorder comprising positive symptoms, negative symptoms, and cognitive deficits. Negative symptoms are associated with stigma, worse functional outcomes, and a significant deterioration in quality of life. Clinical diagnosis is challenging despite its significance, and current treatments offer little improvement in the burden of negative symptoms. This article reviews current pharmacological strategies for treating negative symptoms. Dopaminergic, glutamatergic, serotonergic, noradrenergic, cholinergic, anti-inflammatory compounds, hormones, and psychostimulants are explored. Finally, we review pharmacological global treatment guidelines for negative symptoms. In general, switching to a second-generation antipsychotic seems to be most often recommended for patients with schizophrenia on first-generation antipsychotics, and an add-on antidepressant is considered when depression is also present. However, the treatment of negative symptoms remains an unmet need. Future, larger clinical studies and meta-analyses are needed to establish effective pharmacological agents for the effective treatment of negative symptoms.
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Affiliation(s)
- Evangelia Maria Tsapakis
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Department of Neurosciences, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Michael Treiber
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, 1090 Vienna, Austria
| | - Calypso Mitkani
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Department of Neurology, Agios Pavlos General Hospital of Thessaloniki, 55134 Thessaloniki, Greece
| | - Zoe Drakaki
- Department of Neurosciences, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Anastasios Cholevas
- Department of Neurosciences, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Cleanthe Spanaki
- Department of Neurosciences, School of Medicine, University of Crete, 71003 Heraklion, Greece
- Department of Neurology, University Hospital of Heraklion, Voutes, 71110 Crete, Greece
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Shao H, Deng W, Du R, Zhao Y, Jin D, Wei Y. Mismatch Negativity and P300 in the Diagnosis and Prognostic Assessment of Coma and Other Disorders of Consciousness. Neurocrit Care 2024:10.1007/s12028-024-02058-3. [PMID: 39043983 DOI: 10.1007/s12028-024-02058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/25/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND The objective of this study was to investigate the value of mismatch negativity (MMN) and P300 event-related potentials for discriminating the consciousness state and predicting improvement of consciousness at 6 months in patients with coma and other disorders of consciousness (DOC). METHODS We performed MMN and P300 on 42 patients with DOC with a mean onset time of 40.21 ± 19.43 days. These patients with DOC were categorized into coma, unresponsive wakefulness syndrome (UWS), minimal consciousness minus (MCS-), and minimal consciousness plus (MCS +) groups according to neurobehavioral assessment and the Coma Recovery Scale-Revised score. The primary outcome was the improvement of consciousness at 6 months in patients with DOC. We assessed the efficacy of MMN and P300 in quantitatively predicting the prognosis at 6 months and the capability of MMN and P300 parameters to differentiate between DOC. RESULTS At least one significant difference in either MMN or P300 parameters was displayed among the DOC groups, but not between the MCS- and MCS+ groups (significance level: 0.05). Both MMN and P300 amplitudes showed desirable predictive accuracy at 6 months, with areas under the curve (AUCs) of 0.859 and 0.856, respectively. The optimal thresholds for MMN and P300 amplitudes were 2.044 and 1.095 μV. However, the combined MMN-P300 amplitude showed better 6-month predictive accuracy (AUC 0.934, 95% confidence interval 0.860-1.000), with a sensitivity of 85% and a specificity of 90.9%. CONCLUSIONS MMN and P300 may help discriminate among coma, UWS, and MCS, but not between patients with MCS- and patients with MCS+ . The MMN amplitude, P300 amplitude, and especially combined MMN-P300 amplitude at 6 months may be interesting predictors of consciousness improvement at 6 months in patients with DOC. TRIAL REGISTRATION Chinese Clinical Trial Registry identifier ChiCTR2400083798.
