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Lopes JJ, Carruthers SP, Meyer D, Dean B, Rossell SL. Glutamatergic neurotransmission in schizophrenia: A systematic review and quantitative synthesis of proton magnetic resonance spectroscopy studies across schizophrenia spectrum disorders. Aust N Z J Psychiatry 2024:48674241254216. [PMID: 38812258 DOI: 10.1177/00048674241254216] [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: 05/31/2024]
Abstract
OBJECTIVE Studies using proton magnetic resonance spectroscopy reveal substantial inconsistencies in the levels of brain glutamate, glutamine and glutamate + glutamine across schizophrenia spectrum disorders. This systematic review employs qualitative and quantitative methods to analyse the patterns and relationships between glutamatergic metabolites, schizophrenia spectrum disorders and brain regions. METHODS A literature search was conducted using various databases with keywords including glutamate, glutamine, schizophrenia, psychosis and proton magnetic resonance spectroscopy. Inclusion criteria were limited to case-control studies that reported glutamatergic metabolite levels in adult patients with a schizophrenia spectrum disorder diagnosis - i.e. first-episode psychosis, schizophrenia, treatment-resistant schizophrenia and/or ultra-treatment-resistant schizophrenia - using proton magnetic resonance spectroscopy at 3 T or above. Pooled study data were synthesized and analysed. RESULTS A total of 92 studies met the inclusion criteria, including 2721 healthy controls and 2822 schizophrenia spectrum disorder participants. Glu levels were higher in the basal ganglia, frontal cortex and medial prefrontal of first-episode psychosis participants, contrasting overall lower levels in schizophrenia participants. For Gln, strong differences in metabolite levels were evident in the basal ganglia, dorsolateral prefrontal cortex and frontal cortex, with first-episode psychosis showing significantly higher levels in the basal ganglia. In glutamate + glutamine, higher metabolite levels were found across schizophrenia spectrum disorder groups, particularly in the basal ganglia and dorsolateral prefrontal cortex of treatment-resistant schizophrenia participants. Significant relationships were found between metabolite levels and medication status, clinical measures and methodological variables. CONCLUSION The review highlights abnormal glutamatergic metabolite levels throughout schizophrenia spectrum disorders and in specific brain regions. The review underscores the importance of standardized future research assessing glutamatergic metabolites using proton magnetic resonance spectroscopy due to considerable literature heterogeneity.
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Affiliation(s)
- Jamie J Lopes
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Sean P Carruthers
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Denny Meyer
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Brian Dean
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
- Molecular Psychiatry Laboratory, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia
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Ren H, Li Z, Li J, Zhou J, He Y, Li C, Wang Q, Chen X, Tang J. Correlation Between Cortical Thickness Abnormalities of the Olfactory Sulcus and Olfactory Identification Disorder and Persistent Auditory Verbal Hallucinations in Chinese Patients With Chronic Schizophrenia. Schizophr Bull 2024:sbae040. [PMID: 38577952 DOI: 10.1093/schbul/sbae040] [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: 04/06/2024]
Abstract
BACKGROUND AND HYPOTHESIS Persistent auditory verbal hallucinations (pAVHs) and olfactory identification impairment are common in schizophrenia (SCZ), but the neuroimaging mechanisms underlying both pAVHs and olfactory identification impairment are unclear. This study aimed to investigate whether pAVHs and olfactory identification impairment in SCZ patients are associated with changes in cortical thickness. STUDY DESIGN In this study, cortical thickness was investigated in 78 SCZ patients with pAVHs (pAVH group), 58 SCZ patients without AVHs (non-AVH group), and 83 healthy controls (HC group) using 3T magnetic resonance imaging. The severity of pAVHs was assessed by the Auditory Hallucination Rating Scale. Olfactory identification deficits were assessed using the Odor Stick Identification Test for Japanese (OSIT-J). In addition, the relationship between the severity of pAVHs and olfactory identification disorder and cortical thickness abnormalities was determined. STUDY RESULTS Significant reductions in cortical thickness were observed in the right medial orbital sulcus (olfactory sulcus) and right orbital sulcus (H-shaped sulcus) in the pAVH group compared to both the non-AVH and HC groups (P < .003, Bonferroni correction). Furthermore, the severity of pAVHs was found to be negatively correlated with the reduction in cortical thickness in the olfactory sulcus and H-shaped sulcus. Additionally, a decrease in cortical thickness in the olfactory sulcus showed a positive correlation with the OSIT-J scores (P < .05, false discovery rate correction). CONCLUSIONS Cortical thickness abnormalities in the olfactory sulcus may be a common neuroimaging mechanism for pAVHs and olfactory identification deficits in SCZ patients.
