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Black T, Jenkins BW, Laprairie RB, Howland JG. Therapeutic potential of gamma entrainment using sensory stimulation for cognitive symptoms associated with schizophrenia. Neurosci Biobehav Rev 2024; 161:105681. [PMID: 38641090 DOI: 10.1016/j.neubiorev.2024.105681] [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: 01/25/2024] [Revised: 03/27/2024] [Accepted: 04/16/2024] [Indexed: 04/21/2024]
Abstract
Schizophrenia is a complex neuropsychiatric disorder with significant morbidity. Treatment options that address the spectrum of symptoms are limited, highlighting the need for innovative therapeutic approaches. Gamma Entrainment Using Sensory Stimulation (GENUS) is an emerging treatment for neuropsychiatric disorders that uses sensory stimulation to entrain impaired oscillatory network activity and restore brain function. Aberrant oscillatory activity often underlies the symptoms experienced by patients with schizophrenia. We propose that GENUS has therapeutic potential for schizophrenia. This paper reviews the current status of schizophrenia treatment and explores the use of sensory stimulation as an adjunctive treatment, specifically through gamma entrainment. Impaired gamma frequency entrainment is observed in patients, particularly in response to auditory and visual stimuli. Thus, sensory stimulation, such as music listening, may have therapeutic potential for individuals with schizophrenia. GENUS holds novel therapeutic potential to improve the lives of individuals with schizophrenia, but further research is required to determine the efficacy of GENUS, optimize its delivery and therapeutic window, and develop strategies for its implementation in specific patient populations.
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Affiliation(s)
- Tallan Black
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Bryan W Jenkins
- Division of Behavioral Biology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Robert B Laprairie
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada; Department of Pharmacology, College of Medicine, Dalhousie University, Halifax, NS, Canada
| | - John G Howland
- Department of Anatomy, Physiology, and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Wang J, Cheng G, Li H, Yang W. Effects of cognitive training and behavior modification on aggressive behavior and sleep quality in schizophrenia. Front Psychiatry 2024; 15:1363547. [PMID: 38779544 PMCID: PMC11109749 DOI: 10.3389/fpsyt.2024.1363547] [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: 12/30/2023] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
Background Schizophrenia (SCZ) is linked to a heightened risk of impulsive aggression and disturbances in sleep patterns. Cognitive and social cognitive impairments have been connected to aggression, with social cognitive deficits appearing to play a more immediate role. In this investigation, we conducted a retrospective analysis of the impact of cognitive training and sleep interventions on aggressive behavior and the quality of sleep among individuals with SCZ who were hospitalized. Methods This study divided 80 hospitalized patients into two groups according to medical advice, namely the normal group and the study group. The control group received routine drug treatment and education; The research group implemented cognitive training and sleep intervention based on the normal group. Collect basic clinical data, aggressive behavior indicators, and sleep quality indicators. Results There is no difference in the basic information statistics between the two groups. Both groups can reduce aggressive behavior and improve sleep quality. In the study group, there was a notable decrease in aggressive behavior compared to the control group. Furthermore, the sleep quality in the study group exhibited significant improvement when compared to the control group. Conclusion Cognitive training and sleep intervention have been proven to be effective nonpharmacological treatments, effectively reducing aggressive behavior and improving sleep quality.
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Affiliation(s)
- Jing Wang
- Department of Early Intervention, Wuhan Mental Health Center, Wuhan, Hubei, China
| | - Gangming Cheng
- Department of Early Intervention, Wuhan Mental Health Center, Wuhan, Hubei, China
| | - Hongjie Li
- Department of Early Intervention, Wuhan Mental Health Center, Wuhan, Hubei, China
| | - Wei Yang
- Department of Mental Rehabilitation, Wuhan Mental Health Center, Wuhan, Hubei, China
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de la Salle S, Choueiry J, Payumo M, Devlin M, Noel C, Abozmal A, Hyde M, Baysarowich R, Duncan B, Knott V. Transcranial Alternating Current Stimulation Alters Auditory Steady-State Oscillatory Rhythms and Their Cross-Frequency Couplings. Clin EEG Neurosci 2024; 55:329-339. [PMID: 37306065 PMCID: PMC11020127 DOI: 10.1177/15500594231179679] [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: 08/23/2022] [Accepted: 05/02/2023] [Indexed: 06/13/2023]
Abstract
Auditory cortical plasticity deficits in schizophrenia are evidenced with electroencephalographic (EEG)-derived biomarkers, including the 40-Hz auditory steady-state response (ASSR). Aiming to understand the underlying oscillatory mechanisms contributing to the 40-Hz ASSR, we examined its response to transcranial alternating current stimulation (tACS) applied bilaterally to the temporal lobe of 23 healthy participants. Although not responding to gamma tACS, the 40-Hz ASSR was modulated by theta tACS (vs sham tACS), with reductions in gamma power and phase locking being accompanied by increases in theta-gamma phase-amplitude cross-frequency coupling. Results reveal that oscillatory changes induced by frequency-tuned tACS may be one approach for targeting and modulating auditory plasticity in normal and diseased brains.
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Affiliation(s)
- Sara de la Salle
- Clinical Neuroelectrophysiology and Cognitive Research, The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
- Faculty of Medicine, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Joëlle Choueiry
- Clinical Neuroelectrophysiology and Cognitive Research, The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mark Payumo
- School of Psychology, Carleton University, Ottawa, ON, Canada
| | - Matt Devlin
- Faculty of Medicine, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Chelsea Noel
- Faculty of Medicine, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Ali Abozmal
- Faculty of Medicine, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Molly Hyde
- Clinical Neuroelectrophysiology and Cognitive Research, The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Renée Baysarowich
- Clinical Neuroelectrophysiology and Cognitive Research, The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Brittany Duncan
- Clinical Neuroelectrophysiology and Cognitive Research, The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
| | - Verner Knott
- Clinical Neuroelectrophysiology and Cognitive Research, The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
- Faculty of Medicine, School of Psychology, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Psychology, Carleton University, Ottawa, ON, Canada
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Molina JL, Joshi YB, Nungaray JA, Sprock J, Attarha M, Biagianti B, Thomas ML, Swerdlow NR, Light GA. Early auditory processing abnormalities alter individual learning trajectories and sensitivity to computerized cognitive training in schizophrenia. Psychol Med 2024:1-8. [PMID: 38587021 DOI: 10.1017/s0033291724000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Auditory system plasticity is a promising target for neuromodulation, cognitive rehabilitation and therapeutic development in schizophrenia (SZ). Auditory-based targeted cognitive training (TCT) is a 'bottom up' intervention designed to enhance the speed and accuracy of auditory information processing, which has been shown to improve neurocognition in certain SZ patients. However, the dynamics of TCT learning as a function of training exercises and their impact on neurocognitive functioning and therapeutic outcomes are unknown. METHODS Forty subjects (SZ, n = 21; healthy subjects (HS), n = 19) underwent comprehensive clinical, cognitive, and auditory assessments, including measurements of auditory processing speed (APS) at baseline and after 1-h of TCT. SZ patients additionally completed 30-hours of TCT and repeated assessments ~10-12 weeks later. RESULTS SZ patients were deficient in APS at baseline (d = 0.96, p < 0.005) relative to HS. After 1-h of TCT, analyses revealed significant main effects of diagnosis (d = 1.75, p = 0.002) and time (d = 1.04, p < 0.001), and a diagnosis × time interaction (d = 0.85, p = 0.02) on APS. APS learning effects were robust after 1-h in SZ patients (d = 1.47, p < 0.001) and persisted throughout the 30-h of training. Baseline APS was associated with verbal learning gains after 30-h of TCT (r = 0.51, p = 0.02) in SZ. CONCLUSIONS TCT learning metrics may have prognostic utility and aid in the prospective identification of individuals likely to benefit from TCT. Future experimental medicine studies may advance predictive algorithms that enhance TCT-related clinical, cognitive and functional outcomes.
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Affiliation(s)
- Juan L Molina
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, USA
| | - Yash B Joshi
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, USA
| | - John A Nungaray
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Joyce Sprock
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, USA
| | - Mouna Attarha
- Department of R&D, Posit Science Corporation, San Francisco, CA, USA
| | - Bruno Biagianti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Neal R Swerdlow
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Gregory A Light
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, USA
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Swerdlow NR, Gonzalez CE, Raza MU, Gautam D, Miyakoshi M, Clayson PE, Joshi YB, Molina JL, Talledo J, Thomas ML, Light GA, Sivarao DV. Effects of Memantine on the Auditory Steady-State and Harmonic Responses to 40 Hz Stimulation Across Species. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:346-355. [PMID: 37683728 DOI: 10.1016/j.bpsc.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/21/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Click trains elicit an auditory steady-state response (ASSR) at the driving frequency (1F) and its integer multiple frequencies (2F, 3F, etc.) called harmonics; we call this harmonic response the steady-state harmonic response (SSHR). We describe the 40 Hz ASSR (1F) and 80 Hz SSHR (2F) in humans and rats and their sensitivity to the uncompetitive NMDA antagonist memantine. METHODS In humans (healthy control participants, n = 25; patients with schizophrenia, n = 28), electroencephalography was recorded after placebo or 20 mg memantine in a within-participant crossover design. ASSR used 1 ms, 85-dB clicks presented in 250 40/s 500-ms trains. In freely moving rats (n = 9), electroencephalography was acquired after memantine (0, 0.3, 1, 3 mg/kg) in a within-participant crossover design; 65-dB click trains used 5-mV monophasic, 1-ms square waves (40/s). RESULTS Across species, ASSR at 1F generated greater evoked power (EP) than the 2F SSHR. 1F > 2F intertrial coherence (ITC) was also detected in humans, but the opposite relationship (ITC: 2F > 1F) was seen in rats. EP and ITC at 1F were deficient in patients and were enhanced by memantine across species. EP and ITC at 2F were deficient in patients. Measures at 2F were generally insensitive to memantine across species, although in humans the ITC harmonic ratio (1F:2F) was modestly enhanced by memantine, and in rats, both the EP and ITC harmonic ratios were significantly enhanced by memantine. CONCLUSIONS ASSR and SSHR are robust, nonredundant electroencephalography signals that are suitable for cross-species analyses that reveal potentially meaningful differences across species, diagnoses, and drugs.
