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Husain MO, Jones B, Arshad U, Ameis SH, Mirfallah G, Schifani C, Rodak T, Aiken M, Shafique M, Ahmed F, Voineskos A, Husain MI, Foussias G. A systematic review and meta-analysis of neuroimaging studies examining synaptic density in individuals with psychotic spectrum disorders. BMC Psychiatry 2024; 24:460. [PMID: 38898401 PMCID: PMC11188231 DOI: 10.1186/s12888-024-05788-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 04/25/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Psychotic disorders have long been considered neurodevelopmental disorders where excessive synaptic pruning and cortical volume loss are central to disease pathology. We conducted a systematic review of the literature to identify neuroimaging studies specifically examining synaptic density across the psychosis spectrum. METHODS PRISMA guidelines on reporting were followed. We systematically searched MEDLINE, Embase, APA PsycINFO, Web of Science and The Cochrane Library from inception to December 8, 2023, and included all original peer-reviewed articles or completed clinical neuroimaging studies of any modality measuring synaptic density in participants with a diagnosis of psychosis spectrum disorder as well as individuals with psychosis-risk states. The NIH quality assessment tool for observational cohort and cross-sectional studies was used for the risk of bias assessment. RESULTS Five studies (k = 5) met inclusion criteria, comprising n = 128 adults (psychotic disorder; n = 61 and healthy volunteers; n = 67 and specifically measuring synaptic density via positron emission tomography (PET) imaging of the synaptic vesicle glycoprotein 2 A (SV2A). Three studies were included in our primary meta-analysis sharing the same outcome measure of SV2A binding, volume of distribution (VT). Regional SV2A VT was reduced in psychotic disorder participants in comparison to healthy volunteers, including the occipital lobe (Mean Difference (MD)= -2.17; 95% CI: -3.36 to -0.98; P < 0.001 ), temporal lobe (MD: -2.03; 95% CI: -3.19 to -0.88; P < 0.001 ), parietal lobe (MD:-1.61; 95% CI: -2.85 to -0.37; P = 0.01), anterior cingulate cortex (MD= -1.47; 95% CI: -2.45 to -0.49; P = 0.003), frontal cortex (MD: -1.16; 95% CI: -2.18 to -0.15; P = 0.02), amygdala (MD: -1.36; 95% CI: -2.20 to -0.52, p = 0.002), thalamus (MD:-1.46; 95% CI:-2.46 to -0.46, p = 0.004) and hippocampus (MD= -0.96; 95% CI: -1.59 to -0.33; P = 0.003). CONCLUSIONS Preliminary studies provide in vivo evidence for reduced synaptic density in psychotic disorders. However, replication of findings in larger samples is required prior to definitive conclusions being drawn. PROSPERO CRD42022359018.
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Affiliation(s)
- Muhammad Omair Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Brett Jones
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Usman Arshad
- Pakistan Institute of Living and Learning, Karachi, Pakistan
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Stephanie H Ameis
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Giselle Mirfallah
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Christin Schifani
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Terri Rodak
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Madina Aiken
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Mudassar Shafique
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Fatima Ahmed
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Aristotle Voineskos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Muhammad Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - George Foussias
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Chahl LA. TRPV1 Channels in the Central Nervous System as Drug Targets. Pharmaceuticals (Basel) 2024; 17:756. [PMID: 38931423 PMCID: PMC11206835 DOI: 10.3390/ph17060756] [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: 03/30/2024] [Revised: 05/14/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
TRPV1 channels are polymodal cation channels located predominantly on primary afferent neurons that are activated by inflammatory mediators, capsaicin (the active component in chili peppers), and noxious heat. TRPV1 channel antagonists are potential new analgesic agents, but their development has been hindered by the finding that they also produce loss of thermal homeostasis and response to noxious heat. Results from recent studies of the TRPV1 channel indicate that it might be possible to develop TRPV1 channel antagonists that inhibit pain without affecting noxious heat sensation. TRPV1 channels are also present in the central nervous system (CNS) and have been implicated in learning, memory, and behaviour. TRPV1 channel modulators have been proposed to have possible therapeutic potential in the treatment of neurological and psychiatric conditions. However, further understanding of the role of TRPV1 channels in the CNS is required before therapeutic advances in the treatment of neuropsychiatric conditions with TRPV1 channel modulators can be made.
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Affiliation(s)
- Loris A Chahl
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
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Koster M, Mannsdörfer L, van der Pluijm M, de Haan L, Ziermans T, van Wingen G, Vermeulen J. The Association Between Chronic Tobacco Smoking and Brain Alterations in Schizophrenia: A Systematic Review of Magnetic Resonance Imaging Studies. Schizophr Bull 2024:sbae088. [PMID: 38824451 DOI: 10.1093/schbul/sbae088] [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: 06/03/2024]
Abstract
BACKGROUND AND HYPOTHESIS The high co-occurrence of tobacco smoking in patients with schizophrenia spectrum disorders (SSD) poses a serious health concern, linked to increased mortality and worse clinical outcomes. The mechanisms underlying this co-occurrence are not fully understood. STUDY DESIGN Addressing the need for a comprehensive overview of the impact of tobacco use on SSD neurobiology, we conducted a systematic review of neuroimaging studies (including structural, functional, and neurochemical magnetic resonance imaging studies) that investigate the association between chronic tobacco smoking and brain alterations in patients with SSD. STUDY RESULTS Eight structural and fourteen functional studies were included. Structural studies show widespread independent and additive reductions in gray matter in relation to smoking and SSD. The majority of functional studies suggest that smoking might be associated with improvements in connectivity deficits linked to SSD. However, the limited number of and high amount of cross-sectional studies, and high between-studies sample overlap prevent a conclusive determination of the nature and extent of the impact of smoking on brain functioning in patients with SSD. Overall, functional results imply a distinct neurobiological mechanism for tobacco addiction in patients with SSD, possibly attributed to differences at the nicotinic acetylcholine receptor level. CONCLUSIONS Our findings highlight the need for more longitudinal and exposure-dependent studies to differentiate between inherent neurobiological differences and the (long-term) effects of smoking in SSD, and to unravel the complex interaction between smoking and schizophrenia at various disease stages. This could inform more effective strategies addressing smoking susceptibility in SSD, potentially improving clinical outcomes.
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Affiliation(s)
- Merel Koster
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lilli Mannsdörfer
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke van der Pluijm
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tim Ziermans
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jentien Vermeulen
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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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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Sfera A, Imran H, Sfera DO, Anton JJ, Kozlakidis Z, Hazan S. Novel Insights into Psychosis and Antipsychotic Interventions: From Managing Symptoms to Improving Outcomes. Int J Mol Sci 2024; 25:5904. [PMID: 38892092 PMCID: PMC11173215 DOI: 10.3390/ijms25115904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
For the past 70 years, the dopamine hypothesis has been the key working model in schizophrenia. This has contributed to the development of numerous inhibitors of dopaminergic signaling and antipsychotic drugs, which led to rapid symptom resolution but only marginal outcome improvement. Over the past decades, there has been limited research on the quantifiable pathological changes in schizophrenia, including premature cellular/neuronal senescence, brain volume loss, the attenuation of gamma oscillations in electroencephalograms, and the oxidation of lipids in the plasma and mitochondrial membranes. We surmise that the aberrant activation of the aryl hydrocarbon receptor by toxins derived from gut microbes or the environment drives premature cellular and neuronal senescence, a hallmark of schizophrenia. Early brain aging promotes secondary changes, including the impairment and loss of mitochondria, gray matter depletion, decreased gamma oscillations, and a compensatory metabolic shift to lactate and lactylation. The aim of this narrative review is twofold: (1) to summarize what is known about premature cellular/neuronal senescence in schizophrenia or schizophrenia-like disorders, and (2) to discuss novel strategies for improving long-term outcomes in severe mental illness with natural senotherapeutics, membrane lipid replacement, mitochondrial transplantation, microbial phenazines, novel antioxidant phenothiazines, inhibitors of glycogen synthase kinase-3 beta, and aryl hydrocarbon receptor antagonists.
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Affiliation(s)
- Adonis Sfera
- Patton State Hospital, 3102 Highland Ave., Patton, CA 92369, USA; (H.I.)
