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Yang YS, Smucny J, Zhang H, Maddock RJ. Meta-analytic evidence of elevated choline, reduced N-acetylaspartate, and normal creatine in schizophrenia and their moderation by measurement quality, echo time, and medication status. Neuroimage Clin 2023; 39:103461. [PMID: 37406595 PMCID: PMC10509531 DOI: 10.1016/j.nicl.2023.103461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Brain metabolite abnormalities measured with magnetic resonance spectroscopy (MRS) provide insight into pathological processes in schizophrenia. Prior meta-analyses have not yet answered important questions about the influence of clinical and technical factors on neurometabolite abnormalities and brain region differences. To address these gaps, we performed an updated meta-analysis of N-acetylaspartate (NAA), choline, and creatine levels in patients with schizophrenia and assessed the moderating effects of medication status, echo time, measurement quality, and other factors. METHODS We searched citations from three earlier meta-analyses and the PubMed database after the most recent meta-analysis to identify studies for screening. In total, 113 publications reporting 366 regional metabolite datasets met our inclusion criteria and reported findings in medial prefrontal cortex (MPFC), dorsolateral prefrontal cortex, frontal white matter, hippocampus, thalamus, and basal ganglia from a total of 4445 patient and 3944 control observations. RESULTS Patients with schizophrenia had reduced NAA in five of the six brain regions, with a statistically significant sparing of the basal ganglia. Patients had elevated choline in the basal ganglia and both prefrontal cortical regions. Patient creatine levels were normal in all six regions. In some regions, the NAA and choline differences were greater in studies enrolling predominantly medicated patients compared to studies enrolling predominantly unmedicated patients. Patient NAA levels were more reduced in hippocampus and frontal white matter in studies using longer echo times than those using shorter echo times. MPFC choline and NAA abnormalities were greater in studies reporting better metabolite measurement quality. CONCLUSIONS Choline is elevated in the basal ganglia and prefrontal cortical regions, suggesting regionally increased membrane turnover or glial activation in schizophrenia. The basal ganglia are significantly spared from the well-established widespread reduction of NAA in schizophrenia suggesting a regional difference in disease-associated factors affecting NAA. The echo time findings agree with prior reports and suggest microstructural changes cause faster NAA T2 relaxation in hippocampus and frontal white matter in schizophrenia. Separating the effects of medication status and illness chronicity on NAA and choline abnormalities will require further patient-level studies. Metabolite measurement quality was shown to be a critical factor in MRS studies of schizophrenia.
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Affiliation(s)
- Yvonne S Yang
- VISN22 Mental Illness Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095, USA.
| | - Jason Smucny
- Imaging Research Center, University of California, Davis, 4701 X Street, Sacramento, CA 95817, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Davis, 2230 Stockton Blvd, Sacramento, CA 95817, USA
| | - Huailin Zhang
- Department of Internal Medicine, Adventist Health White Memorial, 1720 E Cesar E Chavez Ave, Los Angeles, CA 90033, USA
| | - Richard J Maddock
- Imaging Research Center, University of California, Davis, 4701 X Street, Sacramento, CA 95817, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Davis, 2230 Stockton Blvd, Sacramento, CA 95817, USA.
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Neurometabolic and functional changes of default-mode network relate to clinical recovery in first-episode psychosis patients: A longitudinal 1H-MRS and fMRI study. Neuroimage Clin 2022; 34:102970. [PMID: 35240468 PMCID: PMC8889416 DOI: 10.1016/j.nicl.2022.102970] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/12/2022] [Accepted: 02/21/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Antipsychotic treatment has improved the disrupted functional connectivity (FC) and neurometabolites levels of the default mode network (DMN) in schizophrenia patients, but a direct relationship between FC change, neurometabolic level alteration, and symptom improvement has not been built. This study examined the association between the alterations in DMN FC, the changes of neurometabolites levels in the medial prefrontal cortex (MPFC), and the improvementsinpsychopathology in a longitudinal study of drug-naïve first-episode psychosis (FEP) patients. METHODS Thirty-two drug-naïve FEP patients and 30 matched healthy controls underwent repeated assessments with the Positive and Negative Syndrome Scale (PANSS) and 3T proton magnetic resonance spectroscopy as well as resting-state functional magnetic resonance imaging. The levels of γ-aminobutyric acid, glutamate, N-acetyl-aspartate in MPFC, and the FC of DMN were measured. After 8-week antipsychotic treatment, 24 patients were re-examined. RESULTS After treatment, the changes in γ-aminobutyric acid were correlated with the alterations of FC between the MPFC and DMN, while the changes in N-acetyl-aspartate were associated with the alterations of FC between the posterior cingulate cortex/precuneus and DMN. The FC changes of both regions were correlated with patients PANSS positive score reductions. The structural equation modeling analyses revealed that the changes of DMN FC mediated the relationship between the changes of neurometabolites and the symptom improvements of the patients. CONCLUSIONS The derived neurometabolic-functional changes underlying the clinical recovery provide insights into the prognosis of FEP patients. It is noteworthy that this is an exploratory study, and future work with larger sample size is needed to validate our findings.
