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Sun H, Liu N, Qiu C, Tao B, Yang C, Tang B, Li H, Zhan K, Cai C, Zhang W, Lui S. Applications of MRI in Schizophrenia: Current Progress in Establishing Clinical Utility. J Magn Reson Imaging 2024. [PMID: 38946400 DOI: 10.1002/jmri.29470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 05/20/2024] [Accepted: 05/20/2024] [Indexed: 07/02/2024] Open
Abstract
Schizophrenia is a severe mental illness that significantly impacts the lives of affected individuals and with increasing mortality rates. Early detection and intervention are crucial for improving outcomes but the lack of validated biomarkers poses great challenges in such efforts. The use of magnetic resonance imaging (MRI) in schizophrenia enables the investigation of the disorder's etiological and neuropathological substrates in vivo. After decades of research, promising findings of MRI have been shown to aid in screening high-risk individuals and predicting illness onset, and predicting symptoms and treatment outcomes of schizophrenia. The integration of machine learning and deep learning techniques makes it possible to develop intelligent diagnostic and prognostic tools with extracted or selected imaging features. In this review, we aimed to provide an overview of current progress and prospects in establishing clinical utility of MRI in schizophrenia. We first provided an overview of MRI findings of brain abnormalities that might underpin the symptoms or treatment response process in schizophrenia patients. Then, we summarized the ongoing efforts in the computer-aided utility of MRI in schizophrenia and discussed the gap between MRI research findings and real-world applications. Finally, promising pathways to promote clinical translation were provided. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Hui Sun
- Department of Radiology, and Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Naici Liu
- Department of Radiology, and Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Changjian Qiu
- Mental Health Center, West China Hospital of Sichuan University, Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Bo Tao
- Department of Radiology, and Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Chengmin Yang
- Department of Radiology, and Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Biqiu Tang
- Department of Radiology, and Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Hongwei Li
- Department of Radiology, and Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
- Department of Radiology, The Third Hospital of Mianyang/Sichuan Mental Health Center, Mianyang, China
| | - Kongcai Zhan
- Department of Radiology, Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, China
| | - Chunxian Cai
- Department of Radiology, the Second People's Hospital of Neijiang, Neijiang, China
| | - Wenjing Zhang
- Department of Radiology, and Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Su Lui
- Department of Radiology, and Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
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2
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Bayar Kapici O, Kapici Y, Tekın A, Şırık M. A novel diagnosis method for schizophrenia based on globus pallidus data. Psychiatry Res Neuroimaging 2023; 336:111732. [PMID: 37922672 DOI: 10.1016/j.pscychresns.2023.111732] [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: 05/09/2023] [Revised: 08/25/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023]
Abstract
This research aims to diagnose schizophrenia with machine learning-based algorithms. Bayesian neural network, logistic regression, decision tree, k-nearest neighbor, and gaussian kernel classification techniques are investigated to diagnose schizophrenia with data from 125 persons. This study showed that left lateral ventricles and left globus pallidus volumes and their percentages in the brain were significantly lower than HCs in FEP patients. Using brain volumes, we were able to diagnose FEP with an accuracy of 73.6 % via logistic regression and with an accuracy of 86.4 % using the SVM kernel classifier method. Therefore, brain volumes can be used to diagnose FEP with the SVM kernel classifier method.
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Affiliation(s)
- Olga Bayar Kapici
- Department of Radiology, Adıyaman Training and Research Hospital, Adıyaman, Turkey
| | - Yaşar Kapici
- Department of Psychiatry, Kahta State Hospital, Adıyaman, Turkey.