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Affiliation(s)
- Huijie Shao
- Department of Neurology Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052, Henan, China.
| | - Wenjing Deng
- Department of Neurology Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Ran Du
- Department of Neurology Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Yanan Zhao
- Department of Neurology Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Di Jin
- Department of Neurology Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Yamin Wei
- Department of Neurology Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052, Henan, China
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Todd J, Salisbury D, Michie PT. Why mismatch negativity continues to hold potential in probing altered brain function in schizophrenia. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e144. [PMID: 38867817 PMCID: PMC11114358 DOI: 10.1002/pcn5.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 06/14/2024]
Abstract
The brain potential known as mismatch negativity (MMN) is one of the most studied indices of altered brain function in schizophrenia. This review looks at what has been learned about MMN in schizophrenia over the last three decades and why the level of interest and activity in this field of research remains strong. A diligent consideration of available evidence suggests that MMN can serve as a biomarker in schizophrenia, but perhaps not the kind of biomarker that early research supposed. This review concludes that MMN measurement is likely to be most useful as a monitoring and response biomarker enabling tracking of an underlying pathology and efficacy of interventions, respectively. The role of, and challenges presented by, pre-clinical models is discussed as well as the merits of different methodologies that can be brought to bear in pursuing a deeper understanding of pathophysiology that might explain smaller MMN in schizophrenia.
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Affiliation(s)
- Juanita Todd
- School of Psychological SciencesUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Dean Salisbury
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Patricia T. Michie
- School of Psychological SciencesUniversity of NewcastleNewcastleNew South WalesAustralia
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Yang ZH, Cai X, Ding ZL, Li W, Zhang CY, Huo JH, Zhang Y, Wang L, Zhang LM, Li SW, Li M, Zhang C, Chang H, Xiao X. Identification of a psychiatric risk gene NISCH at 3p21.1 GWAS locus mediating dendritic spine morphogenesis and cognitive function. BMC Med 2023; 21:254. [PMID: 37443018 PMCID: PMC10347724 DOI: 10.1186/s12916-023-02931-6] [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: 07/12/2022] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Schizophrenia and bipolar disorder (BD) are believed to share clinical symptoms, genetic risk, etiological factors, and pathogenic mechanisms. We previously reported that single nucleotide polymorphisms spanning chromosome 3p21.1 showed significant associations with both schizophrenia and BD, and a risk SNP rs2251219 was in linkage disequilibrium with a human specific Alu polymorphism rs71052682, which showed enhancer effects on transcriptional activities using luciferase reporter assays in U251 and U87MG cells. METHODS CRISPR/Cas9-directed genome editing, real-time quantitative PCR, and public Hi-C data were utilized to investigate the correlation between the Alu polymorphism rs71052682 and NISCH. Primary neuronal culture, immunofluorescence staining, co-immunoprecipitation, lentiviral vector production, intracranial stereotaxic injection, behavioral assessment, and drug treatment were used to examine the physiological impacts of Nischarin (encoded by NISCH). RESULTS Deleting the Alu sequence in U251 and U87MG cells reduced mRNA expression of NISCH, the gene locates 180 kb from rs71052682, and Hi-C data in brain tissues confirmed the extensive chromatin contacts. These data suggested that the genetic risk of schizophrenia and BD predicted elevated NISCH expression, which was also consistent with the observed higher NISCH mRNA levels in the brain tissues from psychiatric patients compared with controls. We then found that overexpression of NISCH resulted in a significantly decreased density of mushroom dendritic spines with a simultaneously increased density of thin dendritic spines in primary cultured neurons. Intriguingly, elevated expression of this gene in mice also led to impaired spatial working memory in the Y-maze. Given that Nischarin is the target of anti-hypertensive agents clonidine and tizanidine, which have shown therapeutic effects in patients with schizophrenia and patients with BD in preliminary clinical trials, we demonstrated that treatment with those antihypertensive drugs could reduce NISCH mRNA expression and rescue the impaired working memory in mice. CONCLUSIONS We identify a psychiatric risk gene NISCH at 3p21.1 GWAS locus influencing dendritic spine morphogenesis and cognitive function, and Nischarin may have potentials for future therapeutic development.