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Bissonnette JN, Francis AM, MacNeil S, Crocker CE, Tibbo PG, Fisher DJ. Glutamate and N-Acetylaspartate Alterations Observed in Early Phase Psychosis: A Systematic Review of Proton Magnetic Resonance Spectroscopy Studies. Psychiatry Res Neuroimaging 2022; 321:111459. [PMID: 35183897 DOI: 10.1016/j.pscychresns.2022.111459] [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: 10/29/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 11/27/2022]
Abstract
Glutamate and N-acetylaspartate have been investigated in the neuropathology of chronic schizophrenia, with fewer studies focusing on early phase psychosis. Additionally, there has been little review and synthesis of the literature focused on multiple brain regions. This systematic review aims to provide a clear report of the current state of research on glutamate and n-acetylaspartate concentrations in early phase psychosis (defined as the first five years following psychosis onset) in multiple brain regions. Existing literature was searched systematically to compile reports of glutamate/glutamate+glutamine (Glx) and n-acetylaspartate absolute levels and ratios in both male and female individuals with early phase psychosis. Reports on glutamate/Glx concentrations in the medial prefrontal region and thalamus were varied, but the majority of reports suggested no alterations in EPP. No studies reported glutamate alterations in the hippocampus or cerebellum. There was no evidence for n-acetylaspartate alterations in the caudate, basal ganglia, and medial prefrontal cortex, and minimal evidence for NAA reductions in the thalamus, anterior cingulate cortex, and hippocampus. Future research should focus on the regions that are less commonly reported, and should aim to explore possible confounds, such as medication status and substance use.
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Affiliation(s)
- J N Bissonnette
- Department of Psychiatry, Dalhousie University, Halifax, NS.
| | - A M Francis
- Department of Psychology, Saint Mary's University, Halifax, NS.
| | - S MacNeil
- Department of Psychology, Mount Saint Vincent University, Halifax, NS.
| | - C E Crocker
- Department of Psychiatry, Dalhousie University, Halifax, NS; Nova Scotia Early Psychosis Program, Halifax, NS; Department of Diagnostic Imaging, Dalhousie University, Halifax, NS.
| | - P G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, NS; Nova Scotia Early Psychosis Program, Halifax, NS.
| | - D J Fisher
- Department of Psychiatry, Dalhousie University, Halifax, NS; Department of Psychology, Saint Mary's University, Halifax, NS; Department of Psychology, Mount Saint Vincent University, Halifax, NS.
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Smesny S, Berberich D, Gussew A, Schönfeld N, Langbein K, Walther M, Reichenbach JR. Alterations of neurometabolism in the dorsolateral prefrontal cortex and thalamus in transition to psychosis patients change under treatment as usual - A two years follow-up 1H/ 31P-MR-spectroscopy study. Schizophr Res 2021; 228:7-18. [PMID: 33429152 DOI: 10.1016/j.schres.2020.11.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/22/2020] [Accepted: 11/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The ultra-high risk (UHR) paradigm allows early contact with patients developing acute psychosis and the study of treatment effects on the underlying pathology. METHODS 29 patients with first acute psychosis according to CAARMS criteria (transition patients, TP) (T0) and thereof 22 patients after two-year follow-up (mean 788 d) (T1) underwent 1H-/31P-MR spectroscopy of the prefrontal (DLPFC) and anterior midcingulate (aMCC) cortices and the thalamus. N-acetylaspartate (NAA), glutamate (Glu, Glx), energy (PCr, ATP) and phospholipid metabolites (PME, PDE) were compared to 27 healthy controls by ANCOVA and correlated with patients' symptom ratings (BPRS-E, SCL-90R). For longitudinal analysis, linear mixed model (LMM) and ANCOVA for repeated measures were used. RESULTS DLPFC: In patients, NAA and PME were decreased bilaterally and Glu on the left side at T0. Left-sided Glu and NAA (trend) and bilateral Glx increased during follow-up. Thalamus: In TP, bilateral NAA, left-sided Glu and right-sided Glx were decreased at T0; bilateral NAA and left-sided Glx increased during follow-up. aMCC: In TP, bilateral NAA, right-sided Glu, and bilateral PME and PDE were decreased, while left-sided PCr was increased at T0. No changes were observed during follow-up. CONCLUSION Regardless of the long-term diagnosis, the psychotic state of illness includes disturbed neuronal function in the DLPFC, thalamus and aMCC. Treatment-as-usual (TAU), including antipsychotic/antidepressant medication and supportive psychotherapy, had an effect on the thalamo-frontal area but not or less pronounced on the neurometabolic deficits of the aMCC.
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Affiliation(s)
- Stefan Smesny
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany.
| | - Diana Berberich
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
| | - Alexander Gussew
- Department of Radiology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, D-06120 Halle (Saale), Germany
| | - Nils Schönfeld
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
| | - Kerstin Langbein
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
| | - Mario Walther
- Jena University of Applied Sciences, Department of Fundamental Sciences, Carl-Zeiss-Promenade 2, D-07745 Jena, Germany
| | - Jürgen R Reichenbach
- Medical Physics Group, Department of Diagnostic and Interventional Radiology, Jena University Hospital, Philosophenweg 3, D-07740 Jena, Germany
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Proton Magnetic Resonance Spectroscopy of N-acetyl Aspartate in Chronic Schizophrenia, First Episode of Psychosis and High-Risk of Psychosis: A Systematic Review and Meta-Analysis. Neurosci Biobehav Rev 2020; 119:255-267. [PMID: 33068555 DOI: 10.1016/j.neubiorev.2020.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/01/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023]
Abstract
N-acetyl-aspartate (NAA) is a readily measured marker of neuronal metabolism. Previous analyses in schizophrenia have shown NAA levels are low in frontal, temporal and thalamic regions, but may be underpowered to detect effects in other regions, in high-risk states and in first episode psychosis. We searched for magnetic resonance spectroscopy studies comparing NAA in chronic schizophrenia, first episode psychosis and high risk of psychosis to controls. 182 studies were included and meta-analysed using a random-effects model for each region and illness stage. NAA levels were significantly lower than controls in the frontal lobe [Hedge's g = -0.36, p < 0.001], hippocampus [-0.52, p < 0.001], temporal lobe [-0.35, p = 0.031], thalamus [-0.32, p = 0.012] and parietal lobe [-0.25, p = 0.028] in chronic schizophrenia, and lower than controls in the frontal lobe [-0.26, p = 0.002], anterior cingulate cortex [-0.24, p = 0.016] and thalamus [-0.28, p = 0.028] in first episode psychosis. NAA was lower in high-risk of psychosis in the hippocampus [-0.20, p = 0.049]. In schizophrenia, NAA alterations appear to begin in hippocampus, frontal cortex and thalamus, and extend later to many other regions.