- University of California Riverside, Riverside 900 University Ave., Riverside, CA 92521, USA
- Loma Linda University, 11139 Anderson St., Loma Linda, CA 92350, USA
| | - Hassan Imran
- Patton State Hospital, 3102 Highland Ave., Patton, CA 92369, USA; (H.I.)
- University of California Riverside, Riverside 900 University Ave., Riverside, CA 92521, USA
- Loma Linda University, 11139 Anderson St., Loma Linda, CA 92350, USA
| | - Dan O. Sfera
- Patton State Hospital, 3102 Highland Ave., Patton, CA 92369, USA; (H.I.)
- University of California Riverside, Riverside 900 University Ave., Riverside, CA 92521, USA
- Loma Linda University, 11139 Anderson St., Loma Linda, CA 92350, USA
| | | | - Zisis Kozlakidis
- International Agency for Research on Cancer, 69372 Lyon, France;
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Faris P, Pischedda D, Palesi F, D’Angelo E. New clues for the role of cerebellum in schizophrenia and the associated cognitive impairment. Front Cell Neurosci 2024; 18:1386583. [PMID: 38799988 PMCID: PMC11116653 DOI: 10.3389/fncel.2024.1386583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Schizophrenia (SZ) is a complex neuropsychiatric disorder associated with severe cognitive dysfunction. Although research has mainly focused on forebrain abnormalities, emerging results support the involvement of the cerebellum in SZ physiopathology, particularly in Cognitive Impairment Associated with SZ (CIAS). Besides its role in motor learning and control, the cerebellum is implicated in cognition and emotion. Recent research suggests that structural and functional changes in the cerebellum are linked to deficits in various cognitive domains including attention, working memory, and decision-making. Moreover, cerebellar dysfunction is related to altered cerebellar circuit activities and connectivity with brain regions associated with cognitive processing. This review delves into the role of the cerebellum in CIAS. We initially consider the major forebrain alterations in CIAS, addressing impairments in neurotransmitter systems, synaptic plasticity, and connectivity. We then focus on recent findings showing that several mechanisms are also altered in the cerebellum and that cerebellar communication with the forebrain is impaired. This evidence implicates the cerebellum as a key component of circuits underpinning CIAS physiopathology. Further studies addressing cerebellar involvement in SZ and CIAS are warranted and might open new perspectives toward understanding the physiopathology and effective treatment of these disorders.
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Affiliation(s)
- Pawan Faris
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Doris Pischedda
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Fulvia Palesi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Egidio D’Angelo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Digital Neuroscience Center, IRCCS Mondino Foundation, Pavia, Italy
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Saglam Y, Ermis C, Takir S, Oz A, Hamid R, Kose H, Bas A, Karacetin G. The Contribution of Explainable Machine Learning Algorithms Using ROI-based Brain Surface Morphology Parameters in Distinguishing Early-onset Schizophrenia From Bipolar Disorder. Acad Radiol 2024:S1076-6332(24)00222-8. [PMID: 38704285 DOI: 10.1016/j.acra.2024.04.013] [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: 12/10/2023] [Revised: 02/25/2024] [Accepted: 04/11/2024] [Indexed: 05/06/2024]
Abstract
RATIONALE AND OBJECTIVES To differentiate early-onset schizophrenia (EOS) from early-onset bipolar disorder (EBD) using surface-based morphometry measurements and brain volumes using machine learning (ML) algorithms. METHOD High-resolution T1-weighted images were obtained to measure cortical thickness (CT), gyrification, gyrification index (GI), sulcal depth (SD), fractal dimension (FD), and brain volumes. After the feature selection step, ML classifiers were applied for each feature set and the combination of them. The SHapley Additive exPlanations (SHAP) technique was implemented to interpret the contribution of each feature. FINDINGS 144 adolescents (16.2 ± 1.4 years, female=39%) with EOS (n = 81) and EBD (n = 63) were included. The Adaptive Boosting (AdaBoost) algorithm had the highest accuracy (82.75%) in the whole dataset that includes all variables from Destrieux atlas. The best-performing algorithms were K-nearest neighbors (KNN) for FD subset, support vector machine (SVM) for SD subset, and AdaBoost for GI subset. The KNN algorithm had the highest accuracy (accuracy=79.31%) in the whole dataset from the Desikan-Killiany-Tourville atlas. CONCLUSION This study demonstrates the use of ML in the differential diagnosis of EOS and EBD using surface-based morphometry measurements. Future studies could focus on multicenter data for the validation of these results.
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Affiliation(s)
- Yesim Saglam
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
| | - Cagatay Ermis
- Queen Silvia Children's Hospital, Department of Child Psychiatry, Gothenburg, Sweden
| | - Seyma Takir
- Department of Artificial Intelligence and Data Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Ahmet Oz
- Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Rauf Hamid
- Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hatice Kose
- Department of Artificial Intelligence and Data Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Ahmet Bas
- Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gul Karacetin
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
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Wu PP, Cao BR, Tian FY, Gao ZB. Development of SV2A Ligands for Epilepsy Treatment: A Review of Levetiracetam, Brivaracetam, and Padsevonil. Neurosci Bull 2024; 40:594-608. [PMID: 37897555 PMCID: PMC11127901 DOI: 10.1007/s12264-023-01138-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/16/2023] [Indexed: 10/30/2023] Open
Abstract
Epilepsy is a common neurological disorder that is primarily treated with antiseizure medications (ASMs). Although dozens of ASMs are available in the clinic, approximately 30% of epileptic patients have medically refractory seizures; other limitations in most traditional ASMs include poor tolerability and drug-drug interactions. Therefore, there is an urgent need to develop alternative ASMs. Levetiracetam (LEV) is a first-line ASM that is well tolerated, has promising efficacy, and has little drug-drug interaction. Although it is widely accepted that LEV acts through a unique therapeutic target synaptic vesicle protein (SV) 2A, the molecular basis of its action remains unknown. Even so, the next-generation SV2A ligands against epilepsy based on the structure of LEV have achieved clinical success. This review highlights the research and development (R&D) process of LEV and its analogs, brivaracetam and padsevonil, to provide ideas and experience for the R&D of novel ASMs.
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Affiliation(s)
- Peng-Peng Wu
- Center for Neurological and Psychiatric Research and Drug Discovery, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Bi-Rong Cao
- Center for Neurological and Psychiatric Research and Drug Discovery, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Fu-Yun Tian
- Center for Neurological and Psychiatric Research and Drug Discovery, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China.
- Zhongshan Institute for Drug Discovery, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Zhongshan, 528400, China.
| | - Zhao-Bing Gao
- Center for Neurological and Psychiatric Research and Drug Discovery, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
- Zhongshan Institute for Drug Discovery, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Zhongshan, 528400, China.
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Garg RK, Kar SK, Malhotra HS, Pandey S, Jain A, Rizvi I, Uniyal R, Kumar N. The spectrum of psychiatric manifestations in subacute sclerosing panencephalitis: A systematic review of published case reports and case series. CNS Spectr 2024; 29:87-95. [PMID: 38282559 DOI: 10.1017/s1092852924000038] [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] [Indexed: 01/30/2024]
Abstract
Data related to psychiatric manifestations in subacute sclerosing panencephalitis (SSPE) is currently available only in the form of isolated case reports. In this systematic review, we evaluated the spectrum of psychiatric manifestations and their impact on the course and outcome of SSPE. Data were obtained from 4 databases (PubMed, Embase, Scopus, and Google Scholar), with the most recent search conducted on March 27, 2023. The PRISMA guidelines were followed, and the PROSPERO registration number for the protocol is CRD42023408227. SSPE was diagnosed using Dyken's criteria. Extracted data were recorded in an Excel spreadsheet. To evaluate the quality of the data, the Joanna Briggs Institute Critical Appraisal tool was employed. Our search resulted in 30 published reports of 32 patients. The mean age was 17.9 years. Schizophrenia, catatonia, and poorly characterized psychotic illnesses were the 3 most common psychiatric presentations that were seen in 63% (20/32) of cases. Catatonia was seen in 4 patients. Affective disorders, mania, and depression were reported among 22% (7/32) cases. In approximately 81% (26/32) cases, the course of SSPE was acute fulminant. Treatment with antipsychotic drugs had poor or no response. Out of 17 patients, who received antipsychotic drugs, 6 patients noted severe extrapyramidal adverse effects. SSPE often masquerades as a psychiatric disorder. Unresponsive psychiatric symptoms, early extrapyramidal signs, and progressive encephalopathy indicate SSPE.