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Affiliation(s)
- Neal R Swerdlow
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California; VISN 22 Mental Illness Research, Education, and Clinical Center, San Diego Veterans Administration Health System, La Jolla, California.
| | - Christopher E Gonzalez
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California; VISN 22 Mental Illness Research, Education, and Clinical Center, San Diego Veterans Administration Health System, La Jolla, California
| | - Muhammad Ummear Raza
- Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee
| | - Deepshila Gautam
- Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee
| | - Makoto Miyakoshi
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Peter E Clayson
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Yash B Joshi
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California; VISN 22 Mental Illness Research, Education, and Clinical Center, San Diego Veterans Administration Health System, La Jolla, California
| | - Juan L Molina
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California; VISN 22 Mental Illness Research, Education, and Clinical Center, San Diego Veterans Administration Health System, La Jolla, California
| | - Jo Talledo
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, Colorado
| | - Gregory A Light
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California; VISN 22 Mental Illness Research, Education, and Clinical Center, San Diego Veterans Administration Health System, La Jolla, California.
| | - Digavalli V Sivarao
- Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee
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Joshi YB, Gonzalez CE, Molina JL, MacDonald LR, Min Din J, Minhas J, Leposke T, Nordberg B, Li F, Talledo J, Sprock J, Swerdlow NR, Light GA. Mismatch negativity predicts initial auditory-based targeted cognitive training performance in a heterogeneous population across psychiatric disorders. Psychiatry Res 2023; 327:115215. [PMID: 37406367 DOI: 10.1016/j.psychres.2023.115215] [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: 12/30/2022] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 07/07/2023]
Abstract
Auditory-based targeted cognitive training (ATCT) programs are emerging pro-cognitive therapeutic interventions which aim to improve auditory processing to attenuate cognitive impairment in a "bottom up" manner. Biomarkers of early auditory information processing (EAIP) like mismatch negativity (MMN) and P3a have been used successfully to predict gains from a full 40 h course of ATCT in schizophrenia (SZ). Here we investigated the ability of EAIP biomarkers to predict ATCT performance in a group of subjects (n = 26) across SZ, MDD, PTSD and GAD diagnoses. Cognition was assessed via the MATRICS Consensus Cognitive Battery (MCCB) and MMN/P3a were collected prior to completing 1 h of "Sound Sweeps," a representative ATCT exercise. Baseline and final performance over the first two levels of cognitive training served as the primary dependent variables. Groups had similar MMN, but the SZ group had attenuated P3a. MMN and MCCB cognitive domain t-scores, but not P3a, were strongly correlated with most ATCT performance measures, and explained up to 61% of variance in ATCT performance. Diagnosis was not a significant predictor for ATCT performance. These data suggest that MMN can predict ATCT performance in heterogeneous neuropsychiatric populations and should be considered in ATCT studies across diagnostically diverse cohorts.
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Affiliation(s)
- Yash B Joshi
- VA San Diego Healthcare System, La Jolla, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA; Desert Pacific Mental Illness Research Education and Clinical Center, La Jolla, CA, USA.
| | - Christopher E Gonzalez
- VA San Diego Healthcare System, La Jolla, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA; Desert Pacific Mental Illness Research Education and Clinical Center, La Jolla, CA, USA
| | - Juan L Molina
- VA San Diego Healthcare System, La Jolla, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA; Desert Pacific Mental Illness Research Education and Clinical Center, La Jolla, CA, USA
| | - Laura R MacDonald
- University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Jenny Min Din
- University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Jessica Minhas
- University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Taylor Leposke
- University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Bethany Nordberg
- University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Francesca Li
- University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Jo Talledo
- VA San Diego Healthcare System, La Jolla, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA; Desert Pacific Mental Illness Research Education and Clinical Center, La Jolla, CA, USA
| | - Joyce Sprock
- VA San Diego Healthcare System, La Jolla, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA; Desert Pacific Mental Illness Research Education and Clinical Center, La Jolla, CA, USA
| | - Neal R Swerdlow
- VA San Diego Healthcare System, La Jolla, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA; Desert Pacific Mental Illness Research Education and Clinical Center, La Jolla, CA, USA
| | - Gregory A Light
- VA San Diego Healthcare System, La Jolla, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA; Desert Pacific Mental Illness Research Education and Clinical Center, La Jolla, CA, USA
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Brændholt M, Kluger DS, Varga S, Heck DH, Gross J, Allen MG. Breathing in waves: Understanding respiratory-brain coupling as a gradient of predictive oscillations. Neurosci Biobehav Rev 2023; 152:105262. [PMID: 37271298 DOI: 10.1016/j.neubiorev.2023.105262] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 05/03/2023] [Accepted: 05/24/2023] [Indexed: 06/06/2023]
Abstract
Breathing plays a crucial role in shaping perceptual and cognitive processes by regulating the strength and synchronisation of neural oscillations. Numerous studies have demonstrated that respiratory rhythms govern a wide range of behavioural effects across cognitive, affective, and perceptual domains. Additionally, respiratory-modulated brain oscillations have been observed in various mammalian models and across diverse frequency spectra. However, a comprehensive framework to elucidate these disparate phenomena remains elusive. In this review, we synthesise existing findings to propose a neural gradient of respiratory-modulated brain oscillations and examine recent computational models of neural oscillations to map this gradient onto a hierarchical cascade of precision-weighted prediction errors. By deciphering the computational mechanisms underlying respiratory control of these processes, we can potentially uncover new pathways for understanding the link between respiratory-brain coupling and psychiatric disorders.
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Affiliation(s)
- Malthe Brændholt
- Center of Functionally Integrative Neuroscience, Aarhus University, Denmark
| | - Daniel S Kluger
- Institute for Biomagnetism and Biosignal Analysis, University of Münster, Germany.
| | - Somogy Varga
- School of Culture and Society, Aarhus University, Denmark; The Centre for Philosophy of Epidemiology, Medicine and Public Health, University of Johannesburg, South Africa
| | - Detlef H Heck
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, MN
| | - Joachim Gross
- Institute for Biomagnetism and Biosignal Analysis, University of Münster, Germany; Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Münster, Germany
| | - Micah G Allen
- Center of Functionally Integrative Neuroscience, Aarhus University, Denmark; Cambridge Psychiatry, University of Cambridge, UK
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Joshi YB, Molina JL, Braff DL, Green MF, Gur RC, Gur RE, Nuechterlein KH, Stone WS, Greenwood TA, Lazzeroni LC, Radant AD, Silverman JM, Sprock J, Sugar CA, Tsuang DW, Tsuang MT, Turetsky BI, Swerdlow NR, Light GA. Sensitivity of Schizophrenia Endophenotype Biomarkers to Anticholinergic Medication Burden. Am J Psychiatry 2023; 180:519-523. [PMID: 37038743 DOI: 10.1176/appi.ajp.20220649] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
- Yash B Joshi
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Juan L Molina
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - David L Braff
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Michael F Green
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Ruben C Gur
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Raquel E Gur
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Keith H Nuechterlein
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - William S Stone
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Tiffany A Greenwood
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Laura C Lazzeroni
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Allen D Radant
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Jeremy M Silverman
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Joyce Sprock
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Catherine A Sugar
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Debby W Tsuang
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Ming T Tsuang
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Bruce I Turetsky
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Neal R Swerdlow
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
| | - Gregory A Light
- Desert Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System (Joshi, Molina, Braff, Sprock, Swerdlow, Light); Department of Psychiatry, University of California, San Diego (Joshi, Molina, Braff, Greenwood, Sprock, M. Tsuang, Swerdlow, Light); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Green, Neuchterlein); Desert Pacific Mental Illness Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles (Green, Sugar); Department of Psychiatry, University of Pennsylvania, Philadelphia (Ruben C. Gur, Raquel E. Gur, Turetsky); Department of Psychiatry, Harvard Medical School, Boston (Stone); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Stone); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Lazzeroni); Department of Biomedical Data Science, Stanford University, Stanford (Lazzeroni); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Radant, D. Tsuang); Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle (D. Tsuang); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Silverman); Research & Development, James J. Peters VA Medical Center, New York (Silverman); Department of Biostatistics, UCLA School of Public Health, Los Angeles (Sugar)
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9
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Zheng Y, Li Q, Gong B, Xia Y, Lu X, Liu Y, Wu H, She S, Wu C. Negative-emotion-induced reduction in speech-in-noise recognition is associated with source-monitoring deficits and psychiatric symptoms in mandarin-speaking patients with schizophrenia. Compr Psychiatry 2023; 124:152395. [PMID: 37216805 DOI: 10.1016/j.comppsych.2023.152395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 05/03/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Patients with schizophrenia (SCH) have deficits in source monitoring (SM), speech-in-noise recognition (SR), and auditory prosody recognition. This study aimed to test the covariation between SM and SR alteration induced by negative prosodies and their association with psychiatric symptoms in SCH. METHODS Fifty-four SCH patients and 59 healthy controls (HCs) underwent a speech SM task, an SR task, and the assessment of positive and negative syndrome scale (PANSS). We used the multivariate analyses of partial least squares (PLS) regression to explore the associations among SM (external/internal/new attribution error [AE] and response bias [RB]), SR alteration/release induced by four negative-emotion (sad, angry, fear, and disgust) prosodies of target speech, and psychiatric symptoms. RESULTS In SCH, but not HCs, a profile (linear combination) of SM (especially the external-source RB) was positively associated with a profile of SR reductions (induced especially by the angry prosody). Moreover, two SR reduction profiles (especially in the anger and sadness conditions) were related to two profiles of psychiatric symptoms (negative symptoms, lack of insight, and emotional disturbances). The two PLS components explained 50.4% of the total variances of the release-symptom association. CONCLUSION Compared to HCs, SCH is more likely to perceive the external-source speech as internal/new source speech. The SM-related SR reduction induced by the angry prosody was mainly associated with negative symptoms. These findings help understand the psychopathology of SCH and may provide a potential direction to improve negative symptoms via minimizing emotional SR reduction in schizophrenia.