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Liu F, Huang J, Hei G, Wu R, Liu Z. Effects of sulforaphane on cognitive function in patients with frontal brain damage: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e037543. [PMID: 33067279 PMCID: PMC7569949 DOI: 10.1136/bmjopen-2020-037543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Many patients with frontal brain damage show serious cognitive function deficits, which hamper their quality of life and result in poor clinical outcomes. Preclinical research has shown that sulforaphane can significantly improve spatial localisation and working memory impairment after brain injury. The primary aim of this double-blind randomised controlled clinical trial is to assess the efficacy of sulforaphane for improving cognitive function in patients with frontal brain damage. METHODS AND ANALYSIS Ninety eligible patients will be randomly allocated to an active treatment or a placebo group in a 2:1 ratio. Participants will undergo a series of cognitive and neuropsychiatric tests at baseline (week 0) and after 12 weeks to determine the effect of sulforaphane on cognition. Magnetic resonance spectrum of the brain will be studied using the 3T MRIs of the brain to detect brain metabolites markers, including N-acetyl aspartate, glutamate (Glu), glutathione (GSH) and γ-aminobutyric acid (GABA). Blood brain-derived neurotrophic factor, Glu, GSH and GABA levels and gut microbiota will also be assessed over this period. This study will also evaluate long-term outcomes of brain trauma, brain tumours and cerebrovascular disease via exploratory analyses. The primary outcome will be the difference in scores of a battery of cognitive tests after 12 weeks of sulforaphane treatment. The secondary outcomes will be changes in the Functional Activities Questionnaire (FAQ), the Patient Health Questionnaire (PHQ-9), the Self-Rating Anxiety Scale, the changes in T1-weighted MRI and resting-state functional MRI findings, and changes in brain and blood metabolic markers and gut microbiota at weeks 0 and 12. We expect that sulforaphane will yield favourable results in treating memory and learning deficits for patients with frontal brain damage. Cognitive functional treatment may also improve brain trauma, brain tumours and cerebrovascular outcomes. ETHICS AND DISSEMINATION The study protocol has been approved by the Medical Ethics committee of the Xiangya Hospital of Central South University (No. 2017121019). The results will be disseminated in peer-reviewed journals and at international conferences. TRIAL REGISTRATION NUMBER This trial was registered on Clinicaltrials.gov on 31 January 2020 (NCT04252261). The protocol version is V.1.0 (20 December 2019).
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Affiliation(s)
- Fangkun Liu
- Department of Neurosurgery, Central South University (CSU), 410008, Changsha, Hunan, China
| | - Jing Huang
- Department of Psychiatry, the Second Xiangya Hospital, Central South University, 410011, Changsha, Hunan, China; Mental Health Institute of the Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, 410011, Changsha, Hunan, China
| | - Gangrui Hei
- Department of Psychiatry, the Second Xiangya Hospital, Central South University, 410011, Changsha, Hunan, China; Mental Health Institute of the Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, 410011, Changsha, Hunan, China
| | - Renrong Wu
- Department of Psychiatry, the Second Xiangya Hospital, Central South University, 410011, Changsha, Hunan, China; Mental Health Institute of the Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, 410011, Changsha, Hunan, China
| | - Zhixiong Liu
- Department of Neurosurgery, Central South University (CSU), 410008, Changsha, Hunan, China
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Li W, Xiang Q, Liu D, Li Y. Disrupted Coupling Between NAA and Functional Connectivity in Ventromedial Prefrontal Cortex of Drug-Naïve First-Episode Psychosis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:1738-1741. [PMID: 33018333 DOI: 10.1109/embc44109.2020.9176293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Ventromedial prefrontal cortex (vmPFC) is an important brain region involved in many psychological functions. Previous neuroimaging studies have shown disrupted function and altered metabolic level within vmPFC of schizophrenia (SCZ) patients. However, the linkage between the functional connectivity and its underlying neurobiological mechanism in SCZ remains unclear. In this study, we aimed to investigate the altered relationship between the functional connectivity strength (FCS) and metabolic concentrations within vmPFC in drug-naïve first-episode psychosis (FEP) patients using a combined functional magnetic resonance imaging (fMRI) and single-voxel proton magnetic resonance spectroscopy (1H- MRS) technique. There were 26 drug-naïve FEP patients and 27 matched healthy controls participated this study. We have found altered correlation between FCS and N-acetylaspartate (NAA) in drug-naïve FEP patients. In addition, the glutamate and glutamine compounds (Glx) and NAA concentrations were positively correlated with Positive and Negative Symptoms Scale (PANSS) total scores. Our findings revealed the disrupted functional-metabolic coupling within vmPFC in drug-naïve FEP patients and provided useful insights in understanding the etiology of SCZ.