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Affiliation(s)
- Ravindra K Garg
- Department of Neurology, King George's Medical University, Lucknow, India
| | - Sujita K Kar
- Department of Psychiatry, King George's Medical University, Lucknow, India
| | - Hardeep S Malhotra
- Department of Neurology, King George's Medical University, Lucknow, India
| | - Shweta Pandey
- Department of Neurology, King George's Medical University, Lucknow, India
| | - Amita Jain
- Department of Microbiology, King George's Medical University, Lucknow, India
| | - Imran Rizvi
- Department of Neurology, King George's Medical University, Lucknow, India
| | - Ravi Uniyal
- Department of Neurology, King George's Medical University, Lucknow, India
| | - Neeraj Kumar
- Department of Neurology, King George's Medical University, Lucknow, India
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Roeske MJ, McHugo M, Rogers B, Armstrong K, Avery S, Donahue M, Heckers S. Modulation of hippocampal activity in schizophrenia with levetiracetam: a randomized, double-blind, cross-over, placebo-controlled trial. Neuropsychopharmacology 2024; 49:681-689. [PMID: 37833590 PMCID: PMC10876634 DOI: 10.1038/s41386-023-01730-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 10/15/2023]
Abstract
Hippocampal hyperactivity is a novel pharmacological target in the treatment of schizophrenia. We hypothesized that levetiracetam (LEV), a drug binding to the synaptic vesicle glycoprotein 2 A, normalizes hippocampal activity in persons with schizophrenia and can be measured using neuroimaging methods. Thirty healthy control participants and 30 patients with schizophrenia (28 treated with antipsychotic drugs), were randomly assigned to a double-blind, cross-over trial to receive a single administration of 500 mg oral LEV or placebo during two study visits. At each visit, we assessed hippocampal function using resting state fractional amplitude of low frequency fluctuations (fALFF), cerebral blood flow (CBF) with arterial spin labeling, and hippocampal blood-oxygen-level-dependent (BOLD) signal during a scene processing task. After placebo treatment, we found significant elevations in hippocampal fALFF in patients with schizophrenia, consistent with hippocampal hyperactivity. Additionally, hippocampal fALFF in patients with schizophrenia after LEV treatment did not significantly differ from healthy control participants receiving placebo, suggesting that LEV may normalize hippocampal hyperactivity. In contrast to our fALFF findings, we did not detect significant group differences or an effect of LEV treatment on hippocampal CBF. In the context of no significant group difference in BOLD signal, we found that hippocampal recruitment during scene processing is enhanced by LEV more significantly in schizophrenia. We conclude that pharmacological modulation of hippocampal hyperactivity in schizophrenia can be studied with some neuroimaging methods, but not others. Additional studies in different cohorts, employing alternate neuroimaging methods and study designs, are needed to establish levetiracetam as a treatment for schizophrenia.
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Affiliation(s)
- Maxwell J Roeske
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Maureen McHugo
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Baxter Rogers
- Vanderbilt University Institute of Imaging Sciences, Nashville, TN, USA
| | - Kristan Armstrong
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Suzanne Avery
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus Donahue
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephan Heckers
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Greš A, Šagud M, Dickov A. The effect of vortioxetine on anhedonia in patients with schizophrenia. Int J Psychiatry Med 2024; 59:139-152. [PMID: 37647498 DOI: 10.1177/00912174231199925] [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] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Anhedonia is a common symptom of depression, but is also a negative symptom of schizophrenia. The purpose of this study was to examine the effects of vortioxetine on anhedonia in patients with schizophrenia. METHODS A total of 120 patients with schizophrenia in remission who met inclusion criteria were randomized 1:1 by the envelope method into intervention and control groups. All participants in both groups were divided into three subgroups based on the antipsychotic therapy they were receiving (olanzapine, risperidone, or aripiprazole). Vortioxetine was administered to those in the intervention group at a fixed dose of 10 mg per day. The Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), and Chapman Scale for Social and Physical Anhedonia (CSPA) were administered. The study lasted 12 weeks. Participants were assessed twice: At baseline and at the end of the study. Six participants dropped out, with 114 completing the trial. FINDINGS Vortioxetine treatment had a significant effect on level of physical anhedonia. The treatment interaction was also statistically significant, but with a relatively small effect (F = 3.17, P < .05; η2 = .061). Vortioxetine treatment had a particularly strong effect on the level of social anhedonia. The interaction between the treatment and the type of antipsychotics was also statistically significant with a small effect (F = 5.04, P < 0. 01; η2 = .091). CONCLUSION The combination of olanzapine and vortioxetine was found to be the best option to reduce symptoms of social and physical anhedonia in these patients with remitted schizophrenia.
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Affiliation(s)
- Alen Greš
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marina Šagud
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Aleksandra Dickov
- Department of Psychiatry, University Clinical Center of Vojvodina, Novi Sad, Serbia
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O'Reardon AB, Litenski MN, Hernandez M, Niyazov Y, Acosta J, Cruz J. Markedly Delayed Presentation of a Psychotic Disorder 10 Years After the First Onset of Symptoms. Cureus 2024; 16:e57191. [PMID: 38681378 PMCID: PMC11056097 DOI: 10.7759/cureus.57191] [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: 01/30/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Schizophrenia affects 1% of the population, causing chronic debilitating symptoms with largely unknown causes. Structural brain changes and neurochemical alterations are believed to contribute to its etiology. Delayed treatment initiation is a major concern. This case involves a male patient with a decade-long history of psychosis, experiencing isolation, agoraphobia, and paranoid delusions. His situation deteriorated to the point where he lived in a self-imposed physically constraining environment for a year, leading to muscle atrophy and deteriorating health. Delayed help-seeking was driven by insurance concerns, despite prior academic success. Following extensive evaluation, he received the diagnosis of schizophrenia (first episode, severe), requiring multidisciplinary treatment, including medication adjustments and therapy. This case serves as a poignant illustration of a missed opportunity for early intervention, with treatment initiated only after symptoms became severe. Research indicates that early intervention in schizophrenia is crucial, typically leading to improved outcomes, emphasizing its critical importance.
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Affiliation(s)
- Aoife B O'Reardon
- Department of Psychiatry and Behavioral Health, Herbert Wertheim College of Medicine, Miami, USA
| | - Melissa N Litenski
- Department of Psychiatry and Behavioral Health, Herbert Wertheim College of Medicine, Miami, USA
| | | | - Yakov Niyazov
- Psychiatry, Mount Sinai Medical Center, Miami Beach, USA
| | - Jadiyer Acosta
- Psychiatry, Mount Sinai Medical Center, Miami Beach, USA
| | - Jose Cruz
- Psychiatry, Mount Sinai Medical Center, Miami Beach, USA
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13
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Zimmer L. Recent applications of positron emission tomographic (PET) imaging in psychiatric drug discovery. Expert Opin Drug Discov 2024; 19:161-172. [PMID: 37948046 DOI: 10.1080/17460441.2023.2278635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Psychiatry is one of the medical disciplines that suffers most from a lack of innovation in its therapeutic arsenal. Many failures in drug candidate trials can be explained by pharmacological properties that have been poorly assessed upstream, in terms of brain passage, brain target binding and clinical outcomes. Positron emission tomography can provide pharmacokinetic and pharmacodynamic data to help select candidate-molecules for further clinical trials. AREAS COVERED This review aims to explain and discuss the various methods using positron-emitting radiolabeled molecules to trace the cerebral distribution of the drug-candidate or indirectly measure binding to its therapeutic target. More than an exhaustive review of PET studies in psychopharmacology, this article highlights the contributions this technology can make in drug discovery applied to psychiatry. EXPERT OPINION PET neuroimaging is the only technological approach that can, in vivo in humans, measure cerebral delivery of a drug candidate, percentage and duration of target binding, and even the pharmacological effects. PET studies in a small number of subjects in the early stages of the development of a psychotropic drug can therefore provide the pharmacokinetic/pharmacodynamic data required for subsequent clinical evaluation. While PET technology is demanding in terms of radiochemical, radiopharmacological and nuclear medicine expertise, its integration into the development process of new drugs for psychiatry has great added value.