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Affiliation(s)
- Yingjun Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510145, Guangdong, China
| | - Qiuhong Li
- Peking University School of Nursing, Beijing 100191, China
| | - Bingyan Gong
- Peking University School of Nursing, Beijing 100191, China
| | - Yu Xia
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510145, Guangdong, China
| | - Xiaohua Lu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510145, Guangdong, China
| | - Yi Liu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510145, Guangdong, China
| | - Huawang Wu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510145, Guangdong, China
| | - Shenglin She
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510145, Guangdong, China.
| | - Chao Wu
- Peking University School of Nursing, Beijing 100191, China.
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10
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Suárez Santiago JE, Roldán GR, Picazo O. Ketamine as a pharmacological tool for the preclinical study of memory deficit in schizophrenia. Behav Pharmacol 2023; 34:80-91. [PMID: 36094064 DOI: 10.1097/fbp.0000000000000689] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Schizophrenia is a serious neuropsychiatric disorder characterized by the presence of positive symptoms (hallucinations, delusions, and disorganization of thought and language), negative symptoms (abulia, alogia, and affective flattening), and cognitive impairment (attention deficit, impaired declarative memory, and deficits in social cognition). Dopaminergic hyperactivity seems to explain the positive symptoms, but it does not completely clarify the appearance of negative and cognitive clinical manifestations. Preclinical data have demonstrated that acute and subchronic treatment with NMDA receptor antagonists such as ketamine (KET) represents a useful model that resembles the schizophrenia symptomatology, including cognitive impairment. This latter has been explained as a hypofunction of NMDA receptors located on the GABA parvalbumin-positive interneurons (near to the cortical pyramidal cells), thus generating an imbalance between the inhibitory and excitatory activity in the corticomesolimbic circuits. The use of behavioral models to explore alterations in different domains of memory is vital to learn more about the neurobiological changes that underlie schizophrenia. Thus, to better understand the neurophysiological mechanisms involved in cognitive impairment related to schizophrenia, the purpose of this review is to analyze the most recent findings regarding the effect of KET administration on these processes.
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Affiliation(s)
- José Eduardo Suárez Santiago
- Escuela Superior de Medicina, Laboratorio de Farmacología Conductual, Instituto Politécnico Nacional
- Facultad de Medicina, Departamento de Fisiología, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Gabriel Roldán Roldán
- Facultad de Medicina, Departamento de Fisiología, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ofir Picazo
- Escuela Superior de Medicina, Laboratorio de Farmacología Conductual, Instituto Politécnico Nacional
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11
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Santarriaga S, Gerlovin K, Layadi Y, Karmacharya R. Human stem cell-based models to study synaptic dysfunction and cognition in schizophrenia: A narrative review. Schizophr Res 2023:S0920-9964(23)00084-1. [PMID: 36925354 PMCID: PMC10500041 DOI: 10.1016/j.schres.2023.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
Cognitive impairment is the strongest predictor of functional outcomes in schizophrenia and is hypothesized to result from synaptic dysfunction. However, targeting synaptic plasticity and cognitive deficits in patients remains a significant clinical challenge. A comprehensive understanding of synaptic plasticity and the molecular basis of learning and memory in a disease context can provide specific targets for the development of novel therapeutics targeting cognitive impairments in schizophrenia. Here, we describe the role of synaptic plasticity in cognition, summarize evidence for synaptic dysfunction in schizophrenia and demonstrate the use of patient derived induced-pluripotent stem cells for studying synaptic plasticity in vitro. Lastly, we discuss current advances and future technologies for bridging basic science research of synaptic dysfunction with clinical and translational research that can be used to predict treatment response and develop novel therapeutics.
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Affiliation(s)
- Stephanie Santarriaga
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Chemical Biology and Therapeutic Science Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kaia Gerlovin
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Chemical Biology and Therapeutic Science Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Yasmine Layadi
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Chimie ParisTech, Université Paris Sciences et Lettres, Paris, France
| | - Rakesh Karmacharya
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Chemical Biology and Therapeutic Science Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA.
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12
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Vinogradov S, Chafee MV, Lee E, Morishita H. Psychosis spectrum illnesses as disorders of prefrontal critical period plasticity. Neuropsychopharmacology 2023; 48:168-185. [PMID: 36180784 PMCID: PMC9700720 DOI: 10.1038/s41386-022-01451-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 01/05/2023]
Abstract
Emerging research on neuroplasticity processes in psychosis spectrum illnesses-from the synaptic to the macrocircuit levels-fill key gaps in our models of pathophysiology and open up important treatment considerations. In this selective narrative review, we focus on three themes, emphasizing alterations in spike-timing dependent and Hebbian plasticity that occur during adolescence, the critical period for prefrontal system development: (1) Experience-dependent dysplasticity in psychosis emerges from activity decorrelation within neuronal ensembles. (2) Plasticity processes operate bidirectionally: deleterious environmental and experiential inputs shape microcircuits. (3) Dysregulated plasticity processes interact across levels of scale and time and include compensatory mechanisms that have pathogenic importance. We present evidence that-given the centrality of progressive dysplastic changes, especially in prefrontal cortex-pharmacologic or neuromodulatory interventions will need to be supplemented by corrective learning experiences for the brain if we are to help people living with these illnesses to fully thrive.
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Affiliation(s)
- Sophia Vinogradov
- Department of Psychiatry & Behavioral Science, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Matthew V Chafee
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Erik Lee
- Masonic Institute for the Developing Brain, University of Minnesota Medical School, Minneapolis, MN, USA
- University of Minnesota Informatics Institute, University of Minnesota, Minneapolis, MN, USA
| | - Hirofumi Morishita
- Department of Psychiatry, Neuroscience, & Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Responses at Individual Gamma Frequencies Are Related to the Processing Speed but Not the Inhibitory Control. J Pers Med 2022; 13:jpm13010026. [PMID: 36675687 PMCID: PMC9861418 DOI: 10.3390/jpm13010026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
The link between the state of networks underlying the generation of periodic responses at gamma ranges and cognitive outcomes is still poorly understood. In this study, we tested the idea that the individual differences in the ability to generate responses to auditory stimulation at gamma frequencies may underlie the individual differences in the inhibitory control. We focused on the processing speed and accuracy in the Bivalent Shape Task (a cognitive inhibition task assessing attentional interference) and explored the relationship with responses at 40 Hz and at individual gamma frequencies (IGFs, assessed utilizing auditory envelope-following responses in 30-60 Hz range). In a sample of 70 subjects, we show that individual measures (phase-locking index and event-related spectral perturbation) of the ability to generate gamma-range activity are not related to the individual differences in inhibitory control but rather reflect basic information processing speed in healthy young subjects. With the individualized approach (at IGFs), the observed associations were found to be somewhat stronger. These findings have important implications for the interpretation of gamma activity in neuropsychiatric disorders.