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Affiliation(s)
- Zhi-Hui Yang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Xin Cai
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Zhong-Li Ding
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Wei Li
- Department of Blood Transfusion, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Chu-Yi Zhang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Jin-Hua Huo
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Yue Zhang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Lu Wang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Lin-Ming Zhang
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Shi-Wu Li
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Ming Li
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Chen Zhang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China.
| | - Hong Chang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China.
| | - Xiao Xiao
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China.
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Kruiper C, Sommer IEC, Koster M, Bakker PR, Durston S, Oranje B. Clonidine augmentation in patients with schizophrenia: A double-blind, randomized placebo-controlled trial. Schizophr Res 2023; 255:148-154. [PMID: 36989672 DOI: 10.1016/j.schres.2023.03.039] [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: 05/23/2022] [Revised: 02/23/2023] [Accepted: 03/18/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Noradrenergic imbalance in the brain of schizophrenia patients may underlie both symptomatology and deficits in basic information processing. The current study investigated whether augmentation with the noradrenergic α2-agonist clonidine might alleviate these symptoms. METHODS In a double-blind placebo-controlled randomized clinical trial, 32 chronic schizophrenia patients were randomly assigned to six-weeks augmentation with either 50 μg clonidine or placebo to their current medication. Effects on symptom severity and both sensory- and sensorimotor gating were assessed at baseline, 3- and 6-weeks. Results were compared with 21 age- and sex-matched healthy controls (HC) who received no treatment. RESULTS Only patients treated with clonidine showed significantly reduced PANSS negative, general and total scores at follow-up compared to baseline. On average, also patients treated with placebo showed minor (non-significant) reductions in these scores, likely indicating a placebo effect. Sensorimotor gating of patients was significantly lower at baseline compared to controls. It increased in patients treated with clonidine over the treatment period, whereas it decreased in both the HC and patients treated with placebo. However, neither treatment nor group effects were found in sensory gating. Clonidine treatment was very well tolerated. CONCLUSION Only patients treated with clonidine showed a significant decrease on two out of the three PANSS subscales, while additionally retained their levels of sensorimotor gating. Given that there are only a few reports on effective treatment for negative symptoms in particular, our current results support augmentation of antipsychotics with clonidine as a promising, low-cost and safe treatment strategy for schizophrenia.
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Affiliation(s)
- Caitlyn Kruiper
- University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Iris E C Sommer
- Rijksuniversiteit Groningen (RUG), department of Biomedical Sciences of Cells and Systems, Department of Psychiatry, University Medical Center Groningen, Netherlands
| | - Michiel Koster
- University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - P Roberto Bakker
- Arkin, Institute for Mental Health, Amsterdam, the Netherlands; Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - Sarah Durston
- University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Bob Oranje
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital - Mental Health Services CPH, Glostrup, Denmark.
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Kool L, Oranje B, Meijs H, De Wilde B, Van Hecke J, Niemegeers P, Luykx JJ. Event-related potentials and use of psychotropic medication in major psychiatric disorders. Psychiatry Res 2022; 314:114637. [PMID: 35649338 DOI: 10.1016/j.psychres.2022.114637] [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: 10/20/2021] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Attention deficits measured using event-related potentials (ERPs) have been frequently reported in several major psychiatric disorders, e.g. mood disorder (MD), psychotic disorder (PD) and substance use disorder (SUD). However, comparisons between these specific categories are lacking. Here we investigated if electrophysiological parameters of basic information processing are associated with the above-mentioned categories of psychiatric disorders, or instead were associated with general psychopathology. METHODS 579 subjects with MD, PD or SUD and healthy controls (HC) were included. Participants were tested in a passive auditory and an active visual oddball paradigm to assess mismatch negativity (MMN), P3A and P3B amplitudes. Additionally, we examined associations between these measures and psychoactive medication treatments. RESULTS All patients had significantly lower P3B amplitudes compared to healthy controls, while only SUD patients had lower P3A amplitudes than MD, PD and HC. PD patients also produced significantly less MMN than both MD and SUD patients. Additionally, we found significantly higher P3B amplitude in HC compared to patients without psychopharmacological treatment and patients treated with two or more psychoactive compounds (polypharmacy), but no significant associations with medication on P3A and MMN amplitudes. CONCLUSIONS Our results add to the theory that P3B deficits are associated with general psychopathology, whereas P3A and MMN deficits appear to be associated with substance abuse and psychotic disorders respectively.