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Affiliation(s)
- Luc Zimmer
- Lyon Neuroscience Research Center, Université Claude Bernard, Lyon, France
- CERMEP, Hospices Civils de Lyon, Lyon, France
- Institut National des Sciences et Technologies Nucléaire, Saclay, France
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14
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Tandon R, Nasrallah H, Akbarian S, Carpenter WT, DeLisi LE, Gaebel W, Green MF, Gur RE, Heckers S, Kane JM, Malaspina D, Meyer-Lindenberg A, Murray R, Owen M, Smoller JW, Yassin W, Keshavan M. The schizophrenia syndrome, circa 2024: What we know and how that informs its nature. Schizophr Res 2024; 264:1-28. [PMID: 38086109 DOI: 10.1016/j.schres.2023.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 03/01/2024]
Abstract
With new data about different aspects of schizophrenia being continually generated, it becomes necessary to periodically revisit exactly what we know. Along with a need to review what we currently know about schizophrenia, there is an equal imperative to evaluate the construct itself. With these objectives, we undertook an iterative, multi-phase process involving fifty international experts in the field, with each step building on learnings from the prior one. This review assembles currently established findings about schizophrenia (construct, etiology, pathophysiology, clinical expression, treatment) and posits what they reveal about its nature. Schizophrenia is a heritable, complex, multi-dimensional syndrome with varying degrees of psychotic, negative, cognitive, mood, and motor manifestations. The illness exhibits a remitting and relapsing course, with varying degrees of recovery among affected individuals with most experiencing significant social and functional impairment. Genetic risk factors likely include thousands of common genetic variants that each have a small impact on an individual's risk and a plethora of rare gene variants that have a larger individual impact on risk. Their biological effects are concentrated in the brain and many of the same variants also increase the risk of other psychiatric disorders such as bipolar disorder, autism, and other neurodevelopmental conditions. Environmental risk factors include but are not limited to urban residence in childhood, migration, older paternal age at birth, cannabis use, childhood trauma, antenatal maternal infection, and perinatal hypoxia. Structural, functional, and neurochemical brain alterations implicate multiple regions and functional circuits. Dopamine D-2 receptor antagonists and partial agonists improve psychotic symptoms and reduce risk of relapse. Certain psychological and psychosocial interventions are beneficial. Early intervention can reduce treatment delay and improve outcomes. Schizophrenia is increasingly considered to be a heterogeneous syndrome and not a singular disease entity. There is no necessary or sufficient etiology, pathology, set of clinical features, or treatment that fully circumscribes this syndrome. A single, common pathophysiological pathway appears unlikely. The boundaries of schizophrenia remain fuzzy, suggesting the absence of a categorical fit and need to reconceptualize it as a broader, multi-dimensional and/or spectrum construct.
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Affiliation(s)
- Rajiv Tandon
- Department of Psychiatry, WMU Homer Stryker School of Medicine, Kalamazoo, MI 49008, United States of America.
| | - Henry Nasrallah
- Department of Psychiatry, University of Cincinnati College of Medicine Cincinnati, OH 45267, United States of America
| | - Schahram Akbarian
- Department of Psychiatry, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, United States of America
| | - William T Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Lynn E DeLisi
- Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA 02139, United States of America
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Dusseldorf, Heinrich-Heine University, Dusseldorf, Germany
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute of Neuroscience and Human Behavior, UCLA, Los Angeles, CA 90024, United States of America; Greater Los Angeles Veterans' Administration Healthcare System, United States of America
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States of America
| | - Stephan Heckers
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN 37232, United States of America
| | - John M Kane
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, NY 11004, United States of America
| | - Dolores Malaspina
- Department of Psychiatry, Neuroscience, Genetics, and Genomics, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, United States of America
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannhein/Heidelberg University, Mannheim, Germany
| | - Robin Murray
- Institute of Psychiatry, Psychology, and Neuroscience, Kings College, London, UK
| | - Michael Owen
- Centre for Neuropsychiatric Genetics and Genomics, and Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Jordan W Smoller
- Center for Precision Psychiatry, Department of Psychiatry, Psychiatric and Neurodevelopmental Unit, Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America
| | - Walid Yassin
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States of America
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States of America
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15
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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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16
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Howes OD, Bukala BR, Beck K. Schizophrenia: from neurochemistry to circuits, symptoms and treatments. Nat Rev Neurol 2024; 20:22-35. [PMID: 38110704 DOI: 10.1038/s41582-023-00904-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/20/2023]
Abstract
Schizophrenia is a leading cause of global disability. Current pharmacotherapy for the disease predominantly uses one mechanism - dopamine D2 receptor blockade - but often shows limited efficacy and poor tolerability. These limitations highlight the need to better understand the aetiology of the disease to aid the development of alternative therapeutic approaches. Here, we review the latest meta-analyses and other findings on the neurobiology of prodromal, first-episode and chronic schizophrenia, and the link to psychotic symptoms, focusing on imaging evidence from people with the disorder. This evidence demonstrates regionally specific neurotransmitter alterations, including higher glutamate and dopamine measures in the basal ganglia, and lower glutamate, dopamine and γ-aminobutyric acid (GABA) levels in cortical regions, particularly the frontal cortex, relative to healthy individuals. We consider how dysfunction in cortico-thalamo-striatal-midbrain circuits might alter brain information processing to underlie psychotic symptoms. Finally, we discuss the implications of these findings for developing new, mechanistically based treatments and precision medicine for psychotic symptoms, as well as negative and cognitive symptoms.
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Affiliation(s)
- Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Faculty of Medicine, Institute of Clinical Sciences, Imperial College London, London, UK.
| | - Bernard R Bukala
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katherine Beck
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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17
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Gangadin SS, Germann M, de Witte LD, Gelderman KA, Mandl RCW, Sommer IEC. Complement component 4A protein levels are negatively related to frontal volumes in patients with schizophrenia spectrum disorders. Schizophr Res 2023; 261:6-14. [PMID: 37678145 DOI: 10.1016/j.schres.2023.08.031] [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: 12/07/2022] [Revised: 05/01/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Excessive C4A-gene expression may result in increased microglia-mediated synaptic pruning. As C4A overexpression is observed in schizophrenia spectrum disorders (SSD), this mechanism may account for the altered brain morphology (i.e. reduced volume and cortical thickness) and cognitive symptoms that characterize SSD. Therefore, this study investigates the association of C4A serum protein levels with brain morphology and cognition, and in particular whether this association differs between recent-onset SSD (n = 69) and HC (n = 40). METHODS Serum C4A protein levels were compared between groups. Main outcomes included total gray matter volume, mean cortical thickness and cognitive performance. Regression analysis on these outcomes included C4A level, group (SSD vs. HC), and C4A*Group interactions. All statistical tests were corrected for age, sex, BMI, and antipsychotic medication dose. Follow-up analyses were performed on separate brain regions and scores on cognitive sub-tasks. RESULTS The group difference in C4A levels was not statistically significant (p = 0.86). The main outcomes did not show a significant interaction effect (p > 0.13) or a C4A main effect (p > 0.27). Follow-up analyses revealed significant interaction effects for the left medial orbitofrontal and left frontal pole volumes (p < 0.001): C4A was negatively related to these volumes in SSD, but positively in HC. CONCLUSION This study demonstrated that C4A was negatively related to - specifically - frontal brain volumes in SSD, but this relation was inverse for HC. The results support the hypothesis of complement-mediated brain volume reduction in SSD. The results also suggest that C4A has a differential association with brain morphology in SSD compared to HC.