| | - Atilla Tekın
- Department of Psychiatry, Adıyaman University Faculty of Medicine, Adıyaman, Turkey
| | - Mehmet Şırık
- Department of Radiology, Adıyaman University Faculty of Medicine, Adıyaman, Turkey
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3
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Porter A, Fei S, Damme KSF, Nusslock R, Gratton C, Mittal VA. A meta-analysis and systematic review of single vs. multimodal neuroimaging techniques in the classification of psychosis. Mol Psychiatry 2023; 28:3278-3292. [PMID: 37563277 PMCID: PMC10618094 DOI: 10.1038/s41380-023-02195-9] [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: 10/03/2022] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Psychotic disorders are characterized by structural and functional abnormalities in brain networks. Neuroimaging techniques map and characterize such abnormalities using unique features (e.g., structural integrity, coactivation). However, it is unclear if a specific method, or a combination of modalities, is particularly effective in identifying differences in brain networks of someone with a psychotic disorder. METHODS A systematic meta-analysis evaluated machine learning classification of schizophrenia spectrum disorders in comparison to healthy control participants using various neuroimaging modalities (i.e., T1-weighted imaging (T1), diffusion tensor imaging (DTI), resting state functional connectivity (rs-FC), or some combination (multimodal)). Criteria for manuscript inclusion included whole-brain analyses and cross-validation to provide a complete picture regarding the predictive ability of large-scale brain systems in psychosis. For this meta-analysis, we searched Ovid MEDLINE, PubMed, PsychInfo, Google Scholar, and Web of Science published between inception and March 13th 2023. Prediction results were averaged for studies using the same dataset, but parallel analyses were run that included studies with pooled sample across many datasets. We assessed bias through funnel plot asymmetry. A bivariate regression model determined whether differences in imaging modality, demographics, and preprocessing methods moderated classification. Separate models were run for studies with internal prediction (via cross-validation) and external prediction. RESULTS 93 studies were identified for quantitative review (30 T1, 9 DTI, 40 rs-FC, and 14 multimodal). As a whole, all modalities reliably differentiated those with schizophrenia spectrum disorders from controls (OR = 2.64 (95%CI = 2.33 to 2.95)). However, classification was relatively similar across modalities: no differences were seen across modalities in the classification of independent internal data, and a small advantage was seen for rs-FC studies relative to T1 studies in classification in external datasets. We found large amounts of heterogeneity across results resulting in significant signs of bias in funnel plots and Egger's tests. Results remained similar, however, when studies were restricted to those with less heterogeneity, with continued small advantages for rs-FC relative to structural measures. Notably, in all cases, no significant differences were seen between multimodal and unimodal approaches, with rs-FC and unimodal studies reporting largely overlapping classification performance. Differences in demographics and analysis or denoising were not associated with changes in classification scores. CONCLUSIONS The results of this study suggest that neuroimaging approaches have promise in the classification of psychosis. Interestingly, at present most modalities perform similarly in the classification of psychosis, with slight advantages for rs-FC relative to structural modalities in some specific cases. Notably, results differed substantially across studies, with suggestions of biased effect sizes, particularly highlighting the need for more studies using external prediction and large sample sizes. Adopting more rigorous and systematized standards will add significant value toward understanding and treating this critical population.
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Affiliation(s)
- Alexis Porter
- Department of Psychology, Northwestern University, Evanston, IL, USA.
| | - Sihan Fei
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Katherine S F Damme
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston and Chicago, IL, USA
| | - Robin Nusslock
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Caterina Gratton
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston and Chicago, IL, USA
- Department of Psychiatry, Northwestern University, Chicago, IL, USA
- Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Policy Research, Northwestern University, Chicago, IL, USA
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4
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Identification of texture MRI brain abnormalities on first-episode psychosis and clinical high-risk subjects using explainable artificial intelligence. Transl Psychiatry 2022; 12:481. [PMID: 36385133 PMCID: PMC9668814 DOI: 10.1038/s41398-022-02242-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022] Open
Abstract
Structural MRI studies in first-episode psychosis and the clinical high-risk state have consistently shown volumetric abnormalities. Aim of the present study was to introduce radiomics texture features in identification of psychosis. Radiomics texture features describe the interrelationship between voxel intensities across multiple spatial scales capturing the hidden information of underlying disease dynamics in addition to volumetric changes. Structural MR images were acquired from 77 first-episode psychosis (FEP) patients, 58 clinical high-risk subjects with no later transition to psychosis (CHR_NT), 15 clinical high-risk subjects with later transition (CHR_T), and 44 healthy controls (HC). Radiomics texture features were extracted from non-segmented images, and two-classification schemas were performed for the identification of FEP vs. HC and FEP vs. CHR_NT. The group of CHR_T was used as external validation in both schemas. The classification of a subject's clinical status was predicted by importing separately (a) the difference of entropy feature map and (b) the contrast feature map, resulting in classification balanced accuracy above 72% in both analyses. The proposed framework enhances the classification decision for FEP, CHR_NT, and HC subjects, verifies diagnosis-relevant features and may potentially contribute to identification of structural biomarkers for psychosis, beyond and above volumetric brain changes.