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Zong X, Hu M, Pantazatos SP, Mann JJ, Wang G, Liao Y, Liu ZC, Liao W, Yao T, Li Z, He Y, Lv L, Sang D, Tang J, Chen H, Zheng J, Chen X. A Dissociation in Effects of Risperidone Monotherapy on Functional and Anatomical Connectivity Within the Default Mode Network. Schizophr Bull 2019; 45:1309-1318. [PMID: 30508134 PMCID: PMC6811838 DOI: 10.1093/schbul/sby175] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Respective changes in functional and anatomical connectivities of default mode network (DMN) after antipsychotic treatment have been reported. However, alterations in structure-function coupling after treatment remain unknown. We performed diffusion tensor imaging (DTI) and resting-state functional magnetic resonance imaging in 42 drug-naive first-episode schizophrenia patients (FESP) both at baseline and after 8-weeks risperidone monotherapy, and in 38 healthy volunteers. Independent component analysis was used to assess voxel-wise DMN synchrony. A 3-step procedure was used to trace fiber paths between DMN components. Structure-function couplings were assessed by Pearson's correlations between mean fractional anisotropy and temporal correlation coefficients in major tracts of DMN. Pretreatment, FESP showed impaired functional connectivity in posterior cingulate cortex/precuneus (PCC/PCUN) and medial prefrontal cortex (mPFC), but no abnormalities in fibers connecting DMN components. After treatment, there were significant increases in functional connectivities of PCC/PCUN. Increases in functional connectivity between PCC/PCUN and mPFC correlated with improvement in positive symptoms. The structure-function coupling in tracts connecting PCC/PCUN and bilateral medial temporal lobes decreased after treatment. No alterations in DMN fiber integrity were detected. This combination of functional and anatomical findings in FESP contributes novel evidence related to neurobehavioral treatment effects. Increased functional connectivities between PCC/PCUN and mPFC may be treatment response biomarkers for positive symptoms. Increases in functional connectivities, no alterations in fiber integrity, combined with decreases in structural-functional coupling, suggest that DMN connectivities may be dissociated by modality after 8-week treatment. Major limitations of this study, however, include lack of repeat scans in healthy volunteers and control group of patients taking placebo or comparator antipsychotics.
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Affiliation(s)
- Xiaofen Zong
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China,Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Division of Molecular Imaging and Neuropathology, Columbia University and New York State Psychiatric Institute, New York, NY
| | - Maolin Hu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China,Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Division of Molecular Imaging and Neuropathology, Columbia University and New York State Psychiatric Institute, New York, NY
| | - Spiro P Pantazatos
- Division of Molecular Imaging and Neuropathology, Columbia University and New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York, NY
| | - J John Mann
- Division of Molecular Imaging and Neuropathology, Columbia University and New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York, NY
| | - Gaohua Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yanhui Liao
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhong-Chun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Wei Liao
- Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Tao Yao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zongchang Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ying He
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Luxian Lv
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Deen Sang
- Department of Psychiatry, Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Jinsong Tang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China,Mental Health Institute of Central South University, Changsha, Hunan, China,National Clinical Research Center on Mental Disorders (Xiangya), National Technology Institute on Mental Disorders, Changsha, Hunan, China,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Huafu Chen
- Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Junjie Zheng
- Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xiaogang Chen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China,Mental Health Institute of Central South University, Changsha, Hunan, China,National Clinical Research Center on Mental Disorders (Xiangya), National Technology Institute on Mental Disorders, Changsha, Hunan, China,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China,To whom correspondence should be addressed; Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; tel: +86-731-85531571, fax: +86-731-85531571, e-mail:
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Newton R, Rouleau A, Nylander AG, Loze JY, Resemann HK, Steeves S, Crespo-Facorro B. Diverse definitions of the early course of schizophrenia-a targeted literature review. NPJ SCHIZOPHRENIA 2018; 4:21. [PMID: 30323274 PMCID: PMC6189105 DOI: 10.1038/s41537-018-0063-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 01/07/2023]
Abstract
Schizophrenia is a debilitating psychiatric disorder and patients experience significant comorbidity, especially cognitive and psychosocial deficits, already at the onset of disease. Previous research suggests that treatment during the earlier stages of disease reduces disease burden, and that a longer time of untreated psychosis has a negative impact on treatment outcomes. A targeted literature review was conducted to gain insight into the definitions currently used to describe patients with a recent diagnosis of schizophrenia in the early course of disease ('early' schizophrenia). A total of 483 relevant English-language publications of clinical guidelines and studies were identified for inclusion after searches of MEDLINE, MEDLINE In-Process, relevant clinical trial databases and Google for records published between January 2005 and October 2015. The extracted data revealed a wide variety of terminology and definitions used to describe patients with 'early' or 'recent-onset' schizophrenia, with no apparent consensus. The most commonly used criteria to define patients with early schizophrenia included experience of their first episode of schizophrenia or disease duration of less than 1, 2 or 5 years. These varied definitions likely result in substantial disparities of patient populations between studies and variable population heterogeneity. Better agreement on the definition of early schizophrenia could aid interpretation and comparison of studies in this patient population and consensus on definitions should allow for better identification and management of schizophrenia patients in the early course of their disease.
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Affiliation(s)
- Richard Newton
- Austin Health, University of Melbourne, Melbourne, VIC, Australia.,Peninsula Health, Frankston, VIC, Australia
| | | | | | | | | | | | - Benedicto Crespo-Facorro
- Department of Medicine & Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Santander, Spain
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Wu Q, Qi C, Long J, Liao Y, Wang X, Xie A, Liu J, Hao W, Tang Y, Yang B, Liu T, Tang J. Metabolites Alterations in the Medial Prefrontal Cortex of Methamphetamine Users in Abstinence: A 1H MRS Study. Front Psychiatry 2018; 9:478. [PMID: 30420814 PMCID: PMC6215956 DOI: 10.3389/fpsyt.2018.00478] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 09/12/2018] [Indexed: 11/13/2022] Open
Abstract
Background: The medial prefrontal cortex (mPFC) contains various neurotransmitter systems and plays an important role in drug use. Broad body of literature on how methamphetamine (MA) affects the structure and metabolism in the animal's mPFC is emerging, while the effects on metabolites of mPFC among human is still unclear. In this study, proton magnetic resonance spectroscopy (1H MRS) was used to measure metabolites of mPFC in methamphetamine dependent subjects. Methods: Sixty-one subjects with a history of MA dependence (fulfiled the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria) and 65 drug-naïve control subjects (age19-45) completed 1H MRS scans using 3.0T Siemens MRI scanner. Single voxel spectra were acquired from the mPFC bilaterally using a point resolved spectroscopy sequence (PRESS). The 1H MRS data were automatically fit with linear combination model for quantification of metabolite levels of n-acetyl-aspartate (NAA), myo-inositol (mI), glycerophosphocholine plus phosphocholine(GPC+PC), phosphocreatine plus creatine (PCr+Cr), and glutamate (Glu). Metabolite levels were reported as ratios to PCr+Cr. Results: The MA group showed a significant reduction in NAA/PCr+Cr ratio and elevation in Glu/PCr+Cr ratio and mI/PCr+Cr ratio, compared with healthy control. No significant correlation was found between metabolite ratios and MA use variables. Conclusions: MA use is associated with a significant increased Glu/PCr+Cr ratio, mI/PCr+Cr ratio and reduced NAA/PCr+Cr ratio in the mPFC of MA dependence subjects. These findings suggest that Glu may play a key role in MA induced neurotoxicity.