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Affiliation(s)
- S S Gangadin
- University of Groningen, Department of Psychiatry, University Medical Center Groningen (UMCG), Groningen, the Netherlands.
| | - M Germann
- University of Groningen, Department of Psychiatry, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - L D de Witte
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - K A Gelderman
- Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - R C W Mandl
- University of Groningen, Department of Psychiatry, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - I E C Sommer
- University of Groningen, Department of Psychiatry, University Medical Center Groningen (UMCG), Groningen, the Netherlands
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18
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Forsyth JK, Bearden CE. Rethinking the First Episode of Schizophrenia: Identifying Convergent Mechanisms During Development and Moving Toward Prediction. Am J Psychiatry 2023; 180:792-804. [PMID: 37908094 DOI: 10.1176/appi.ajp.20230736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Affiliation(s)
- Jennifer K Forsyth
- Department of Psychology, University of Washington, Seattle (Forsyth); Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Behavioral Sciences, and Department of Psychology, University of California, Los Angeles (Bearden)
| | - Carrie E Bearden
- Department of Psychology, University of Washington, Seattle (Forsyth); Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Behavioral Sciences, and Department of Psychology, University of California, Los Angeles (Bearden)
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19
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Tanaka R, Yamada K. Genomic and Reverse Translational Analysis Discloses a Role for Small GTPase RhoA Signaling in the Pathogenesis of Schizophrenia: Rho-Kinase as a Novel Drug Target. Int J Mol Sci 2023; 24:15623. [PMID: 37958606 PMCID: PMC10648424 DOI: 10.3390/ijms242115623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Schizophrenia is one of the most serious psychiatric disorders and is characterized by reductions in both brain volume and spine density in the frontal cortex. RhoA belongs to the RAS homolog (Rho) family and plays critical roles in neuronal development and structural plasticity via Rho-kinase. RhoA activity is regulated by GTPase-activating proteins (GAPs) and guanine nucleotide exchange factors (GEFs). Several variants in GAPs and GEFs associated with RhoA have been reported to be significantly associated with schizophrenia. Moreover, several mouse models carrying schizophrenia-associated gene variants involved in RhoA/Rho-kinase signaling have been developed. In this review, we summarize clinical evidence showing that variants in genes regulating RhoA activity are associated with schizophrenia. In the last half of the review, we discuss preclinical evidence indicating that RhoA/Rho-kinase is a potential therapeutic target of schizophrenia. In particular, Rho-kinase inhibitors exhibit anti-psychotic-like effects not only in Arhgap10 S490P/NHEJ mice, but also in pharmacologic models of schizophrenia (methamphetamine- and MK-801-treated mice). Accordingly, we propose that Rho-kinase inhibitors may have antipsychotic effects and reduce cognitive deficits in schizophrenia despite the presence or absence of genetic variants in small GTPase signaling pathways.
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Affiliation(s)
- Rinako Tanaka
- Department of Neuropsychopharmacology and Hospital Pharmacy, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan;
| | - Kiyofumi Yamada
- Department of Neuropsychopharmacology and Hospital Pharmacy, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan;
- International Center for Brain Science (ICBS), Fujita Health University, Toyoake 470-1192, Japan
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20
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Jiang Y, Luo C, Wang J, Palaniyappan L, Chang X, Xiang S, Zhang J, Duan M, Huang H, Gaser C, Nemoto K, Miura K, Hashimoto R, Westlye LT, Richard G, Fernandez-Cabello S, Parker N, Andreassen OA, Kircher T, Nenadić I, Stein F, Thomas-Odenthal F, Teutenberg L, Usemann P, Dannlowski U, Hahn T, Grotegerd D, Meinert S, Lencer R, Tang Y, Zhang T, Li C, Yue W, Zhang Y, Yu X, Zhou E, Lin CP, Tsai SJ, Rodrigue AL, Glahn D, Pearlson G, Blangero J, Karuk A, Pomarol-Clotet E, Salvador R, Fuentes-Claramonte P, Garcia-León MÁ, Spalletta G, Piras F, Vecchio D, Banaj N, Cheng J, Liu Z, Yang J, Gonul AS, Uslu O, Burhanoglu BB, Demir AU, Rootes-Murdy K, Calhoun VD, Sim K, Green M, Quidé Y, Chung YC, Kim WS, Sponheim SR, Demro C, Ramsay IS, Iasevoli F, de Bartolomeis A, Barone A, Ciccarelli M, Brunetti A, Cocozza S, Pontillo G, Tranfa M, Park MTM, Kirschner M, Georgiadis F, Kaiser S, Rheenen TEV, Rossell SL, Hughes M, Woods W, Carruthers SP, Sumner P, Ringin E, Spaniel F, Skoch A, Tomecek D, Homan P, Homan S, Omlor W, Cecere G, Nguyen DD, Preda A, Thomopoulos S, Jahanshad N, Cui LB, Yao D, Thompson PM, Turner JA, van Erp TG, Cheng W, Feng J. Two neurostructural subtypes: results of machine learning on brain images from 4,291 individuals with schizophrenia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.11.23296862. [PMID: 37873296 PMCID: PMC10593004 DOI: 10.1101/2023.10.11.23296862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Machine learning can be used to define subtypes of psychiatric conditions based on shared clinical and biological foundations, presenting a crucial step toward establishing biologically based subtypes of mental disorders. With the goal of identifying subtypes of disease progression in schizophrenia, here we analyzed cross-sectional brain structural magnetic resonance imaging (MRI) data from 4,291 individuals with schizophrenia (1,709 females, age=32.5 years±11.9) and 7,078 healthy controls (3,461 females, age=33.0 years±12.7) pooled across 41 international cohorts from the ENIGMA Schizophrenia Working Group, non-ENIGMA cohorts and public datasets. Using a machine learning approach known as Subtype and Stage Inference (SuStaIn), we implemented a brain imaging-driven classification that identifies two distinct neurostructural subgroups by mapping the spatial and temporal trajectory of gray matter (GM) loss in schizophrenia. Subgroup 1 (n=2,622) was characterized by an early cortical-predominant loss (ECL) with enlarged striatum, whereas subgroup 2 (n=1,600) displayed an early subcortical-predominant loss (ESL) in the hippocampus, amygdala, thalamus, brain stem and striatum. These reconstructed trajectories suggest that the GM volume reduction originates in the Broca's area/adjacent fronto-insular cortex for ECL and in the hippocampus/adjacent medial temporal structures for ESL. With longer disease duration, the ECL subtype exhibited a gradual worsening of negative symptoms and depression/anxiety, and less of a decline in positive symptoms. We confirmed the reproducibility of these imaging-based subtypes across various sample sites, independent of macroeconomic and ethnic factors that differed across these geographic locations, which include Europe, North America and East Asia. These findings underscore the presence of distinct pathobiological foundations underlying schizophrenia. This new imaging-based taxonomy holds the potential to identify a more homogeneous sub-population of individuals with shared neurobiological attributes, thereby suggesting the viability of redefining existing disorder constructs based on biological factors.