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Korda AI, Andreou C, Avram M, Handels H, Martinetz T, Borgwardt S. Chaos analysis of the brain topology in first-episode psychosis and clinical high risk patients. Front Psychiatry 2022; 13:965128. [PMID: 36311536 PMCID: PMC9606602 DOI: 10.3389/fpsyt.2022.965128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Structural MRI studies in first-episode psychosis (FEP) and in clinical high risk (CHR) patients have consistently shown volumetric abnormalities in frontal, temporal, and cingulate cortex areas. The aim of the present study was to employ chaos analysis for the identification of brain topology differences in people with psychosis. Structural MRI were acquired from 77 FEP, 73 CHR and 44 healthy controls (HC). Chaos analysis of the gray matter distribution was performed: First, the distances of each voxel from the center of mass in the gray matter image was calculated. Next, the distances multiplied by the voxel intensity were represented as a spatial-series, which then was analyzed by extracting the Largest-Lyapunov-Exponent (lambda). The lambda brain map depicts thus how the gray matter topology changes. Between-group differences were identified by (a) comparing the lambda brain maps, which resulted in statistically significant differences in FEP and CHR compared to HC; and (b) matching the lambda series with the Morlet wavelet, which resulted in statistically significant differences in the scalograms of FEP against CHR and HC. The proposed framework using spatial-series extraction enhances the between-group differences of FEP, CHR and HC subjects, verifies diagnosis-relevant features and may potentially contribute to the identification of structural biomarkers for psychosis.
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Affiliation(s)
- Alexandra I. Korda
- Translational Psychiatry, Department of Psychiatry and Psycotherapy, University of Lübeck, Lübeck, Germany
| | - Christina Andreou
- Translational Psychiatry, Department of Psychiatry and Psycotherapy, University of Lübeck, Lübeck, Germany
| | - Mihai Avram
- Translational Psychiatry, Department of Psychiatry and Psycotherapy, University of Lübeck, Lübeck, Germany
| | - Heinz Handels
- Institute of Medical Informatics, University of Lübeck, Lübeck, Germany
| | - Thomas Martinetz
- Institute for Neuro- and Bioinformatics, University of Lübeck, Lübeck, Germany
| | - Stefan Borgwardt
- Translational Psychiatry, Department of Psychiatry and Psycotherapy, University of Lübeck, Lübeck, Germany
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6
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Smesny S, Gussew A, Schack S, Langbein K, Wagner G, Reichenbach JR. Neurometabolic patterns of an "at risk for mental disorders" syndrome involve abnormalities in the thalamus and anterior midcingulate cortex. Schizophr Res 2022; 243:285-295. [PMID: 32444202 DOI: 10.1016/j.schres.2020.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/03/2020] [Accepted: 04/19/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The ultra-high risk (UHR) paradigm allows the investigation of individuals at increased risk of developing psychotic or other mental disorders with the aim of making prevention and early intervention as specific as possible in terms of the individual outcome. METHODS Single-session 1H-/31P-Chemical Shift Imaging of thalamus, prefrontal (DLPFC) and anterior midcingulate (aMCC) cortices was applied to 69 UHR patients for psychosis and 61 matched healthy controls. N-acetylaspartate (NAA), glutamate/glutamine complex (Glx), energy (PCr, ATP) and phospholipid metabolites were assessed, analysed by ANOVA (or ANCOVA [with covariates]) and correlated with symptomatology (SCL-90R). RESULTS The thalamus showed decreased NAA, inversely correlated with self-rated aggressiveness, as well as increased PCr, and altered phospholipid breakdown. While the aMCC showed a pattern of NAA decrease and PCr increase, the DLPFC showed PCr increase only in the close-to-psychosis patient subgroup. There were no specific findings in transition patients. CONCLUSION The results do not support the notion of a specific pre-psychotic neurometabolic pattern, but likely reflect correlates of an "at risk for mental disorders syndrome". This includes disturbed neuronal (mitochondrial) metabolism in the thalamus and aMCC, with emphasis on left-sided structures, and altered PL remodeling across structures.