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Affiliation(s)
- Qiuxia Wu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Mental Health Institute, The Second Xiangya Hospital, Central South University, Changsha, China
- Chinese National Clinical Research Center on Mental Disorders, Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center on Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, United States
| | - Chang Qi
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Mental Health Institute, The Second Xiangya Hospital, Central South University, Changsha, China
- Chinese National Clinical Research Center on Mental Disorders, Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center on Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Jiang Long
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Mental Health Institute, The Second Xiangya Hospital, Central South University, Changsha, China
- Chinese National Clinical Research Center on Mental Disorders, Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center on Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Yanhui Liao
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Mental Health Institute, The Second Xiangya Hospital, Central South University, Changsha, China
- Chinese National Clinical Research Center on Mental Disorders, Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center on Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Xuyi Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Mental Health Institute, The Second Xiangya Hospital, Central South University, Changsha, China
- Chinese National Clinical Research Center on Mental Disorders, Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center on Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - An Xie
- Department of Radiology, Hunan Provincial People's Hospital, Changsha, China
| | - Jianbin Liu
- Department of Radiology, Hunan Provincial People's Hospital, Changsha, China
| | - Wei Hao
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Mental Health Institute, The Second Xiangya Hospital, Central South University, Changsha, China
- Chinese National Clinical Research Center on Mental Disorders, Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center on Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Yiyuan Tang
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, United States
| | - Baozhu Yang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Tieqiao Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Mental Health Institute, The Second Xiangya Hospital, Central South University, Changsha, China
- Chinese National Clinical Research Center on Mental Disorders, Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center on Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Jinsong Tang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Mental Health Institute, The Second Xiangya Hospital, Central South University, Changsha, China
- Chinese National Clinical Research Center on Mental Disorders, Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center on Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
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11
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Zhang X, Zhang Y, Liao J, Jiang S, Yan J, Yue W, Zhang D, Yan H. Progressive Grey Matter Volume Changes in Patients with Schizophrenia over 6 Weeks of Antipsychotic Treatment and Their Relationship to Clinical Improvement. Neurosci Bull 2018; 34:816-826. [PMID: 29779085 PMCID: PMC6129241 DOI: 10.1007/s12264-018-0234-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/05/2018] [Indexed: 12/20/2022] Open
Abstract
Cross-sectional and longitudinal studies have identified widespread and progressive grey matter volume (GMV) reductions in schizophrenia, especially in the frontal lobe. In this study, we found a progressive GMV decrease in the rostral medial frontal cortex (rMFC, including the anterior cingulate cortex) in the patient group during a 6-week follow-up of 40 patients with schizophrenia and 31 healthy controls well-matched for age, gender, and education. The higher baseline GMV in the rMFC predicted better improvement in the positive score on the Positive and Negative Syndrome Scale (PANSS), and this might be related to the improved reality-monitoring. Besides, a higher baseline GMV in the posterior rMFC predicted better remission of general symptoms, and a lesser GMV reduction in this region was correlated with better remission of negative symptoms, probably associated with ameliorated self-referential processing and social cognition. Besides, a shorter disease course and higher educational level contributed to better improvement in the general psychopathological PANSS score, and a family history was negatively associated with improvement of the negative and total PANSS scores. These phenomena might be important for understanding the neuropathological mechanisms underlying the symptoms of schizophrenia and for making clinical decisions.
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Affiliation(s)
- Xiao Zhang
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China
- Key Laboratory of Mental Health, Ministry of Health (Peking University) and National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Yuyanan Zhang
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China
- Key Laboratory of Mental Health, Ministry of Health (Peking University) and National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Jinmin Liao
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China
- Key Laboratory of Mental Health, Ministry of Health (Peking University) and National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Sisi Jiang
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China
- Key Laboratory of Mental Health, Ministry of Health (Peking University) and National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Jun Yan
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China
- Key Laboratory of Mental Health, Ministry of Health (Peking University) and National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Weihua Yue
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China
- Key Laboratory of Mental Health, Ministry of Health (Peking University) and National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China
| | - Dai Zhang
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China.
- Key Laboratory of Mental Health, Ministry of Health (Peking University) and National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.
- Peking-Tsinghua Joint Center for Life Sciences and PKU IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100871, China.
| | - Hao Yan
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, 100191, China.
- Key Laboratory of Mental Health, Ministry of Health (Peking University) and National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China.