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Affiliation(s)
- Yuchao Jiang
- Institute of Science and Technology for Brain Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of life Science and technology, University of Electronic Science and Technology of China, Chengdu, China
- High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Research Unit of NeuroInformation (2019RU035), Chinese Academy of Medical Sciences, Chengdu, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lena Palaniyappan
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Canada
| | - Xiao Chang
- Institute of Science and Technology for Brain Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
| | - Shitong Xiang
- Institute of Science and Technology for Brain Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
| | - Jie Zhang
- Institute of Science and Technology for Brain Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
| | - Mingjun Duan
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of life Science and technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Huan Huang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of life Science and technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Christian Gaser
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Germany
| | - Kiyotaka Nemoto
- Department of Psychiatry, Division of Clinical Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, 305-8575, Japan
| | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, 187-8553, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, 187-8553, Japan
| | - Lars T. Westlye
- Department of Psychology, University of Oslo, Oslo, Norway
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Genevieve Richard
- Department of Psychology, University of Oslo, Oslo, Norway
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Sara Fernandez-Cabello
- Department of Psychology, University of Oslo, Oslo, Norway
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Nadine Parker
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole A. Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps Universität Marburg, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, Philipps Universität Marburg, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, Philipps Universität Marburg, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany
| | - Florian Thomas-Odenthal
- Department of Psychiatry and Psychotherapy, Philipps Universität Marburg, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany
| | - Lea Teutenberg
- Department of Psychiatry and Psychotherapy, Philipps Universität Marburg, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany
| | - Paula Usemann
- Department of Psychiatry and Psychotherapy, Philipps Universität Marburg, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tim Hahn
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Susanne Meinert
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Rebekka Lencer
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry and Psychotherapie and Center for Brain, Behavior and Metabolism, Lübeck University, Lübeck, Germany
- Institute for Transnational Psychiatry and Otto Creutzfeldt Center for Behavioral and Cognitive Neuroscience, University of Münster, Münster, Germany
| | - Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianhong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weihua Yue
- 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, PR China
- Chinese Institute for Brain Research, Beijing, PR China
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, PR China
| | - Yuyanan Zhang
- 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, PR 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, PR China
| | - Enpeng Zhou
- 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, PR China
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Amanda L. Rodrigue
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston MA, USA
| | - David Glahn
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston MA, USA
| | - Godfrey Pearlson
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT, USA
| | - John Blangero
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas of the Rio Grande Valley, Brownsville, TX, USA
| | - Andriana Karuk
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona 08035, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona 08035, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Spain
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona 08035, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Spain
| | - Paola Fuentes-Claramonte
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona 08035, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Spain
| | - María Ángeles Garcia-León
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona 08035, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Spain
| | - Gianfranco Spalletta
- Neuropsychiatry Laboratory, Department of Clinical Neuroscience and Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Fabrizio Piras
- Neuropsychiatry Laboratory, Department of Clinical Neuroscience and Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Daniela Vecchio
- Neuropsychiatry Laboratory, Department of Clinical Neuroscience and Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Nerisa Banaj
- Neuropsychiatry Laboratory, Department of Clinical Neuroscience and Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhening Liu
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China
| | - Jie Yang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan, PR China
| | - Ali Saffet Gonul
- Ege University School of Medicine Department of Psychiatry, SoCAT Lab, Izmir, Turkey
| | - Ozgul Uslu
- Ege University Institute of Health Sciences Department of Neuroscience, Izmir, Turkey
| | | | - Aslihan Uyar Demir
- Ege University School of Medicine Department of Psychiatry, SoCAT Lab, Izmir, Turkey
| | - Kelly Rootes-Murdy
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS) [Georgia State University, Georgia Institute of Technology, Emory University], Atlanta, GA, USA
| | - Vince D. Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS) [Georgia State University, Georgia Institute of Technology, Emory University], Atlanta, GA, USA
| | - Kang Sim
- West Region, Institute of Mental Health, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Melissa Green
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Yann Quidé
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Young Chul Chung
- Department of Psychiatry, Jeonbuk National University Hospital, Jeonju, Korea
- Department of Psychiatry, Jeonbuk National University, Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Woo-Sung Kim
- Department of Psychiatry, Jeonbuk National University Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Scott R. Sponheim
- Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Caroline Demro
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Ian S. Ramsay
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Felice Iasevoli
- Section of Psychiatry - Department of Neuroscience - University “Federico II”, Naples, Italy
| | - Andrea de Bartolomeis
- Section of Psychiatry - Department of Neuroscience - University “Federico II”, Naples, Italy
| | - Annarita Barone
- Section of Psychiatry - Department of Neuroscience - University “Federico II”, Naples, Italy
| | - Mariateresa Ciccarelli
- Section of Psychiatry - Department of Neuroscience - University “Federico II”, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences - University “Federico II”, Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences - University “Federico II”, Naples, Italy
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences - University “Federico II”, Naples, Italy
| | - Mario Tranfa
- Department of Advanced Biomedical Sciences - University “Federico II”, Naples, Italy
| | - Min Tae M. Park
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Matthias Kirschner
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital University of Zurich, Switzerland
| | - Foivos Georgiadis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital University of Zurich, Switzerland
| | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Switzerland
| | - Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Centre for Mental Health and Brain Sciences, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health and Brain Sciences, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Matthew Hughes
- Centre for Mental Health and Brain Sciences, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - William Woods
- Centre for Mental Health and Brain Sciences, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Sean P Carruthers
- Centre for Mental Health and Brain Sciences, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Philip Sumner
- Centre for Mental Health and Brain Sciences, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Elysha Ringin
- National Institute of Mental Health, Klecany, Czech Republic
| | - Filip Spaniel
- National Institute of Mental Health, Klecany, Czech Republic
| | - Antonin Skoch
- National Institute of Mental Health, Klecany, Czech Republic
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - David Tomecek
- National Institute of Mental Health, Klecany, Czech Republic
- Institute of Computer Science, Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Philipp Homan
- Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich & Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Stephanie Homan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Switzerland
- Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Switzerland
| | - Wolfgang Omlor
- Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Giacomo Cecere
- Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Dana D Nguyen
- Department of Pediatrics, University of California Irvine, Irvine, California, USA
| | - Adrian Preda
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, California, USA
| | - Sophia Thomopoulos
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Long-Biao Cui
- Department of Clinical Psychology, Fourth Military Medical University, Xi’an, PR China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of life Science and technology, University of Electronic Science and Technology of China, Chengdu, China
- High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Research Unit of NeuroInformation (2019RU035), Chinese Academy of Medical Sciences, Chengdu, China
| | - Paul M. Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jessica A. Turner
- Psychiatry and Behavioral Health, Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Theo G.M. van Erp
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human Behavior, University of California Irvine, Irvine Hall, room 109, Irvine, CA, 92697-3950, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, 309 Qureshey Research Lab, Irvine, CA, 92697, USA
| | - Wei Cheng
- Institute of Science and Technology for Brain Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- Shanghai Medical College and Zhongshan Hospital Immunotherapy Technology Transfer Center, Shanghai, China
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- Fudan ISTBI—ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua, China
| | | | | | - Jianfeng Feng
- Institute of Science and Technology for Brain Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- Fudan ISTBI—ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- Zhangjiang Fudan International Innovation Center, Shanghai, China
- School of Data Science, Fudan University, Shanghai, China
- Department of Computer Science, University of Warwick, Coventry CV4 7AL, UK
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21
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Sawada K, Kamiya S, Kobayashi T. Neonatal Exposure to Lipopolysaccharide Promotes Neurogenesis of Subventricular Zone Progenitors in the Developing Neocortex of Ferrets. Int J Mol Sci 2023; 24:14962. [PMID: 37834410 PMCID: PMC10573966 DOI: 10.3390/ijms241914962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Lipopolysaccharide (LPS) is a natural agonist of toll-like receptor 4 that serves a role in innate immunity. The current study evaluated the LPS-mediated regulation of neurogenesis in the subventricular zone (SVZ) progenitors, that is, the basal radial glia and intermediate progenitors (IPs), in ferrets. Ferret pups were subcutaneously injected with LPS (500 μg/g of body weight) on postnatal days (PDs) 6 and 7. Furthermore, 5-ethynyl-2'-deoxyuridine (EdU) and 5-bromo-2'-deoxyuridine (BrdU) were administered on PDs 5 and 7, respectively, to label the post-proliferative and proliferating cells in the inner SVZ (iSVZ) and outer SVZ (oSVZ). A significantly higher density of BrdU single-labeled proliferating cells was observed in the iSVZ of LPS-exposed ferrets than in controls but not in post-proliferative EdU single-labeled and EdU/BrdU double-labeled self-renewing cells. BrdU single-labeled cells exhibited a lower proportion of Tbr2 immunostaining in LPS-exposed ferrets (22.2%) than in controls (42.6%) and a higher proportion of Ctip2 immunostaining in LPS-exposed ferrets (22.2%) than in controls (8.6%). The present findings revealed that LPS modified the neurogenesis of SVZ progenitors. Neonatal LPS exposure facilitates the proliferation of SVZ progenitors, followed by the differentiation of Tbr2-expressing IPs into Ctip2-expressing immature neurons.
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Affiliation(s)
- Kazuhiko Sawada
- Department of Nutrition, Faculty of Medical and Health Sciences, Tsukuba International University, Tsuchiura 300-0051, Japan
| | - Shiori Kamiya
- Department of Regulation Biology, Faculty of Science, Saitama University, Saitama 338-8570, Japan; (S.K.); (T.K.)
| | - Tetsuya Kobayashi
- Department of Regulation Biology, Faculty of Science, Saitama University, Saitama 338-8570, Japan; (S.K.); (T.K.)
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22
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Yao Y, Jin C, Liao Y, Huang X, Wei Z, Zhang Y, Li D, Su H, Han W, Qin D. Schizophrenia-Like Behaviors Arising from Dysregulated Proline Metabolism Are Associated with Altered Neuronal Morphology and Function in Mice with Hippocampal PRODH Deficiency. Aging Dis 2023:AD.2023.0902. [PMID: 37815900 DOI: 10.14336/ad.2023.0902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/02/2023] [Indexed: 10/12/2023] Open
Abstract
Despite decades of research being conducted to understand what physiological deficits in the brain are an underlying basis of psychiatric diseases like schizophrenia, it has remained difficult to establish a direct causal relationship between neuronal dysfunction and specific behavioral phenotypes. Moreover, it remains unclear how metabolic processes, including amino acid metabolism, affect neuronal function and consequently modulate animal behaviors. PRODH, which catalyzes the first step of proline degradation, has been reported as a susceptibility gene for schizophrenia. It has consistently been shown that PRODH knockout mice exhibit schizophrenia-like behaviors. However, whether the loss of PRODH directly impacts neuronal function or whether such neuronal deficits are linked to schizophrenia-like behaviors has not yet been examined. Herein, we first ascertained that dysregulated proline metabolism in humans is associated with schizophrenia. We then found that PRODH was highly expressed in the oreins layer of the mouse dorsal hippocampus. By using AAV- mediated shRNA, we depleted PRODH expression in the mouse dorsal hippocampus and subsequently observed hyperactivity and impairments in the social behaviors, learning, and memory of these mice. Furthermore, the loss of PRODH led to altered neuronal morphology and function both in vivo and in vitro. Our study demonstrates that schizophrenia-like behaviors may arise from dysregulated proline metabolism due to the loss of PRODH and are associated with altered neuronal morphology and function in mice.