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Onitsuka T, Tsuchimoto R, Oribe N, Spencer KM, Hirano Y. Neuronal imbalance of excitation and inhibition in schizophrenia: a scoping review of gamma-band ASSR findings. Psychiatry Clin Neurosci 2022; 76:610-619. [PMID: 36069299 DOI: 10.1111/pcn.13472] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 08/04/2022] [Accepted: 08/16/2022] [Indexed: 12/01/2022]
Abstract
Recent empirical findings suggest that altered neural synchronization, which is hypothesized to be associated with an imbalance of excitatory (E) and inhibitory (I) neuronal activities, may underlie a core pathophysiological mechanism in patients with schizophrenia. The auditory steady-state response (ASSR) examined by electroencephalography (EEG) and magnetoencephalography (MEG) has been proposed as a potential biomarker for evaluating altered neural synchronization in schizophrenia. For this review, we performed a comprehensive literature search for papers published between 1999 and 2021 examining ASSRs in patients with schizophrenia. Almost all EEG-ASSR studies reported gamma-band ASSR reductions, especially to 40-Hz stimuli both in power and/or phase synchronization in chronic and first-episode schizophrenia. In addition, similar to EEG-ASSR findings, MEG-ASSR deficits to 80-Hz stimuli (high gamma) have been reported in patients with schizophrenia. Moreover, the 40-Hz ASSR is likely to be a predictor of the onset of schizophrenia. Notably, increased spontaneous (or ongoing) broadband (30-100 Hz) gamma power has been reported during ASSR tasks, which resembles the increased spontaneous gamma activity reported in animal models of E/I imbalance. Further research on ASSRs and evoked and spontaneous gamma oscillations is expected to elucidate the pathophysiology of schizophrenia with translational implications.
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Affiliation(s)
- Toshiaki Onitsuka
- Department of Neuroimaging Psychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Rikako Tsuchimoto
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoya Oribe
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Division of Clinical Research, National Hospital Organization, Hizen Psychiatric Medical Center, Saga, Japan
| | - Kevin M Spencer
- Neural Dynamics Laboratory, Research Service, Veterans Affairs Boston Healthcare System, and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, 02130, USA.,Clinical Neuroscience Division, Laboratory of Neuroscience, Department of Psychiatry, Boston VA Healthcare System, Brockton Division and Harvard Medical School, Brockton, Massachusetts, USA
| | - Yoji Hirano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Neural Dynamics Laboratory, Research Service, Veterans Affairs Boston Healthcare System, and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, 02130, USA.,Clinical Neuroscience Division, Laboratory of Neuroscience, Department of Psychiatry, Boston VA Healthcare System, Brockton Division and Harvard Medical School, Brockton, Massachusetts, USA
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15
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de la Salle S, Shah U, Hyde M, Baysarowich R, Aidelbaum R, Choueiry J, Knott V. Synchronized Auditory Gamma Response to Frontal Transcranial Direct Current Stimulation (tDCS) and its Inter-Individual Variation in Healthy Humans. Clin EEG Neurosci 2022; 53:472-483. [PMID: 35491558 DOI: 10.1177/15500594221098285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In schizophrenia, a disorder associated with N-methyl-D-aspartate receptor (NMDAR) hypofunction, auditory cortical plasticity deficits have been indexed by the synchronized electroencephalographic (EEG) auditory steady-state gamma-band (40-Hz) response (ASSR) and the early auditory evoked gamma-band response (aeGBR), both considered to be target engagement biomarkers for NMDAR function, and potentially amenable to treatment by NMDAR modulators. As transcranial direct current stimulation (tDCS) is likely dependent on NMDAR neurotransmission, this preliminary study, conducted in 30 healthy volunteers, assessed the off-line effects of prefrontal anodal tDCS and sham (placebo) treatment on 40-Hz ASSR and aeGBR. Anodal tDCS failed to alter aeGBR but increased both 40-Hz ASSR power, as measured by event-related spectral perturbations (ERSP), and phase locking, as measured by inter-trial phase consistency (ITPC). Inter-individual differences in tDCS-induced increases in ERSP were negatively related to baseline ERSPs. These findings provide tentative support for further study of tDCS as a potential NMDAR neuromodulatory intervention for synchronized auditory gamma response deficits.
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Affiliation(s)
- Sara de la Salle
- 580059The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
| | - Urusa Shah
- Neuroscience, 6339Carleton University, Ottawa, ON, Canada
| | - Molly Hyde
- Department of Cellular and Molecular Medicine, 6363University of Ottawa, Ottawa, ON, Canada
| | - Renee Baysarowich
- Department of Cellular and Molecular Medicine, 6363University of Ottawa, Ottawa, ON, Canada
| | - Robert Aidelbaum
- School of Psychology, 6339Carleton University, Ottawa, ON, Canada
| | - Joëlle Choueiry
- 580059The Royal's Institute of Mental Health Research, Ottawa, ON, Canada.,Department of Cellular and Molecular Medicine, 6363University of Ottawa, Ottawa, ON, Canada
| | - Verner Knott
- 580059The Royal's Institute of Mental Health Research, Ottawa, ON, Canada.,Neuroscience, 6339Carleton University, Ottawa, ON, Canada.,Department of Cellular and Molecular Medicine, 6363University of Ottawa, Ottawa, ON, Canada.,School of Psychology, 6339Carleton University, Ottawa, ON, Canada
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16
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Perrottelli A, Giordano GM, Brando F, Giuliani L, Pezzella P, Mucci A, Galderisi S. Unveiling the Associations between EEG Indices and Cognitive Deficits in Schizophrenia-Spectrum Disorders: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12092193. [PMID: 36140594 PMCID: PMC9498272 DOI: 10.3390/diagnostics12092193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Cognitive dysfunctions represent a core feature of schizophrenia-spectrum disorders due to their presence throughout different illness stages and their impact on functioning. Abnormalities in electrophysiology (EEG) measures are highly related to these impairments, but the use of EEG indices in clinical practice is still limited. A systematic review of articles using Pubmed, Scopus and PsychINFO was undertaken in November 2021 to provide an overview of the relationships between EEG indices and cognitive impairment in schizophrenia-spectrum disorders. Out of 2433 screened records, 135 studies were included in a qualitative review. Although the results were heterogeneous, some significant correlations were identified. In particular, abnormalities in alpha, theta and gamma activity, as well as in MMN and P300, were associated with impairments in cognitive domains such as attention, working memory, visual and verbal learning and executive functioning during at-risk mental states, early and chronic stages of schizophrenia-spectrum disorders. The review suggests that machine learning approaches together with a careful selection of validated EEG and cognitive indices and characterization of clinical phenotypes might contribute to increase the use of EEG-based measures in clinical settings.
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17
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Viktorin V, Griškova-Bulanova I, Voicikas A, Dojčánová D, Zach P, Bravermanová A, Andrashko V, Tylš F, Korčák J, Viktorinová M, Koudelka V, Hájková K, Kuchař M, Horáček J, Brunovský M, Páleníček T. Psilocybin—Mediated Attenuation of Gamma Band Auditory Steady-State Responses (ASSR) Is Driven by the Intensity of Cognitive and Emotional Domains of Psychedelic Experience. J Pers Med 2022; 12:jpm12061004. [PMID: 35743788 PMCID: PMC9225116 DOI: 10.3390/jpm12061004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Psilocybin is a classical serotoninergic psychedelic that induces cognitive disruptions similar to psychosis. Gamma activity is affected in psychosis and is tightly related to cognitive processing. The 40 Hz auditory steady-state responses (ASSR) are frequently used as indicators to test the ability to generate gamma activity. Based on previous literature, we studied the impact of psilocybin on 40 Hz ASSR in healthy volunteers. The study was double blind and placebo controlled with a crossover design. A sample of 20 healthy subjects (10M/10F) received psilocybin orally 0.26 mg/kg or placebo. Participants were measured four times in total, one time before ingestion of psilocybin/placebo and one time after ingestion, during the peak of intoxication. A series of 500 ms click trains were used for stimulation. Psilocybin induced a psychedelic effect and decreased 40 Hz ASSR phase-locking index compared to placebo. The extent of the attenuation was related to Cognition and Affect on the Hallucinogen Rating Scale. The current study shows that psilocybin lowers the synchronization level and the amplitude of 40 Hz auditory steady-state responses, which yields further support for the role of gamma oscillations in cognitive processing and its disturbance.
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Affiliation(s)
- Vojtěch Viktorin
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (V.V.); (D.D.); (P.Z.); (A.B.); (V.A.); (F.T.); (J.K.); (M.V.); (V.K.); (J.H.); (M.B.)
- Third Faculty of Medicine, Charles University, Ruská 2411, 100 00 Prague, Czech Republic
| | - Inga Griškova-Bulanova
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (V.V.); (D.D.); (P.Z.); (A.B.); (V.A.); (F.T.); (J.K.); (M.V.); (V.K.); (J.H.); (M.B.)
- Institute of Biosciences, Vilnius University, 7 Saulėtekio Ave, 10257 Vilnius, Lithuania;
- Correspondence: (I.G.-B.); (T.P.)
| | - Aleksandras Voicikas
- Institute of Biosciences, Vilnius University, 7 Saulėtekio Ave, 10257 Vilnius, Lithuania;
| | - Dominika Dojčánová
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (V.V.); (D.D.); (P.Z.); (A.B.); (V.A.); (F.T.); (J.K.); (M.V.); (V.K.); (J.H.); (M.B.)