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Affiliation(s)
- Honghong Ren
- Department of Clinical Psychology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Clinical Psychology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zongchang Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jinguang Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jun Zhou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ying He
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chunwang Li
- Department of Radiology, Hunan Children's Hospital, Changsha, China
| | - Qianjin Wang
- Department of Clinical Psychology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Clinical Psychology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaogang Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jinsong Tang
- Department of Psychiatry, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Hunan Provincial Brain Hospital (The second people's Hospital of Hunan Province), Changsha, China
- Zigong Mental Health Center, Zigong, China
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Fan L, Liang L, Wang Y, Ma X, Yuan L, Ouyang L, He Y, Li Z, Li C, Chen X, Palaniyappan L. Glutamatergic basis of antipsychotic response in first-episode psychosis: a dual voxel study of the anterior cingulate cortex. Neuropsychopharmacology 2024; 49:845-853. [PMID: 37752221 PMCID: PMC10948866 DOI: 10.1038/s41386-023-01741-x] [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: 06/12/2023] [Revised: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
A subgroup of patients with schizophrenia is believed to have aberrant excess of glutamate in the frontal cortex; this subgroup is thought to show poor response to first-line antipsychotic treatments that focus on dopamine blockade. If we can identify this subgroup early in the course of illness, we can reduce the repeated use of first-line antipsychotics and potentially stratify first-episode patients to intervene early with second-line treatments such as clozapine. The use of proton magnetic resonance spectroscopy (1H-MRS) to measure glutamate and Glx (glutamate plus glutamine) may provide a means for such a stratification. We must first establish if there is robust evidence linking elevations in anterior cingulate cortex (ACC) glutamate metabolites to poor response, and determine if the use of antipsychotics worsens the glutamatergic excess in eventual nonresponders. In this study, we estimated glutamate levels at baseline in 42 drug-naive patients with schizophrenia. We then treated them all with risperidone at a standard dose range of 2-6 mg/day and followed them up for 3 months to categorize their response status. We expected to see baseline "hyperglutamatergia" in nonresponders, and expected this to worsen over time at the follow-up. In line with our predictions, nonresponders had higher glutamate than responders, but patients as a group did not differ in glutamate and Glx from the healthy control (HC) group before treatment-onset (F1,79 = 3.20, p = 0.046, partial η2 = 0.075). Glutamatergic metabolites did not change significantly over time in both nonresponders and responders over the 3 months of antipsychotic exposure (F1,31 = 1.26, p = 0.270, partial η2 = 0.039). We conclude that the use of antipsychotics without prior knowledge of later response delays symptom relief in a subgroup of first-episode patients, but does not worsen the glutamatergic excess seen at the baseline. Given the current practice of nonstratified use of antipsychotics, longer-time follow-up MRS studies are required to see if improvement in symptoms accompanies a dynamic shift in glutamate profile.