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Affiliation(s)
- Yuxiao Yao
- Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou 510799, China
| | - Chenchen Jin
- Bioland Laboratory, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Yilie Liao
- Bioland Laboratory, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Xiang Huang
- Bioland Laboratory, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Ziying Wei
- Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou 510799, China
| | - Yahong Zhang
- Guangzhou Laboratory, Guangzhou, Guangdong, China
| | - Dongwei Li
- Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou 510799, China
| | - Huanxing Su
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
| | - Weiping Han
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Dajiang Qin
- Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou 510799, China
- Bioland Laboratory, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
- Centre for Regenerative Medicine and Health, Hong Kong Institute of Science & Innovation, Chinese Academy of Sciences; Hong Kong SAR, China
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23
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Persson K, Leonardsen EH, Edwin TH, Knapskog AB, Tangen GG, Selbæk G, Wolfers T, Westlye LT, Engedal K. Diagnostic accuracy of brain age prediction in a memory clinic population and comparison with clinically available volumetric measures. Sci Rep 2023; 13:14957. [PMID: 37696909 PMCID: PMC10495330 DOI: 10.1038/s41598-023-42354-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023] Open
Abstract
The aim of this study was to assess the diagnostic validity of a deep learning-based method estimating brain age based on magnetic resonance imaging (MRI) and to compare it with volumetrics obtained using NeuroQuant (NQ) in a clinical cohort. Brain age prediction was performed on minimally processed MRI data using deep convolutional neural networks and an independent training set. The brain age gap (difference between chronological and biological age) was calculated, and volumetrics were performed in 110 patients with dementia (Alzheimer's disease, frontotemporal dementia (FTD), and dementia with Lewy bodies), and 122 with non-dementia (subjective and mild cognitive impairment). Area-under-the-curve (AUC) based on receiver operating characteristics and logistic regression analyses were performed. The mean age was 67.1 (9.5) years and 48.7% (113) were females. The dementia versus non-dementia sensitivity and specificity of the volumetric measures exceeded 80% and yielded higher AUCs compared to BAG. The explained variance of the prediction of diagnostic stage increased when BAG was added to the volumetrics. Further, BAG separated patients with FTD from other dementia etiologies with > 80% sensitivity and specificity. NQ volumetrics outperformed BAG in terms of diagnostic discriminatory power but the two methods provided complementary information, and BAG discriminated FTD from other dementia etiologies.
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Affiliation(s)
- Karin Persson
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
| | - Esten H Leonardsen
- Department of Psychology, University of Oslo, Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trine Holt Edwin
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Gro Gujord Tangen
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Geir Selbæk
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Thomas Wolfers
- Department of Psychology, University of Oslo, Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany
| | - Lars T Westlye
- Department of Psychology, University of Oslo, Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Knut Engedal
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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24
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Emsley R. Antipsychotics and structural brain changes: could treatment adherence explain the discrepant findings? Ther Adv Psychopharmacol 2023; 13:20451253231195258. [PMID: 37701891 PMCID: PMC10493054 DOI: 10.1177/20451253231195258] [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: 03/15/2023] [Accepted: 07/11/2023] [Indexed: 09/14/2023] Open
Abstract
Progressive structural brain changes are well documented in schizophrenia and have been linked to both illness progression and the extent of antipsychotic treatment exposure. Literature reporting longitudinal changes in brain structure in individuals with schizophrenia is selectively reviewed to assess the roles of illness, antipsychotic treatment, adherence and other factors in the genesis of these changes. This narrative review considers literature investigating longitudinal changes in brain structure in individuals with schizophrenia. The review focusses on structural changes in the cortex, basal ganglia and white matter. It also examines effects of medication non-adherence and relapse on the clinical course of the illness and on structural brain changes. Studies investigating structural magnetic resonance imaging changes in patients treated with long-acting injectable antipsychotics are reviewed. Temporal changes in brain structure in schizophrenia can be divided into those that are associated with antipsychotic treatment and those that are not. Changes associated with treatment include increases in basal ganglia and white matter volumes. Relapse episodes may be a critical factor in illness progression and brain volume reductions. Medication adherence may be an important factor that could explain the findings that brain volume reductions are associated with poor treatment response, higher intensity of antipsychotic treatment exposure and more time spent in relapse. Improved adherence via long-acting injectable antipsychotics and adherence focussed psychosocial interventions could maximize protective effects of antipsychotics against illness progression.
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Affiliation(s)
- Robin Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Tygerberg Campus, Cape Town 8000, South Africa
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25
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Wang C, Zhang Y, Lim LG, Cao W, Zhang W, Wan X, Fan L, Liu Y, Zhang X, Tian Z, Liu X, Pan X, Zheng Y, Pan R, Tan Y, Zhang Z, McIntyre RS, Li Z, Ho RCM, Tang TB. An fNIRS investigation of novel expressed emotion stimulations in schizophrenia. Sci Rep 2023; 13:11141. [PMID: 37429942 DOI: 10.1038/s41598-023-38057-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 07/02/2023] [Indexed: 07/12/2023] Open
Abstract
Living in high expressed emotion (EE) environments tends to increase the relapse rate in schizophrenia (SZ). At present, the neural substrates responsible for high EE in SZ remain poorly understood. Functional near-infrared spectroscopy (fNIRS) may be of great use to quantitatively assess cortical hemodynamics and elucidate the pathophysiology of psychiatric disorders. In this study, we designed novel low- (positivity and warmth) and high-EE (criticism, negative emotion, and hostility) stimulations, in the form of audio, to investigate cortical hemodynamics. We used fNIRS to measure hemodynamic signals while participants listened to the recorded audio. Healthy controls (HCs, [Formula: see text]) showed increased hemodynamic activation in the major language centers across EE stimulations, with stronger activation in Wernicke's area during the processing of negative emotional language. Compared to HCs, people with SZ ([Formula: see text]) exhibited smaller hemodynamic activation in the major language centers across EE stimulations. In addition, people with SZ showed weaker or insignificant hemodynamic deactivation in the medial prefrontal cortex. Notably, hemodynamic activation in SZ was found to be negatively correlated with the negative syndrome scale score at high EE. Our findings suggest that the neural mechanisms in SZ are altered and disrupted, especially during negative emotional language processing. This supports the feasibility of using the designed EE stimulations to assess people who are vulnerable to high-EE environments, such as SZ. Furthermore, our findings provide preliminary evidence for future research on functional neuroimaging biomarkers for people with psychiatric disorders.