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Affiliation(s)
- Lindy Kool
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Huispostnummer Str. 4.205, Universiteitsweg 100, Utrecht 3584 CG, The Netherlands; Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Bob Oranje
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Academic Hospital Glostrup, Glostrup, Denmark
| | - Hannah Meijs
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Huispostnummer Str. 4.205, Universiteitsweg 100, Utrecht 3584 CG, The Netherlands; Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, The Netherlands
| | - Bieke De Wilde
- Department of Psychiatry, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium
| | - Jan Van Hecke
- Department of Psychiatry, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium
| | - Peter Niemegeers
- Department of Psychiatry, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium
| | - Jurjen J Luykx
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Huispostnummer Str. 4.205, Universiteitsweg 100, Utrecht 3584 CG, The Netherlands; Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Outpatient second opinion clinic, GGNet Mental Health, Apeldoorn, The Netherlands
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Knight EJ, Oakes L, Hyman SL, Freedman EG, Foxe JJ. Individuals With Autism Have No Detectable Deficit in Neural Markers of Prediction Error When Presented With Auditory Rhythms of Varied Temporal Complexity. Autism Res 2020; 13:2058-2072. [PMID: 32881408 PMCID: PMC9073708 DOI: 10.1002/aur.2362] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/07/2020] [Accepted: 06/29/2020] [Indexed: 01/31/2023]
Abstract
The brain's ability to encode temporal patterns and predict upcoming events is critical for speech perception and other aspects of social communication. Deficits in predictive coding may contribute to difficulties with social communication and overreliance on repetitive predictable environments in individuals with autism spectrum disorder (ASD). Using a mismatch negativity (MMN) task involving rhythmic tone sequences of varying complexity, we tested the hypotheses that (1) individuals with ASD have reduced MMN response to auditory stimuli that deviate in presentation timing from expected patterns, particularly as pattern complexity increases and (2) amplitude of MMN signal is inversely correlated with level of impairment in social communication and repetitive behaviors. Electroencephalography was acquired as individuals (age 6-21 years) listened to repeated five-rhythm tones that varied in the Shannon entropy of the rhythm across three conditions (zero, medium-1 bit, and high-2 bit entropy). The majority of the tones conformed to the established rhythm (standard tones); occasionally the fourth tone was temporally shifted relative to its expected time of occurrence (deviant tones). Social communication and repetitive behaviors were measured using the Social Responsiveness Scale and Repetitive Behavior Scale-Revised. Both neurotypical controls (n = 19) and individuals with ASD (n = 21) show stepwise decreases in MMN as a function of increasing entropy. Contrary to the result forecasted by a predictive coding hypothesis, individuals with ASD do not differ from controls in these neural mechanisms of prediction error to auditory rhythms of varied temporal complexity, and there is no relationship between these signals and social communication or repetitive behavior measures. LAY SUMMARY: We tested the idea that the brain's ability to use previous experience to influence processing of sounds is weaker in individuals with autism spectrum disorder (ASD) than in neurotypical individuals. We found no difference between individuals with ASD and neurotypical controls in brain wave responses to sounds that occurred earlier than expected in either simple or complex rhythms. There was also no relationship between these brain waves and social communication or repetitive behavior scores.
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Affiliation(s)
- Emily J. Knight
- The Cognitive Neurophysiology Laboratory, The Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Leona Oakes
- The Cognitive Neurophysiology Laboratory, The Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Susan L. Hyman
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Edward G. Freedman
- The Cognitive Neurophysiology Laboratory, The Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - John J. Foxe
- The Cognitive Neurophysiology Laboratory, The Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
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