- Third Faculty of Medicine, Charles University, Ruská 2411, 100 00 Prague, Czech Republic
| | - Peter Zach
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (V.V.); (D.D.); (P.Z.); (A.B.); (V.A.); (F.T.); (J.K.); (M.V.); (V.K.); (J.H.); (M.B.)
| | - Anna Bravermanová
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (V.V.); (D.D.); (P.Z.); (A.B.); (V.A.); (F.T.); (J.K.); (M.V.); (V.K.); (J.H.); (M.B.)
- First Faculty of Medicine, Charles University, Kateřinská 32, 121 08 Prague, Czech Republic
| | - Veronika Andrashko
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (V.V.); (D.D.); (P.Z.); (A.B.); (V.A.); (F.T.); (J.K.); (M.V.); (V.K.); (J.H.); (M.B.)
- Third Faculty of Medicine, Charles University, Ruská 2411, 100 00 Prague, Czech Republic
| | - Filip Tylš
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (V.V.); (D.D.); (P.Z.); (A.B.); (V.A.); (F.T.); (J.K.); (M.V.); (V.K.); (J.H.); (M.B.)
- Third Faculty of Medicine, Charles University, Ruská 2411, 100 00 Prague, Czech Republic
| | - Jakub Korčák
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (V.V.); (D.D.); (P.Z.); (A.B.); (V.A.); (F.T.); (J.K.); (M.V.); (V.K.); (J.H.); (M.B.)
| | - Michaela Viktorinová
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (V.V.); (D.D.); (P.Z.); (A.B.); (V.A.); (F.T.); (J.K.); (M.V.); (V.K.); (J.H.); (M.B.)
- Third Faculty of Medicine, Charles University, Ruská 2411, 100 00 Prague, Czech Republic
| | - Vlastimil Koudelka
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (V.V.); (D.D.); (P.Z.); (A.B.); (V.A.); (F.T.); (J.K.); (M.V.); (V.K.); (J.H.); (M.B.)
| | - Kateřina Hájková
- Forensic Laboratory of Biologically Active Substances, Department of Chemistry of Natural Compounds, University of Chemistry and Technology Prague, Technická 5, 166 28 Prague, Czech Republic; (K.H.); (M.K.)
| | - Martin Kuchař
- Forensic Laboratory of Biologically Active Substances, Department of Chemistry of Natural Compounds, University of Chemistry and Technology Prague, Technická 5, 166 28 Prague, Czech Republic; (K.H.); (M.K.)
| | - Jiří Horáček
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (V.V.); (D.D.); (P.Z.); (A.B.); (V.A.); (F.T.); (J.K.); (M.V.); (V.K.); (J.H.); (M.B.)
- Third Faculty of Medicine, Charles University, Ruská 2411, 100 00 Prague, Czech Republic
| | - Martin Brunovský
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (V.V.); (D.D.); (P.Z.); (A.B.); (V.A.); (F.T.); (J.K.); (M.V.); (V.K.); (J.H.); (M.B.)
- Third Faculty of Medicine, Charles University, Ruská 2411, 100 00 Prague, Czech Republic
| | - Tomáš Páleníček
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (V.V.); (D.D.); (P.Z.); (A.B.); (V.A.); (F.T.); (J.K.); (M.V.); (V.K.); (J.H.); (M.B.)
- Third Faculty of Medicine, Charles University, Ruská 2411, 100 00 Prague, Czech Republic
- Correspondence: (I.G.-B.); (T.P.)
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18
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Rosenbrock H, Dorner-Ciossek C, Giovannini R, Schmid B, Schuelert N. Effects of the glycine transporter-1 inhibitor iclepertin (BI 425809) on sensory processing, neural network function, and cognition in animal models related to schizophrenia. J Pharmacol Exp Ther 2022; 382:223-232. [PMID: 35661632 DOI: 10.1124/jpet.121.001071] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/04/2022] [Indexed: 11/22/2022] Open
Abstract
N-methyl-D-aspartate (NMDA) receptor hypofunction leading to neural network dysfunction is thought to play an important role in the pathophysiology of cognitive impairment associated with schizophrenia (CIAS). Increasing extracellular concentrations of the NMDA receptor co-agonist glycine through inhibition of glycine transporter-1 (GlyT1) has the potential to treat CIAS by improving cortical network function through enhanced glutamatergic signaling. Indeed, the novel GlyT1 inhibitor iclepertin (BI 425809) improved cognition in a recent clinical study in patients with schizophrenia. The present study tested the ability of iclepertin to reverse MK-801-induced deficits in auditory sensory processing and cortical network function using electroencephalography (EEG) to measure auditory event-related potentials (AERP) and 40 Hz auditory steady-state response (ASSR). In addition, improvements in memory performance with iclepertin were evaluated using the T-maze spontaneous alternation test in MK-801-treated mice and the social recognition test in naïve rats. Iclepertin reversed MK-801-induced deficits in the AERP readouts N1 amplitude and N1 gating, as well as 40 Hz ASSR power and inter-trial coherence. Additionally, iclepertin significantly attenuated an MK-801-induced increase in basal gamma power. Furthermore, iclepertin reversed MK-801-induced working memory deficits in mice and improved social recognition memory performance in rats. Overall, this study demonstrates that inhibition of GlyT1 is sufficient to attenuate MK-801-induced deficits in translatable EEG parameters relevant to schizophrenia. Moreover, iclepertin showed memory-enhancing effects in rodent cognition tasks, further demonstrating the potential for GlyT1 inhibition to treat CIAS. Significance Statement Despite the significant patient burden caused by cognitive impairment associated with schizophrenia, there are currently no approved pharmacotherapies. In this preclinical study, the novel glycine transporter inhibitor iclepertin (BI 425809) reversed sensory processing deficits and neural network dysfunction evoked by inhibition of N-methyl-D-aspartate (NMDA) receptors, and enhanced working memory performance and social recognition in rodents. These findings support previous clinical evidence for the pro-cognitive effects of iclepertin.
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Affiliation(s)
- Holger Rosenbrock
- CNS Discovery Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Germany
| | | | | | - Bernhard Schmid
- Drug Discovery Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Germany
| | - Niklas Schuelert
- CNS Discovery Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Germany
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19
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Clayson PE, Joshi YB, Thomas ML, Sprock J, Nungaray J, Swerdlow NR, Light GA. Click-evoked auditory brainstem responses (ABRs) are intact in schizophrenia and not sensitive to cognitive training. Biomark Neuropsychiatry 2022. [DOI: 10.1016/j.bionps.2022.100046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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20
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Biagianti B, Bigoni D, Maggioni E, Brambilla P. Can neuroimaging-based biomarkers predict response to cognitive remediation in patients with psychosis? A state-of-the-art review. J Affect Disord 2022; 305:196-205. [PMID: 35283181 DOI: 10.1016/j.jad.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cognitive Remediation (CR) is designed to halt the pathological neural systems that characterize major psychotic disorders (MPD), and its main objective is to improve cognitive functioning. The magnitude of CR-induced cognitive gains greatly varies across patients with MPD, with up to 40% of patients not showing gains in global cognitive performance. This is likely due to the high degree of heterogeneity in neural activation patterns underlying cognitive endophenotypes, and to inter-individual differences in neuroplastic potential, cortical organization and interaction between brain systems in response to learning. Here, we review studies that used neuroimaging to investigate which biomarkers could potentially serve as predictors of treatment response to CR in MPD. METHODS This systematic review followed the PRISMA guidelines. An electronic database search (Embase, Elsevier; Scopus, PsycINFO, APA; PubMed, APA) was conducted in March 2021. peer-reviewed, English-language studies were included if they reported data for adults aged 18+ with MPD, reported findings from randomized controlled trials or single-arm trials of CR; and presented neuroimaging data. RESULTS Sixteen studies were included and eight neuroimaging-based biomarkers were identified. Auditory mismatch negativity (3 studies), auditory steady-state response (1), gray matter morphology (3), white matter microstructure (1), and task-based fMRI (7) can predict response to CR. Efference copy corollary/discharge, resting state, and thalamo-cortical connectivity (1) require further research prior to being implemented. CONCLUSIONS Translational research on neuroimaging-based biomarkers can help elucidate the mechanisms by which CR influences the brain's functional architecture, better characterize psychotic subpopulations, and ultimately deliver CR that is optimized and personalized.
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Affiliation(s)
- Bruno Biagianti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Davide Bigoni
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Eleonora Maggioni
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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21
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Structural and Functional Deviations of the Hippocampus in Schizophrenia and Schizophrenia Animal Models. Int J Mol Sci 2022; 23:ijms23105482. [PMID: 35628292 PMCID: PMC9143100 DOI: 10.3390/ijms23105482] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 01/04/2023] Open
Abstract
Schizophrenia is a grave neuropsychiatric disease which frequently onsets between the end of adolescence and the beginning of adulthood. It is characterized by a variety of neuropsychiatric abnormalities which are categorized into positive, negative and cognitive symptoms. Most therapeutical strategies address the positive symptoms by antagonizing D2-dopamine-receptors (DR). However, negative and cognitive symptoms persist and highly impair the life quality of patients due to their disabling effects. Interestingly, hippocampal deviations are a hallmark of schizophrenia and can be observed in early as well as advanced phases of the disease progression. These alterations are commonly accompanied by a rise in neuronal activity. Therefore, hippocampal formation plays an important role in the manifestation of schizophrenia. Furthermore, studies with animal models revealed a link between environmental risk factors and morphological as well as electrophysiological abnormalities in the hippocampus. Here, we review recent findings on structural and functional hippocampal abnormalities in schizophrenic patients and in schizophrenia animal models, and we give an overview on current experimental approaches that especially target the hippocampus. A better understanding of hippocampal aberrations in schizophrenia might clarify their impact on the manifestation and on the outcome of this severe disease.