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12
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N-Acetyl-Aspartate in the dorsolateral prefrontal cortex in men with schizophrenia and auditory verbal hallucinations: A 1.5 T Magnetic Resonance Spectroscopy Study. Sci Rep 2018. [PMID: 29515172 PMCID: PMC5841306 DOI: 10.1038/s41598-018-22597-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Auditory verbal hallucinations (AVH) in patients with schizophrenia are linked to abnormalities within a large cerebral network including frontal and temporal regions. Whilst abnormalities of frontal speech production and temporal speech perception regions have been extensively studied, alterations of the dorsolateral prefrontal cortex (DLPFC), a region critically involved in the pathophysiology of schizophrenia, have rarely been studied in relation to AVH. Using 1.5 T proton magnetic resonance spectroscopy, this study examined the relationship between right and left DLPFCs N-AcetylAspartate (NAA) levels and the severity of AVH in patients with schizophrenia. Twenty-seven male patients with schizophrenia were enrolled in this study, 15 presented daily treatment-resistant AVH (AVH+) and 12 reported no AVH (no-AVH). AVH+ patients displayed higher NAA levels in the right DLPFC than no-AVH patients (p = 0.033). In AVH+ patients, NAA levels were higher in the right DLPFC than in the left (p = 0.024). No difference between the right and left DLPFC was observed in no-AVH patients. There was a positive correlation between NAA levels in the right DLPFC and the severity of AVH (r = 0.404, p = 0.037). Despite limited by magnetic field strength, these results suggest that AVH may be associated with increased NAA levels in the right DLPFC in schizophrenia.
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13
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Huang M, Guo W, Lu S, Pan F, Chen J, Hu J, Hu S, Xu W, Shang D, Xu Y. The relationship between the alterations in metabolite levels in the dorsolateral prefrontal cortex and clinical symptoms of patients with first-episode schizophrenia: a one year follow-up study. Oncotarget 2018; 10:606-615. [PMID: 30728911 PMCID: PMC6355173 DOI: 10.18632/oncotarget.23983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/15/2017] [Indexed: 11/25/2022] Open
Abstract
Background Reduced brain metabolites such as N-acetyl-aspartate (NAA), glutamate (Glx), Choline (Cho) and myo-inositol (MI) have been repeatedly found in first-episode schizophrenia (FES) and suggest neuronal loss or dysfunction. However, the potential relationship between the metabolite level and the clinical symptoms or the recovery of FES remained unclear. Objectives This study aimed to investigate the correlation between the alterations in dorsolateral prefrontal cortex (DLPFC) metabolite levels of patients with first-episode schizophrenia (FES) and the changes in clinical symptoms after one year treatment. Materials and Methods FES patients underwent 1H-MRS scan twice: one time at the baseline and the other one year later, while the healthy group patients underwent only once at the baseline time. The symptom severity of patients was measured by PANSS. Principal Observations An increase in the NAA/Cr level was detected in the left DLPFC of patients with FES. The change in the NAA/Cr level was significantly correlated with the alteration in their PANSS-P score. The Cho/Cr levels on both sides of DLPFC in patients with FES were lower compared with the healthy controls both at the baseline and after the treatment. The NAA/Cr and MI/Cr levels in the right DLPFC were decreased after the treatment. Conclusions (1) the depletion of NAA in left DLPFC might be a state characteristic; (2) the Cho/Cr level might be the potential endophenotype of schizophrenia; (3) the decrease of NAA/Cr and MI/Cr level in right DLPFC might be due to the development of schizophrenia.
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Affiliation(s)
- Manli Huang
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Wuqiu Guo
- Department of Psychology and Behavioral Science, Zhejiang University, Hangzhou 310028, China
| | - Shaojia Lu
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Fen Pan
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Jinkai Chen
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Jianbo Hu
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Shaohua Hu
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Weijuan Xu
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Desheng Shang
- Department of Radiology, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Yi Xu
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
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14
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Huang ML, Khoh TT, Lu SJ, Pan F, Chen JK, Hu JB, Hu SH, Xu WJ, Zhou WH, Wei N, Qi HL, Shang DS, Xu Y. Relationships between dorsolateral prefrontal cortex metabolic change and cognitive impairment in first-episode neuroleptic-naive schizophrenia patients. Medicine (Baltimore) 2017; 96:e7228. [PMID: 28640119 PMCID: PMC5484227 DOI: 10.1097/md.0000000000007228] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 05/28/2017] [Accepted: 05/30/2017] [Indexed: 01/07/2023] Open
Abstract
The present study aimed to explore the possible associations between the dorsolateral prefrontal cortex (DLPFC) metabolites and the cognitive function in first-episode schizophrenia (FES).This study included 58 patients with FES (29 males and 29 females; mean age, 22.66 ± 7.64 years) recruited from the First Affiliated Hospital, College of Medicine, Zhejiang University, and 43 locally recruited healthy controls (16 males and 27 females; mean age, 23.07 ± 7.49 years). The single-voxel proton magnetic resonance spectroscopy was used to measure the levels of N-acetylaspartate (NAA); complex of glutamate, glutamine, and γ-aminobutyric acid (Glx); choline-containing compounds; and myo-inositol in the DLPFC. The ratios of metabolites to creatine (Cr) were calculated. The cognitive function was assessed by Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB). Correlation analysis was used to assess the relationships between the DLPFC metabolites and the cognitive function.Compared with the healthy controls, the patients with FES showed significantly reduced scores in each part of the MCCB, significantly reduced NAA/Cr, and significantly increased Glx/Cr in the left DLPFC. Poor performance in verbal learning and visual learning was correlated to the reduced NAA/Cr ratio in the left DLPFC.These findings suggest that a lower NAA/Cr ratio in the left DLPFC is associated with the cognitive deficits in patients with FES, and may be an early biochemical marker for the cognitive impairment in schizophrenia.