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Affiliation(s)
- Stefan Smesny
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany.
| | - Alexander Gussew
- Department of Radiology, Halle University Hospital, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Stephan Schack
- 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
| | - Gerd Wagner
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 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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7
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Starke G, De Clercq E, Borgwardt S, Elger BS. Computing schizophrenia: ethical challenges for machine learning in psychiatry. Psychol Med 2021; 51:2515-2521. [PMID: 32536358 DOI: 10.1017/s0033291720001683] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recent advances in machine learning (ML) promise far-reaching improvements across medical care, not least within psychiatry. While to date no psychiatric application of ML constitutes standard clinical practice, it seems crucial to get ahead of these developments and address their ethical challenges early on. Following a short general introduction concerning ML in psychiatry, we do so by focusing on schizophrenia as a paradigmatic case. Based on recent research employing ML to further the diagnosis, treatment, and prediction of schizophrenia, we discuss three hypothetical case studies of ML applications with view to their ethical dimensions. Throughout this discussion, we follow the principlist framework by Tom Beauchamp and James Childress to analyse potential problems in detail. In particular, we structure our analysis around their principles of beneficence, non-maleficence, respect for autonomy, and justice. We conclude with a call for cautious optimism concerning the implementation of ML in psychiatry if close attention is paid to the particular intricacies of psychiatric disorders and its success evaluated based on tangible clinical benefit for patients.
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Affiliation(s)
- Georg Starke
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel, Basel, Switzerland
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Bernice Simone Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- University Center of Legal Medicine, University of Geneva, Geneva, Switzerland
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8
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Wang Q, Hu K, Wang M, Zhao Y, Liu Y, Fan L, Liu B. Predicting brain age during typical and atypical development based on structural and functional neuroimaging. Hum Brain Mapp 2021; 42:5943-5955. [PMID: 34520078 PMCID: PMC8596985 DOI: 10.1002/hbm.25660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/20/2021] [Accepted: 08/31/2021] [Indexed: 11/08/2022] Open
Abstract
Exploring typical and atypical brain developmental trajectories is very important for understanding the normal pace of brain development and the mechanisms by which mental disorders deviate from normal development. A precise and sex-specific brain age prediction model is desirable for investigating the systematic deviation and individual heterogeneity of disorders associated with atypical brain development, such as autism spectrum disorders. In this study, we used partial least squares regression and the stacking algorithm to establish a sex-specific brain age prediction model based on T1-weighted structural magnetic resonance imaging and resting-state functional magnetic resonance imaging. The model showed good generalization and high robustness on four independent datasets with different ethnic information and age ranges. A predictor weights analysis showed the differences and similarities in changes in structure and function during brain development. At the group level, the brain age gap estimation for autistic patients was significantly smaller than that for healthy controls in both the ABIDE dataset and the healthy brain network dataset, which suggested that autistic patients as a whole exhibited the characteristics of delayed development. However, within the ABIDE dataset, the premature development group had significantly higher Autism Diagnostic Observation Schedule (ADOS) scores than those of the delayed development group, implying that individuals with premature development had greater severity. Using these findings, we built an accurate typical brain development trajectory and developed a method of atypical trajectory analysis that considers sex differences and individual heterogeneity. This strategy may provide valuable clues for understanding the relationship between brain development and mental disorders.