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22
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Koshiyama D, Miyakoshi M, Tanaka-Koshiyama K, Sprock J, Light GA. High-power gamma-related delta phase alteration in schizophrenia patients at rest. Psychiatry Clin Neurosci 2022; 76:179-186. [PMID: 35037330 DOI: 10.1111/pcn.13331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/12/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022]
Abstract
AIM Information processing is supported by the cortico-cortical transmission of neural oscillations across brain regions. Recent studies have demonstrated that the rhythmic firing of neural populations is not random but is governed by interactions with other frequency bands. Specifically, the amplitude of gamma-band oscillations is associated with the phase of lower frequency oscillations in support of short and long-range communications among networks. This cross-frequency relation is thought to reflect the temporal coordination of neural communication. While schizophrenia patients show abnormal oscillatory responses across multiple frequencies at rest, it is unclear whether the functional relationships among frequency bands are intact. This study aimed to characterize the lower frequency (delta/theta, 1-8 Hz) phase and the amplitude of gamma oscillations in healthy subjects and schizophrenia patients at rest. METHODS Low frequency-phase (delta- and theta- band) angles and gamma-band amplitude relationships were assessed in 142 schizophrenia patients and 128 healthy subjects. RESULTS Significant low-frequency phase alteration related to high-power gamma was detected across broadly distributed scalp regions in both healthy subjects and patients. In patients, delta phase synchronization related to high-power gamma was significantly decreased at the frontocentral, right middle temporal, and left temporoparietal electrodes but significantly increased at the left parietal electrode. CONCLUSIONS High-power gamma-related delta phase alteration may reflect a core pathophysiologic abnormality in schizophrenia. Data-driven measures of functional relationships among frequency bands may prove useful in the development of novel therapeutics. Future studies are needed to determine whether these alterations are specific to schizophrenia or appear in other neuropsychiatric patient populations.
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Affiliation(s)
- Daisuke Koshiyama
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Makoto Miyakoshi
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California San Diego, La Jolla, California, USA
| | | | - Joyce Sprock
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, California, USA
| | - Gregory A Light
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, California, USA
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Sohal VS. Transforming Discoveries About Cortical Microcircuits and Gamma Oscillations Into New Treatments for Cognitive Deficits in Schizophrenia. Am J Psychiatry 2022; 179:267-276. [PMID: 35360913 DOI: 10.1176/appi.ajp.20220147] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The major cause of disability in schizophrenia is cognitive impairment, which remains largely refractory to existing treatments. This reflects the fact that antipsychotics and other therapies have not been designed to address specific brain abnormalities that cause cognitive impairment. This overview proposes that understanding how specific cellular and synaptic loci within cortical microcircuits contribute to cortical gamma oscillations may reveal treatments for cognitive impairment. Gamma oscillations are rhythmic patterns of high frequency (∼30-100 Hz) neuronal activity that are synchronized within and across brain regions, generated by a class of inhibitory interneurons that express parvalbumin, and recruited during a variety of cognitive tasks. In schizophrenia, both parvalbumin interneuron function and task-evoked gamma oscillations are deficient. While it has long been controversial whether gamma oscillations are merely a biomarker of circuit function or actually contribute to information processing by neuronal networks, recent neurobiological studies in mice have shown that disrupting or enhancing synchronized gamma oscillations can reproduce or ameliorate cognitive deficits resembling those seen in schizophrenia. In fact, transiently enhancing the synchrony of parvalbumin interneuron-generated gamma oscillations can lead to long-lasting improvements in cognition in mice that model aspects of schizophrenia. Gamma oscillations emerge from specific patterns of connections between a variety of cell types within cortical microcircuits. Thus, a critical next step is to understand how specific cell types and synapses generate gamma oscillations, mediate the effects of gamma oscillations on information processing, and/or undergo plasticity following the induction of gamma oscillations. Modulating these circuit loci, potentially in combination with other approaches such as cognitive training and brain stimulation, may yield potent and selective interventions for enhancing cognition in schizophrenia.
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Affiliation(s)
- Vikaas S Sohal
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, and Kavli Institute for Fundamental Neuroscience, University of California, San Francisco
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Advances in Cognitive Remediation Training in Schizophrenia: A Review. Brain Sci 2022; 12:brainsci12020129. [PMID: 35203893 PMCID: PMC8870375 DOI: 10.3390/brainsci12020129] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/07/2022] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
Cognitive Remediation Training (CRT) in schizophrenia has made great strides since its introduction in the 1990s. CRT was developed with the aim of improving the everyday functioning of individuals living with cognitive impairment. MEDLINE, PsychINFO, and Google Scholar were searched to extract peer-reviewed randomized controlled trials to produce the current review article. The aim of the present review is to summarize CRT effects on addressing cognitive changes in patients undergoing CRT as defined by the Cognitive Remediation Experts Workshop and to describe the areas of greatest impact in specific cognitive domains. Another area of this review aims to summarize the modalities of intervention (paper and pencil; computerized; home bound), the persistence of improvements, and their generalization to other domains of functioning. Finally, this review delineates barriers for wider dissemination of CRT, such as the transfer of research findings into clinical everyday practice and future developments of CRT.
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Clayson PE, Molina JL, Joshi YB, Thomas ML, Sprock J, Nungaray J, Swerdlow NR, Light GA. Evaluation of the frequency following response as a predictive biomarker of response to cognitive training in schizophrenia. Psychiatry Res 2021; 305:114239. [PMID: 34673326 DOI: 10.1016/j.psychres.2021.114239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/01/2021] [Accepted: 10/09/2021] [Indexed: 11/28/2022]
Abstract
Neurophysiological biomarkers of auditory processing show promise predicting outcomes following auditory-based targeted cognitive training (TCT) in schizophrenia, but the viability of the frequency following response (FFR) as a biomarker has yet to be examined, despite its ecological and face validity for auditory-based interventions. FFR is an event-related potential (ERP) that reflects early auditory processing. We predicted that schizophrenia patients would show acute- and longer-term FFR malleability in the context of TCT. Patients were randomized to either TCT (n = 30) or treatment as usual (TAU; n = 22), and electroencephalography was recorded during rapid presentation of an auditory speech stimulus before treatment, after one hour of training, and after 30 h of training. Whereas patients in the TCT group did not show changes in FFR after training, amplitude reductions were observed in the TAU. FFR was positively associated with performance on a measure of single word-in-noise perception in the TCT group, and with a measure of sentence-in-noise perception in both groups. Psychometric reliability analyses of FFR scores indicated high internal consistency but low one-hour and 12-week test-rest reliability. These findings support the dissociation between measures of speech discriminability along the hierarchy of cortical and subcortical early auditory information processing in schizophrenia.
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Affiliation(s)
- Peter E Clayson
- Department of Psychology, University of South Florida, University of California San Diego, 9500 Gilman Drive #0804 La Jolla, Tampa, CA 92093, USA
| | - Juan L Molina
- VISN 22 Mental Illness Research, Education and Clinical Center (MIRECC), San Diego VA Healthcare System, San Diego, CA, USA
| | - Yash B Joshi
- VISN 22 Mental Illness Research, Education and Clinical Center (MIRECC), San Diego VA Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Joyce Sprock
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - John Nungaray
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Neal R Swerdlow
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Gregory A Light
- VISN 22 Mental Illness Research, Education and Clinical Center (MIRECC), San Diego VA Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
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Ng HYH, Wu CW, Huang FY, Cheng YT, Guu SF, Huang CM, Hsu CF, Chao YP, Jung TP, Chuang CH. Mindfulness Training Associated With Resting-State Electroencephalograms Dynamics in Novice Practitioners via Mindful Breathing and Body-Scan. Front Psychol 2021; 12:748584. [PMID: 34777144 PMCID: PMC8581621 DOI: 10.3389/fpsyg.2021.748584] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/05/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives: Mindfulness-based stress reduction has been proven to improve mental health and quality of life. This study examined how mindfulness training and various types of mindfulness practices altered brain activity. Methods: Specifically, the spectral powers of scalp electroencephalography of the mindfulness-based stress reduction (MBSR) group (n=17) who underwent an 8-week MBSR training-including mindful breathing and body-scan-were evaluated and compared with those of the waitlist controls (n=14). Results: Empirical results indicated that the post-intervention effect of MBSR significantly elevated the resting-state beta powers and reduced resting-state delta powers in both practices; such changes were not observed in the waitlist control. Compared with mindful breathing, body-scanning resulted in an overall decline in electroencephalograms (EEG) spectral powers at both delta and low-gamma bands among trained participants. Conclusion: Together with our preliminary data of expert mediators, the aforementioned spectral changes were salient after intervention, but mitigated along with expertise. Additionally, after receiving training, the MBSR group's mindfulness and emotion regulation levels improved significantly, which were correlated with the EEG spectral changes in the theta, alpha, and low-beta bands. The results supported that MBSR might function as a unique internal processing tool that involves increased vigilant capability and induces alterations similar to other cognitive training.