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Affiliation(s)
- Man-Li Huang
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province
| | | | - Shao-Jia Lu
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province
| | - Fen Pan
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province
| | - Jin-Kai Chen
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province
| | - Jian-Bo Hu
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province
| | - Shao-Hua Hu
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province
| | - Wei-Juan Xu
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province
| | - Wei-Hua Zhou
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province
| | - Ning Wei
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province
| | - Hong-Li Qi
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province
| | - De-Sheng Shang
- Department of Radiology, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Yi Xu
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province
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15
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Larabi DI, Liemburg EJ, Pijnenborg GHM, Sibeijn-Kuiper A, de Vos AE, Bais L, Knegtering H, Ćurčić-Blake B, Aleman A. Association between prefrontal N-acetylaspartate and insight in psychotic disorders. Schizophr Res 2017; 179:112-118. [PMID: 27658999 DOI: 10.1016/j.schres.2016.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 11/29/2022]
Abstract
Insight is impaired in most patients with psychosis and has been associated with poorer prognosis. The exact neural basis of impaired insight is still unknown, but it may involve disrupted prefrontal neural connectivity. Numerous studies have indeed found white matter (WM) abnormalities in psychosis. The association between prefrontal WM abnormalities and insight has not been studied yet by means of proton magnetic resonance spectroscopy (1H-MRS). 1H-MRS can be used to measure N-acetylaspartate (NAA), which is considered to be a marker of neuronal integrity. We measured insight with the Birchwood Insight Scale (BIS) as well as item G12 of the Positive and Negative Syndrome Scale (PANSS) in 88 patients with psychosis. Prefrontal WM concentrations of NAA and ratios of NAA to creatine (Cr) were assessed with 1H-MRS. Nonparametric partial correlational analyses were conducted between NAA concentrations and insight controlling for illness duration, standardized antipsychotic dose, symptom scores, voxel grey matter content and voxel cerebrospinal fluid content. We found a significant correlation between reduced NAA/Cr ratios and poorer insight as measured with the BIS, which remained significant after additional correction for full width at half maximum, signal/noise and age. This is the first study reporting a relationship between lower prefrontal concentrations of a marker of neuronal integrity and impaired insight, providing further evidence that prefrontal pathology may play an important role in impaired insight in psychosis. This may be explained by the involvement of the prefrontal cortex in several executive and metacognitive functions, such as cognitive flexibility and perspective taking.
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Affiliation(s)
- Daouia I Larabi
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Antonius Deusinglaan 2, Groningen, The Netherlands.
| | - Edith J Liemburg
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Antonius Deusinglaan 2, Groningen, The Netherlands; Lentis Psychiatric Institute, Hereweg 80, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Hanzeplein 1, Groningen, The Netherlands
| | - Gerdina H M Pijnenborg
- GGZ Drenthe, Department of Psychotic Disorders, Dennenweg 9, Assen, The Netherlands; University of Groningen, Department of Psychology, Grote Kruisstraat 2/1, Groningen, The Netherlands
| | - Anita Sibeijn-Kuiper
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Antonius Deusinglaan 2, Groningen, The Netherlands
| | - Annerieke E de Vos
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Antonius Deusinglaan 2, Groningen, The Netherlands; GGZ Drenthe, Department of Psychotic Disorders, Dennenweg 9, Assen, The Netherlands
| | - Leonie Bais
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Antonius Deusinglaan 2, Groningen, The Netherlands; Lentis Psychiatric Institute, Hereweg 80, Groningen, The Netherlands
| | - Henderikus Knegtering
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Antonius Deusinglaan 2, Groningen, The Netherlands; Lentis Psychiatric Institute, Hereweg 80, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Hanzeplein 1, Groningen, The Netherlands
| | - Branislava Ćurčić-Blake
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Antonius Deusinglaan 2, Groningen, The Netherlands
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Antonius Deusinglaan 2, Groningen, The Netherlands; University of Groningen, Department of Psychology, Grote Kruisstraat 2/1, Groningen, The Netherlands
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16
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Hu ML, Zong XF, Mann JJ, Zheng JJ, Liao YH, Li ZC, He Y, Chen XG, Tang JS. A Review of the Functional and Anatomical Default Mode Network in Schizophrenia. Neurosci Bull 2016; 33:73-84. [PMID: 27995564 DOI: 10.1007/s12264-016-0090-1] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 10/14/2016] [Indexed: 12/26/2022] Open
Abstract
Schizophrenia is a severe mental disorder characterized by impaired perception, delusions, thought disorder, abnormal emotion regulation, altered motor function, and impaired drive. The default mode network (DMN), since it was first proposed in 2001, has become a central research theme in neuropsychiatric disorders, including schizophrenia. In this review, first we define the DMN and describe its functional activity, functional and anatomical connectivity, heritability, and inverse correlation with the task positive network. Second, we review empirical studies of the anatomical and functional DMN, and anti-correlation between DMN and the task positive network in schizophrenia. Finally, we review preliminary evidence about the relationship between antipsychotic medications and regulation of the DMN, review the role of DMN as a treatment biomarker for this disease, and consider the DMN effects of individualized therapies for schizophrenia.
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Affiliation(s)
- Mao-Lin Hu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Departments of Psychiatry and Radiology, Columbia University, New York, NY, 10032, USA
- Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Xiao-Fen Zong
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Departments of Psychiatry and Radiology, Columbia University, New York, NY, 10032, USA
- Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - J John Mann
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Departments of Psychiatry and Radiology, Columbia University, New York, NY, 10032, USA
| | - Jun-Jie Zheng
- Key Laboratory for NeuroInformation of the Ministry of Education, School of Life Science and Technology and Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Yan-Hui Liao
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience, David Geffen School of Medicine, Los Angeles, CA, 90024, USA
| | - Zong-Chang Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Ying He
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Xiao-Gang Chen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
- Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.
| | - Jin-Song Tang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience, David Geffen School of Medicine, Los Angeles, CA, 90024, USA.