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Affiliation(s)
| | | | - Lam Ghai Lim
- Department of Electrical and Robotics Engineering, School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia.
| | - Weiqi Cao
- Huaibei Normal University, Huaibei, China
| | - Wei Zhang
- Huaibei Mental Health Center, Huaibei, China
| | | | - Lijun Fan
- Huaibei Normal University, Huaibei, China
| | - Ying Liu
- Huaibei Normal University, Huaibei, China
| | - Xi Zhang
- Huaibei Mental Health Center, Huaibei, China
| | | | | | - Xiuzhi Pan
- Huaibei Normal University, Huaibei, China
| | - Yuan Zheng
- Huaibei Normal University, Huaibei, China
| | - Riyu Pan
- Anqing Normal University, Anqing, China
| | - Yilin Tan
- Huaibei Normal University, Huaibei, China
| | | | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Zhifei Li
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 117599, Singapore
| | - Roger C M Ho
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 117599, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Tong Boon Tang
- Centre for Intelligent Signal and Imaging Research (CISIR), Universiti Teknologi PETRONAS, 32610, Seri Iskandar, Perak, Malaysia
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Fernqvist A, Alexiou E, Zetterberg H, Howner K, Nilsson T, Andiné P. Plasma neurofilament light chain protein is not increased in forensic psychiatric populations: a pilot study. Front Psychiatry 2023; 14:1176266. [PMID: 37215673 PMCID: PMC10192562 DOI: 10.3389/fpsyt.2023.1176266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/12/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Neurofilament light chain protein (NfL) is a fluid biomarker of neural injury measurable in cerebrospinal fluid and blood. Patients with different neurodegenerative disorders and mild traumatic brain injury display elevated levels of NfL. However, so far, elevated levels of NfL have not been demonstrated in persons with psychiatric disorders. To our knowledge, the occurrence of NfL in the blood has not previously been studied in persons undergoing forensic psychiatric assessment or persons treated in forensic mental health services. Supposedly, these persons suffer from experiences and conditions with a higher risk of neural injury than other psychiatric patients. Methods In this pilot study, we investigated plasma levels of NfL in 20 persons undergoing forensic psychiatric assessment and 20 patients at a forensic psychiatric hospital. NfL values were compared with control groups of healthy individuals matched for age and sex. Results The prevalence of increased NfL in both forensic groups was low and did not differ compared with the controls. However, some persons undergoing forensic psychiatric assessment showed slightly elevated values. Discussion The slightly elevated values were observed in the group investigated closer in time to the index crime, when elevated NfL levels could be expected to be more prevalent due to acute conditions from the time of the offense. This gives reason to look further into this group.
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Affiliation(s)
- Anja Fernqvist
- Center for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden
| | - Eirini Alexiou
- Center for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom
- UK Dementia Research Institute, University College London, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, Hong Kong SAR, China
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Katarina Howner
- Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Nilsson
- Center for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Andiné
- Center for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
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Howes OD, Onwordi EC. The synaptic hypothesis of schizophrenia version III: a master mechanism. Mol Psychiatry 2023; 28:1843-1856. [PMID: 37041418 PMCID: PMC10575788 DOI: 10.1038/s41380-023-02043-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 04/13/2023]
Abstract
The synaptic hypothesis of schizophrenia has been highly influential. However, new approaches mean there has been a step-change in the evidence available, and some tenets of earlier versions are not supported by recent findings. Here, we review normal synaptic development and evidence from structural and functional imaging and post-mortem studies that this is abnormal in people at risk and with schizophrenia. We then consider the mechanism that could underlie synaptic changes and update the hypothesis. Genome-wide association studies have identified a number of schizophrenia risk variants converging on pathways regulating synaptic elimination, formation and plasticity, including complement factors and microglial-mediated synaptic pruning. Induced pluripotent stem cell studies have demonstrated that patient-derived neurons show pre- and post-synaptic deficits, synaptic signalling alterations, and elevated, complement-dependent elimination of synaptic structures compared to control-derived lines. Preclinical data show that environmental risk factors linked to schizophrenia, such as stress and immune activation, can lead to synapse loss. Longitudinal MRI studies in patients, including in the prodrome, show divergent trajectories in grey matter volume and cortical thickness compared to controls, and PET imaging shows in vivo evidence for lower synaptic density in patients with schizophrenia. Based on this evidence, we propose version III of the synaptic hypothesis. This is a multi-hit model, whereby genetic and/or environmental risk factors render synapses vulnerable to excessive glia-mediated elimination triggered by stress during later neurodevelopment. We propose the loss of synapses disrupts pyramidal neuron function in the cortex to contribute to negative and cognitive symptoms and disinhibits projections to mesostriatal regions to contribute to dopamine overactivity and psychosis. It accounts for the typical onset of schizophrenia in adolescence/early adulthood, its major risk factors, and symptoms, and identifies potential synaptic, microglial and immune targets for treatment.
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Affiliation(s)
- Oliver D Howes
- Faculty of Medicine, Institute of Clinical Sciences (ICS), Imperial College London, London, W12 0NN, UK.
- Psychiatric Imaging Group, Medical Research Council, London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK.
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
| | - Ellis Chika Onwordi
- Faculty of Medicine, Institute of Clinical Sciences (ICS), Imperial College London, London, W12 0NN, UK.
- Psychiatric Imaging Group, Medical Research Council, London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK.
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, E1 2AB, UK.
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Markiewicz-Gospodarek A, Markiewicz R, Borowski B, Dobrowolska B, Łoza B. Self-Regulatory Neuronal Mechanisms and Long-Term Challenges in Schizophrenia Treatment. Brain Sci 2023; 13:brainsci13040651. [PMID: 37190616 DOI: 10.3390/brainsci13040651] [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: 03/30/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Schizophrenia is a chronic and relapsing disorder that is characterized not only by delusions and hallucinations but also mainly by the progressive development of cognitive and social deficits. These deficits are related to impaired synaptic plasticity and impaired neurotransmission in the nervous system. Currently, technological innovations and medical advances make it possible to use various self-regulatory methods to improve impaired synaptic plasticity. To evaluate the therapeutic effect of various rehabilitation methods, we reviewed methods that modify synaptic plasticity and improve the cognitive and executive processes of patients with a diagnosis of schizophrenia. PubMed, Scopus, and Google Scholar bibliographic databases were searched with the keywords mentioned below. A total of 555 records were identified. Modern methods of schizophrenia therapy with neuroplastic potential, including neurofeedback, transcranial magnetic stimulation, transcranial direct current stimulation, vagus nerve stimulation, virtual reality therapy, and cognitive remediation therapy, were reviewed and analyzed. Since randomized controlled studies of long-term schizophrenia treatment do not exceed 2-3 years, and the pharmacological treatment itself has an incompletely estimated benefit-risk ratio, treatment methods based on other paradigms, including neuronal self-regulatory and neural plasticity mechanisms, should be considered. Methods available for monitoring neuroplastic effects in vivo (e.g., fMRI, neuropeptides in serum), as well as unfavorable parameters (e.g., features of the metabolic syndrome), enable individualized monitoring of the effectiveness of long-term treatment of schizophrenia.
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Affiliation(s)
| | - Renata Markiewicz
- Department of Neurology, Neurological and Psychiatric Nursing, Medical University of Lublin, 20-093 Lublin, Poland
| | - Bartosz Borowski
- Students Scientific Association at the Department of Human Anatomy, Medical University of Lublin, 20-090 Lublin, Poland
| | - Beata Dobrowolska
- Department of Holistic Care and Management in Nursing, Medical University of Lublin, 20-081 Lublin, Poland
| | - Bartosz Łoza
- Department of Psychiatry, Medical University of Warsaw, 02-091 Warsaw, Poland
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Progressive brain abnormalities in schizophrenia across different illness periods: a structural and functional MRI study. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:2. [PMID: 36604437 PMCID: PMC9816110 DOI: 10.1038/s41537-022-00328-7] [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: 03/03/2022] [Accepted: 11/16/2022] [Indexed: 01/07/2023]
Abstract
Schizophrenia is a chronic brain disorder, and neuroimaging abnormalities have been reported in different stages of the illness for decades. However, when and how these brain abnormalities occur and evolve remains undetermined. We hypothesized structural and functional brain abnormalities progress throughout the illness course at different rates in schizophrenia. A total of 115 patients with schizophrenia were recruited and stratified into three groups of different illness periods: 5-year group (illness duration: ≤5 years), 15-year group (illness duration: 12-18 years), and 25-year group (illness duration: ≥25 years); 230 healthy controls were matched by age and sex to the three groups, respectively. All participants underwent resting-state MRI scanning. Each group of patients with schizophrenia was compared with the corresponding controls in terms of voxel-based morphometry (VBM), fractional anisotropy (FA), global functional connectivity density (gFCD), and sample entropy (SampEn) abnormalities. In the 5-year group we observed only SampEn abnormalities in the putamen. In the 15-year group, we observed VBM abnormalities in the insula and cingulate gyrus and gFCD abnormalities in the temporal cortex. In the 25-year group, we observed FA abnormalities in nearly all white matter tracts, and additional VBM and gFCD abnormalities in the frontal cortex and cerebellum. By using two structural and two functional MRI analysis methods, we demonstrated that individual functional abnormalities occur in limited brain areas initially, functional connectivity and gray matter density abnormalities ensue later in wider brain areas, and structural connectivity abnormalities involving almost all white matter tracts emerge in the third decade of the course in schizophrenia.
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