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Affiliation(s)
- Lejia Fan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Liangbing Liang
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Yujue Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoqian Ma
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Liu Yuan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lijun Ouyang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ying He
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zongchang Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chunwang Li
- Department of Radiology, Hunan Children's Hospital, Changsha, China
| | - Xiaogang Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China.
| | - Lena Palaniyappan
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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Song Y, Zöllner HJ, Hui SCN, Hupfeld KE, Oeltzschner G, Edden RAE. Impact of gradient scheme and non-linear shimming on out-of-voxel echo artifacts in edited MRS. NMR IN BIOMEDICINE 2023; 36:e4839. [PMID: 36196802 PMCID: PMC9845189 DOI: 10.1002/nbm.4839] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 05/30/2023]
Abstract
Out-of-voxel (OOV) signals are common spurious echo artifacts in MRS. These signals often manifest in the spectrum as very strong "ripples," which interfere with spectral quantification by overlapping with targeted metabolite resonances. Dephasing optimization through coherence order pathway selection (DOTCOPS) gradient schemes are algorithmically optimized to suppress all potential alternative coherence transfer pathways (CTPs), and should suppress unwanted OOV echoes. In addition, second-order shimming uses non-linear gradient fields to maximize field homogeneity inside the voxel, which unfortunately increases the diversity of local gradient fields outside of the voxel. Given that strong local spatial B0 gradients can refocus unintended CTPs, it is possible that OOVs are less prevalent when only linear first-order shimming is applied. Here we compare the size of unwanted OOV signals in Hadamard-edited (HERMES) data acquired with either a local gradient scheme (which we refer to here as "Shared") or DOTCOPS, and with first- or second-order shimming. We collected data from 15 healthy volunteers in two brain regions (voxel size 30 × 26 × 26 mm3 ) from which it is challenging to acquire MRS data: medial prefrontal cortex and left temporal cortex. Characteristic OOV echoes were seen in both GABA- and GSH-edited spectra for both brain regions, gradient schemes, and shimming approaches. A linear mixed-effect model revealed a statistically significant difference in the average residual based on the gradient scheme in both GABA- (p < 0.001) and GSH-edited (p < 0.001) spectra: that is, the DOTCOPS gradient scheme resulted in smaller OOV artifacts compared with the Shared scheme. There were no significant differences in OOV artifacts associated with shimming method. Thus, these results suggest that the DOTCOPS gradient scheme for J-difference-edited PRESS acquisitions yields spectra with smaller OOV echo artifacts than the Shared gradient scheme implemented in a widely disseminated editing sequence.
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Affiliation(s)
- Yulu Song
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Helge J Zöllner
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Steve C N Hui
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Kathleen E Hupfeld
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Georg Oeltzschner
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Richard A E Edden
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
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Ren H, Wang Q, Li C, Li J, Dai L, Dong M, Zhou J, He J, Liao Y, He Y, Li Z, Chen X, Tang J. Correlation between abnormal N-acetyl-aspartate levels in posterior cingulate cortex and persistent auditory verbal hallucinations in Chinese patients with chronic schizophrenia. Asian J Psychiatr 2023; 80:103416. [PMID: 36577325 DOI: 10.1016/j.ajp.2022.103416] [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: 11/12/2022] [Revised: 12/03/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
The aim of this study was to investigate the relationship between persistent auditory verbal hallucinations (pAVHs) and N-acetyl-aspartate (NAA) levels in posterior cingulate cortex (PCC). 117 schizophrenia (SCZ) patients (61 pAVHs and 56 non-AVHs) and 66 healthy controls were included. The P3 item of the Positive and Negative Syndrome Scale and the Auditory Hallucinations subscale of the Psychotic Symptom Rating Scale were used to assess the severity of pAVHs. NAA levels were significantly lower in the AVHs group, and were negatively correlated with pAVHs. Therefore, increasing the NAA levels in PCC may be helpful in treating pAVHs.
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Affiliation(s)
- Honghong Ren
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Qianjin Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chunwang Li
- Department of Radiology, Hunan Children's Hospital, Changsha, Hunan, China
| | - Jinguang Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Lulin Dai
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Min Dong
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jun Zhou
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jingqi He
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yanhui Liao
- Department of Psychiatry, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ying He
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zongchang Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Xiaogang Chen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Jinsong Tang
- Department of Psychiatry, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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