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Affiliation(s)
- Hei-Yin Hydra Ng
- Research Center for Education and Mind Sciences, College of Education, National Tsing Hua University, Hsinchu, Taiwan
- Department of Educational Psychology and Counseling, College of Education, National Tsing Hua University, Hsinchu, Taiwan
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Changwei W. Wu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
- Brain and Consciousness Research Center, Shuang Ho Hospital-Taipei Medical University, Taipei, Taiwan
| | - Feng-Ying Huang
- Department of Education, National Taipei University of Education, Taipei, Taiwan
| | - Yu-Ting Cheng
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Shiao-Fei Guu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Fen Hsu
- Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Child Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yi-Ping Chao
- Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Tzyy-Ping Jung
- Research Center for Education and Mind Sciences, College of Education, National Tsing Hua University, Hsinchu, Taiwan
- Institute for Neural Computation and Institute of Engineering in Medicine, University of California, San Diego, San Diego, CA, United States
| | - Chun-Hsiang Chuang
- Research Center for Education and Mind Sciences, College of Education, National Tsing Hua University, Hsinchu, Taiwan
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Central auditory processing deficits in schizophrenia: Effects of auditory-based cognitive training. Schizophr Res 2021; 236:135-141. [PMID: 34500174 PMCID: PMC9259506 DOI: 10.1016/j.schres.2021.07.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/23/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sensory processing abnormalities are common in schizophrenia (SZ) and impact everyday functions, such as speech perception in noisy environments. Auditory-based targeted cognitive training (TCT) is a "bottom up" cognitive remediation intervention designed to enhance the speed and accuracy of low-level auditory information processing. However, the effects of TCT on behavioral measures of central auditory processing (CAP) and the role of CAP function on verbal learning outcomes in SZ are unknown. METHODS SZ (n = 42) and healthy subjects (CTL; n = 18) underwent comprehensive clinical, neurocognitive, and auditory assessments, including tests of hearing sensitivity and speech recognition (Words-in-Noise (WIN), Quick Speech-in-Noise (SIN)). SZ patients were randomized to receive either treatment-as-usual (TAU); or 30-h of TCT + TAU using a stratified, parallel design. SZ patients repeated assessments ~10-12 weeks later. RESULTS Patients exhibited deficits in both WIN (p < 0.05, d = 0.50) and SIN (p < 0.01, d = 0.63). A treatment × time interaction on WIN (p < 0.05, d = 0.74), but not SIN discriminability, was seen in the TCT group relative to TAU. Specific enhancements in the 4-dB over background range drove gains in WIN performance. Moreover, SZ patients with greater CAP deficits experienced robust gains in verbal learning after 30-h of TCT relative to SZ patients without CAP impairment (p < 0.01, d = 1.28). CONCLUSION Findings demonstrate that intensive auditory training enhances the fidelity of auditory processing and perception, such that specific CAP deficits were 'normalized' and were predictive of gains in verbal learning after TCT. It is conceivable that patients with deficiencies in CAP measures may benefit most from TCT and other interventions targeting auditory dysfunction in SZ.
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Raza MU, Sivarao DV. Test-retest reliability of tone- and 40 Hz train-evoked gamma oscillations in female rats and their sensitivity to low-dose NMDA channel blockade. Psychopharmacology (Berl) 2021; 238:2325-2334. [PMID: 33944972 DOI: 10.1007/s00213-021-05856-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
RATIONALE Schizophrenia patients consistently show deficits in sensory-evoked broadband gamma oscillations and click-evoked entrainment at 40 Hz, called the 40-Hz auditory steady-state response (ASSR). Since such evoked oscillations depend on cortical N-methyl D-aspartic acid (NMDA)-mediated network activity, they can serve as pharmacodynamic biomarkers in the preclinical and clinical development of drug candidates engaging these circuits. However, there are few test-retest reliability data in preclinical species, a prerequisite for within-subject testing paradigms. OBJECTIVE We investigated the long-term psychometric stability of these measures in a rodent model. METHODS Female rats with chronic epidural implants were used to record tone- and 40 Hz click-evoked responses at multiple time points and across six sessions, spread over 3 weeks. We assessed reliability using intraclass correlation coefficients (ICC). Separately, we used mixed-effects ANOVA to examine time and session effects. Individual subject variability was determined using the coefficient of variation (CV). Lastly, to illustrate the importance of long-term measure stability for within-subject testing design, we used low to moderate doses of an NMDA antagonist MK801 (0.025-0.15 mg/kg) to disrupt the evoked response. RESULTS We found that 40-Hz ASSR showed good reliability (ICC=0.60-0.75), while the reliability of tone-evoked gamma ranged from poor to good (0.33-0.67). We noted time but no session effects. Subjects showed a lower variance for ASSR over tone-evoked gamma. Both measures were dose-dependently attenuated by NMDA antagonism. CONCLUSION Overall, while both evoked gamma measures use NMDA transmission, 40-Hz ASSR showed superior psychometric properties of higher ICC and lower CV, relative to tone-evoked gamma.
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Affiliation(s)
- Muhammad Ummear Raza
- Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, VA Building 7, Room 324, Maple Ave, Johnson City, TN, 37604, USA
| | - Digavalli V Sivarao
- Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, VA Building 7, Room 324, Maple Ave, Johnson City, TN, 37604, USA.
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Yang H, Luo Y, Hu Q, Tian X, Wen H. Benefits in Alzheimer's Disease of Sensory and Multisensory Stimulation. J Alzheimers Dis 2021; 82:463-484. [PMID: 34057081 DOI: 10.3233/jad-201554] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Alzheimer's disease (AD) is a serious neurodegenerative disease, which seriously affects the behavior, cognition, and memory of patients. Studies have shown that sensory stimulation can effectively improve the cognition and memory of AD patients, and its role in brain plasticity and neural regulation is initially revealed. This paper aims to review the effect of various sensory stimulation and multisensory stimulation for AD, and to explain the possible mechanism, so as to provide some new ideas for further research in this field. We searched the Web of Science and PubMed databases (from 2000 to October 27, 2020) for literature on the treatment of AD with sensory and multisensory stimulation, including music therapy, aromatherapy, rhythmic (e.g., visual or acoustic) stimulation, light therapy, multisensory stimulation, and virtual reality assisted therapy, then conducted a systematic analysis. Results show these sensory and multisensory stimulations can effectively ameliorate the pathology of AD, arouse memory, and improve cognition and behaviors. What's more, it can cause brain nerve oscillation, enhance brain plasticity, and regulate regional cerebral blood flow. Sensory and multisensory stimulation are very promising therapeutic methods, and they play an important role in the improvement and treatment of AD, but their potential mechanism and stimulation parameters need to be explored and improved.