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17
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Short-term Effects of Risperidone Monotherapy on Spontaneous Brain Activity in First-episode Treatment-naïve Schizophrenia Patients: A Longitudinal fMRI Study. Sci Rep 2016; 6:34287. [PMID: 27698361 PMCID: PMC5048418 DOI: 10.1038/srep34287] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/09/2016] [Indexed: 01/25/2023] Open
Abstract
It is unclear whether abnormal spontaneous neural activation patterns found in chronic schizophrenia patients (CSP) are part of the pathogenesis of disease, consequences of chronic illness, or effects of antipsychotic treatment. We performed a longitudinal resting-state functional magnetic resonance imaging (fMRI) study in 42 treatment-naïve first-episode schizophrenia patients (FESP) at baseline and then after 8-weeks of risperidone monotherapy, and compared the findings to 38 healthy volunteers. Spontaneous brain activity was quantified using the fractional amplitude of low-frequency fluctuations (fALFF) and regional homogeneity (ReHo) and compared between patients and controls. Pretreatment, patients exhibited higher fALFF in left caudate compared with controls. After treatment, patients had elevated fALFF in bilateral putamen and right caudate, and increased ReHo in right caudate and left putamen. Greater increase of fALFF in the left putamen correlated with less improvement in positive symptoms. Thus, abnormalities of spontaneous neural activity in chronic schizophrenia is at least partly due to a medication effect. The observed post-treatment increase in striatal intrinsic activity may reflect counter-therapeutic functional adaptation to dopamine D2 receptor occupancy required for medication effects on psychosis.
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18
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Hu M, Zong X, Zheng J, Mann JJ, Li Z, Pantazatos SP, Li Y, Liao Y, He Y, Zhou J, Sang D, Zhao H, Tang J, Chen H, Lv L, Chen X. Risperidone-induced topological alterations of anatomical brain network in first-episode drug-naive schizophrenia patients: a longitudinal diffusion tensor imaging study. Psychol Med 2016; 46:2549-2560. [PMID: 27338296 PMCID: PMC5242555 DOI: 10.1017/s0033291716001380] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND It remains unclear whether the topological deficits of the white matter network documented in cross-sectional studies of chronic schizophrenia patients are due to chronic illness or to other factors such as antipsychotic treatment effects. To answer this question, we evaluated the white matter network in medication-naive first-episode schizophrenia patients (FESP) before and after a course of treatment. METHOD We performed a longitudinal diffusion tensor imaging study in 42 drug-naive FESP at baseline and then after 8 weeks of risperidone monotherapy, and compared them with 38 healthy volunteers. Graph theory was utilized to calculate the topological characteristics of brain anatomical network. Patients' clinical state was evaluated using the Positive and Negative Syndrome Scale (PANSS) before and after treatment. RESULTS Pretreatment, patients had relatively intact overall topological organizations, and deficient nodal topological properties primarily in prefrontal gyrus and limbic system components such as the bilateral anterior and posterior cingulate. Treatment with risperidone normalized topological parameters in the limbic system, and the enhancement positively correlated with the reduction in PANSS-positive symptoms. Prefrontal topological impairments persisted following treatment and negative symptoms did not improve. CONCLUSIONS During the early phase of antipsychotic medication treatment there are region-specific alterations in white matter topological measures. Limbic white matter topological dysfunction improves with positive symptom reduction. Prefrontal deficits and negative symptoms are unresponsive to medication intervention, and prefrontal deficits are potential trait biomarkers and targets for negative symptom treatment development.
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Affiliation(s)
- M. Hu
- Mental Health Institute of the Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, People’s Republic of China
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Departments of Psychiatry and Radiology, Columbia University, 1051 Riverside Drive, Box 42, New York, NY 10032, USA
| | - X. Zong
- Mental Health Institute of the Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, People’s Republic of China
| | - J. Zheng
- Key Laboratory for NeuroInformation of the Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, People’s Republic of China
| | - J. J. Mann
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Departments of Psychiatry and Radiology, Columbia University, 1051 Riverside Drive, Box 42, New York, NY 10032, USA
| | - Z. Li
- Mental Health Institute of the Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, People’s Republic of China
| | - S. P. Pantazatos
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Departments of Psychiatry, Columbia University, New York, NY 10032, USA
| | - Y. Li
- Key Laboratory for NeuroInformation of the Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, People’s Republic of China
| | - Y. Liao
- Mental Health Institute of the Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, People’s Republic of China
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience, David Geffen School of Medicine, Los Angeles, CA 90024, USA
| | - Y. He
- Mental Health Institute of the Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, People’s Republic of China
| | - J. Zhou
- Mental Health Institute of the Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, People’s Republic of China
| | - D. Sang
- Department of Radiology, Henan Mental Hospital, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan 453002, People’s Republic of China
| | - H. Zhao
- Department of Radiology, Henan Mental Hospital, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan 453002, People’s Republic of China
| | - J. Tang
- Mental Health Institute of the Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, People’s Republic of China
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience, David Geffen School of Medicine, Los Angeles, CA 90024, USA
| | - H. Chen
- Key Laboratory for NeuroInformation of the Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, People’s Republic of China
| | - L. Lv
- Department of Psychiatry, Henan Mental Hospital, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan 453002, People’s Republic of China
- Henan Key Laboratory of Biological Psychiatry, Henan Mental Hospital, Xinxiang Medical University, Xinxiang, Henan 453002, People’s Republic of China
| | - X. Chen
- Mental Health Institute of the Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, People’s Republic of China
- The China National Clinical Research Center for Mental Health Disorders, 139 Middle Renmin Road, Changsha, Hunan 410011, People’s Republic of China
- National Technology Institute of Psychiatry, 139 Middle Renmin Road, Changsha, Hunan 410011, People’s Republic of China
- Key Laboratory of Psychiatry and Mental Health of Hunan Province, 139 Middle Renmin Road, Changsha, Hunan 410011, People’s Republic of China
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Lanfermann H, Schindler C, Jordan J, Krug N, Raab P. Pharmacological MRI (phMRI) of the Human Central Nervous System. Clin Neuroradiol 2015; 25 Suppl 2:259-66. [DOI: 10.1007/s00062-015-0457-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 08/12/2015] [Indexed: 01/09/2023]
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