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Affiliation(s)
- Hong Yang
- Chongqing Key Laboratory of Neurobiology,Department of Neurobiology, School of Basic Medicine, Army Medical University, Chongqing, China.,Chongqing Medical Electronics Engineering Technology Research Center, Laboratory of Neural Regulation and Rehabilitation Technology, College of Bioengineering, Chongqing University, Chongqing, China
| | - Yinpei Luo
- Chongqing Medical Electronics Engineering Technology Research Center, Laboratory of Neural Regulation and Rehabilitation Technology, College of Bioengineering, Chongqing University, Chongqing, China
| | - Qingrong Hu
- Chongqing Medical Electronics Engineering Technology Research Center, Laboratory of Neural Regulation and Rehabilitation Technology, College of Bioengineering, Chongqing University, Chongqing, China
| | - Xuelong Tian
- Chongqing Medical Electronics Engineering Technology Research Center, Laboratory of Neural Regulation and Rehabilitation Technology, College of Bioengineering, Chongqing University, Chongqing, China
| | - Huizhong Wen
- Chongqing Key Laboratory of Neurobiology,Department of Neurobiology, School of Basic Medicine, Army Medical University, Chongqing, China
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de Filippis R, Gaetano R, Schoretsanitis G, Verde G, Oliveti CA, Kane JM, Segura-Garcia C, De Fazio P. Clozapine Management in Schizophrenia Inpatients: A 5-Year Prospective Observational Study of Its Safety and Tolerability Profile. Neuropsychiatr Dis Treat 2021; 17:2141-2150. [PMID: 34234440 PMCID: PMC8257059 DOI: 10.2147/ndt.s312095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/15/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Clozapine is well known for its efficacy and clinical superiority compared to other antipsychotics in treatment-resistant schizophrenia (TRS). However, it is frequently underutilized worldwide because of its acute adverse events, as well as for its long-term cardiometabolic and hematological consequences. OBJECTIVE The aim of the study was to evaluate 5-year safety in chronic TRS inpatients with continuous clozapine use. METHODS Patients with TRS and clozapine treatment were evaluated for 5 years. All participants were assessed using the Brief Psychiatric Rating Scale (BPRS), Glasgow Antipsychotic Side-effect Scale for Clozapine (GASS-C), Social Performance Scale (PSP) and Short Portable Mental Status Questionnaire (SPMSQ). Clinical, cardiometabolic and hematological data were collected periodically. General linear models (GLM) repeated measures controlling for CLZ dose were utilized to determine differences in variables across the time. RESULTS Overall, 189 inpatients were screened for study participation. The final sample included twenty-one TRS patients (16 males, 76%) with an average age of 57.6 years, all with 5-year continuous use of clozapine (mean dose 266 mg/day). There was not a significant effect of time on BPRS (p=0.774), PSP (p=0.855) and SPMSQ (p=0.066); differences remained not significant after controlling for CLZ dose (p=0.585, p=0.467 and p=0.105, respectively). No changes were found in blood and clinical parameters except for red blood cell count, which decreased over time (p=0.024; η2= 0.952). Patients reported a significant BMI decrease (-8.98 kg, p=0.008) between baseline and 5 years last observation. CONCLUSION The findings show how the application of a structured dietary, clinical and therapeutic monitoring program in psychiatric care facilities could allow the safe and effective long-term cardiometabolic and hematological management of clozapine. The unique role that clozapine plays in the current treatment of patients with TRS requires greater clinical awareness. Although its acute and chronic side effects are notorious, its safety management is feasible and broadens its potential practical application.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raffaele Gaetano
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Giuseppe Verde
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - John M Kane
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Cristina Segura-Garcia
- Psychiatry Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Individual Resonant Frequencies at Low-Gamma Range and Cognitive Processing Speed. J Pers Med 2021; 11:jpm11060453. [PMID: 34071027 PMCID: PMC8224604 DOI: 10.3390/jpm11060453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/03/2021] [Accepted: 05/21/2021] [Indexed: 02/04/2023] Open
Abstract
Brain electrophysiological activity within the low gamma frequencies (30–80 Hz) has been proposed to reflect information encoding and transfer processes. The 40-Hz auditory steady-state response (40-Hz ASSR) is frequently discussed in relation to changed cognitive processing in neuropsychiatric disorders. However, the relationship between ASSRs and cognitive functioning still remains unclear. Most of the studies assessed the single frequency ASSR, while the individual resonance frequency in the gamma range (30–60 Hz), also called individual gamma frequency (IGF), has received limited attention thus far. Nevertheless, IGF potentially might better reflect individual network characteristics than standardly utilized 40-Hz ASSRs. Here, we focused on the processing speed across different types of cognitive tasks and explored its relationship with responses at 40 Hz and at IGFs in an attempt to uncover how IGFs relate to certain aspects of cognitive functioning. We show that gamma activity is related to the performance speed on complex cognitive task tapping planning and problem solving, both when responses at 40 Hz and at IGFs were evaluated. With the individualized approach, the observed associations were found to be somewhat stronger, and the association seemed to primarily reflect individual differences in higher-order cognitive processing. These findings have important implications for the interpretation of gamma activity in neuropsychiatric disorders.
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Abstract
PURPOSE OF REVIEW To provide recent evidence on real-time neurofeedback (NFB) training for auditory verbal hallucinations (AVH) in schizophrenia patients. RECENT FINDINGS NFB is a promising technique that allows patients to gain control over their AVH by modulating their own speech-related/language-related networks including superior temporal gyrus (STG) and anterior cingulate cortex (ACC) using fMRI, fNIRS and EEG/MEG. A recent limited number of studies showed that while an EEG-based NFB study failed to regulate auditory-evoked potentials and reduce AVH, downregulation of STG hyperactivity and upregulation of ACC activity with fMRI-based NFB appear to alleviate treatment-resistant AVH in schizophrenia patients. A deeper understanding of AVH and development of more effective methodologies are still needed. SUMMARY Despite recent innovations in antipsychotics, many schizophrenia patients continue to suffer from treatment-resistant AVH and social dysfunctions. Recent studies suggested that real-time NFB shows promise in enabling patients to gain control over AVH by regulating their own speech-related/language-related networks. Although fMRI-NFB is suitable for regulating localized activity, EEG/MEG-NFB are ideal for regulating the ever-changing AVH. Although there are still many challenges including logistic complexity and burden on patients, we hope that such innovative real-time NFB trainings will help patients to alleviate severe symptoms and improve social functioning.
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Koshiyama D, Miyakoshi M, Joshi YB, Molina JL, Tanaka-Koshiyama K, Sprock J, Braff DL, Swerdlow NR, Light GA. Neural network dynamics underlying gamma synchronization deficits in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2021; 107:110224. [PMID: 33340619 PMCID: PMC8631608 DOI: 10.1016/j.pnpbp.2020.110224] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/06/2020] [Accepted: 12/09/2020] [Indexed: 01/09/2023]
Abstract
Gamma-band (40-Hz) activity is critical for cortico-cortical transmission and the integration of information across neural networks during sensory and cognitive processing. Patients with schizophrenia show selective reductions in the capacity to support synchronized gamma-band oscillations in response to auditory stimulation presented 40-Hz. Despite widespread application of this 40-Hz auditory steady-state response (ASSR) as a translational electroencephalographic biomarker for therapeutic development for neuropsychiatric disorders, the spatiotemporal dynamics underlying the ASSR have not been fully characterized. In this study, a novel Granger causality analysis was applied to assess the propagation of gamma oscillations in response to 40-Hz steady-state stimulation across cortical sources in schizophrenia patients (n = 426) and healthy comparison subjects (n = 293). Both groups showed multiple ASSR source interactions that were broadly distributed across brain regions. Schizophrenia patients showed distinct, hierarchically sequenced connectivity abnormalities. During the response onset interval, patients exhibited abnormal increased connectivity from the inferior frontal gyrus to the superior temporal gyrus, followed by decreased connectivity from the superior temporal to the middle cingulate gyrus. In the later portion of the ASSR response (300-500 ms), patients showed significantly increased connectivity from the superior temporal to the middle frontal gyrus followed by decreased connectivity from the left superior frontal gyrus to the right superior and middle frontal gyri. These findings highlight both the orchestration of distributed multiple sources in response to simple gamma-frequency stimulation in healthy subjects as well as the patterns of deficits in the generation and maintenance of gamma-band oscillations across the temporo-frontal sources in schizophrenia patients.
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Affiliation(s)
- Daisuke Koshiyama
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093-0804, USA
| | - Makoto Miyakoshi
- Swartz Center for Neural Computation, University of California San Diego, La Jolla, CA 92093-0559, USA.
| | - Yash B. Joshi
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093-0804, USA,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Juan L. Molina
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093-0804, USA,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA 92161, USA
| | | | - Joyce Sprock
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093-0804, USA,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - David L. Braff
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093-0804, USA,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Neal R. Swerdlow
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093-0804, USA
| | - Gregory A. Light
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093-0804, USA,VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA 92161, USA
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Koshiyama D, Miyakoshi M, Thomas ML, Joshi YB, Molina JL, Tanaka-Koshiyama K, Nungaray JA, Sprock J, Braff DL, Swerdlow NR, Light GA. Auditory-Based Cognitive Training Drives Short- and Long-Term Plasticity in Cortical Networks in Schizophrenia. ACTA ACUST UNITED AC 2020. [DOI: 10.1093/schizbullopen/sgaa065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Schizophrenia patients have widespread deficits in neurocognitive functioning linked to underlying abnormalities in gamma oscillations that are readily measured by the 40 Hz auditory steady-state response (ASSR). Emerging interventions such as auditory-based targeted cognitive training (TCT) improve neurocognitive function in patients. While acute ASSR changes after 1 hour of TCT predict clinical and cognitive gains after a 30-hour course of TCT, the neural substrates of underlying short- and long-term TCT interventions are unknown. To determine the neural substrates underlying TCT-associated ASSR changes, a novel data analysis method was applied to assess the effective connectivity of gamma-band ASSR among estimated cortical sources. In this study, schizophrenia patients (N = 52) were randomized to receive either a treatment as usual (TAU; N = 22) or TAU augmented with TCT (N = 30). EEG recordings were obtained immediately before (T0) and after 1 hour of either computer games (TAU) or cognitive training (TCT; T1), and at 65 ± 15 days (mean ± SD) post-randomization (T2). Results showed increased connectivity from the left ventral middle cingulate gyrus to the left posterior cingulate gyrus, accompanied by decreased connectivity from the left Rolandic operculum (a region that includes auditory cortex) to the right ventral middle cingulate gyrus after 1 hour of TCT. After 30 hours, decreased connectivity from the frontal cortex to a region near the calcarine sulcus were detected. Auditory-based cognitive training drives short- and long-term plasticity in cortical network functioning in schizophrenia patients. These findings may help us understand the mechanisms underlying cognitive training effects in schizophrenia patients and enhance the development of pro-cognitive therapeutics.
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Affiliation(s)
- Daisuke Koshiyama
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Makoto Miyakoshi
- Swartz Center for Neural Computation, University of California San Diego, La Jolla, CA
| | - Michael L Thomas
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Department of Psychology, Colorado State University, Fort Collins, CO
| | - Yash B Joshi
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA
| | - Juan L Molina
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | | | - John A Nungaray
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Joyce Sprock
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - David L Braff
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA
| | - Neal R Swerdlow
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Gregory A Light
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA
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