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Affiliation(s)
- Qi Wang
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Ke Hu
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Meng Wang
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Yuxin Zhao
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Yong Liu
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Lingzhong Fan
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Bing Liu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
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9
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Baldinger-Melich P, Urquijo Castro MF, Seiger R, Ruef A, Dwyer DB, Kranz GS, Klöbl M, Kambeitz J, Kaufmann U, Windischberger C, Kasper S, Falkai P, Lanzenberger R, Koutsouleris N. Sex Matters: A Multivariate Pattern Analysis of Sex- and Gender-Related Neuroanatomical Differences in Cis- and Transgender Individuals Using Structural Magnetic Resonance Imaging. Cereb Cortex 2021; 30:1345-1356. [PMID: 31368487 PMCID: PMC7132951 DOI: 10.1093/cercor/bhz170] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/28/2019] [Accepted: 06/28/2019] [Indexed: 12/22/2022] Open
Abstract
Univariate analyses of structural neuroimaging data have produced heterogeneous results regarding anatomical sex- and gender-related differences. The current study aimed at delineating and cross-validating brain volumetric surrogates of sex and gender by comparing the structural magnetic resonance imaging data of cis- and transgender subjects using multivariate pattern analysis. Gray matter (GM) tissue maps of 29 transgender men, 23 transgender women, 35 cisgender women, and 34 cisgender men were created using voxel-based morphometry and analyzed using support vector classification. Generalizability of the models was estimated using repeated nested cross-validation. For external validation, significant models were applied to hormone-treated transgender subjects (n = 32) and individuals diagnosed with depression (n = 27). Sex was identified with a balanced accuracy (BAC) of 82.6% (false discovery rate [pFDR] < 0.001) in cisgender, but only with 67.5% (pFDR = 0.04) in transgender participants indicating differences in the neuroanatomical patterns associated with sex in transgender despite the major effect of sex on GM volume irrespective of the self-identification as a woman or man. Gender identity and gender incongruence could not be reliably identified (all pFDR > 0.05). The neuroanatomical signature of sex in cisgender did not interact with depressive features (BAC = 74.7%) but was affected by hormone therapy when applied in transgender women (P < 0.001).
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Affiliation(s)
- Pia Baldinger-Melich
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria.,Neuroimaging Labs (NIL) PET, MRI, EEG, TMS and Chemical Lab, Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Maria F Urquijo Castro
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany.,Section for Neurodiagnostic Applications, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany
| | - René Seiger
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria.,Neuroimaging Labs (NIL) PET, MRI, EEG, TMS and Chemical Lab, Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany.,Section for Neurodiagnostic Applications, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany.,Section for Neurodiagnostic Applications, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany
| | - Georg S Kranz
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria.,Neuroimaging Labs (NIL) PET, MRI, EEG, TMS and Chemical Lab, Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria.,Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Manfred Klöbl
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany.,Section for Neurodiagnostic Applications, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany
| | - Ulrike Kaufmann
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Christian Windischberger
- MR Centre of Excellence, Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria.,Neuroimaging Labs (NIL) PET, MRI, EEG, TMS and Chemical Lab, Department of Psychiatry and Psychotherapy, Clinical Division of General Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany.,Section for Neurodiagnostic Applications, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Bavaria, Germany
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10
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Lai JW, Ang CKE, Acharya UR, Cheong KH. Schizophrenia: A Survey of Artificial Intelligence Techniques Applied to Detection and Classification. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6099. [PMID: 34198829 PMCID: PMC8201065 DOI: 10.3390/ijerph18116099] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023]
Abstract
Artificial Intelligence in healthcare employs machine learning algorithms to emulate human cognition in the analysis of complicated or large sets of data. Specifically, artificial intelligence taps on the ability of computer algorithms and software with allowable thresholds to make deterministic approximate conclusions. In comparison to traditional technologies in healthcare, artificial intelligence enhances the process of data analysis without the need for human input, producing nearly equally reliable, well defined output. Schizophrenia is a chronic mental health condition that affects millions worldwide, with impairment in thinking and behaviour that may be significantly disabling to daily living. Multiple artificial intelligence and machine learning algorithms have been utilized to analyze the different components of schizophrenia, such as in prediction of disease, and assessment of current prevention methods. These are carried out in hope of assisting with diagnosis and provision of viable options for individuals affected. In this paper, we review the progress of the use of artificial intelligence in schizophrenia.
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Affiliation(s)
- Joel Weijia Lai
- Science, Mathematics and Technology, Singapore University of Technology and Design, 8 Somapah Road, Singapore 487372, Singapore; (J.W.L.); (C.K.E.A.)
| | - Candice Ke En Ang
- Science, Mathematics and Technology, Singapore University of Technology and Design, 8 Somapah Road, Singapore 487372, Singapore; (J.W.L.); (C.K.E.A.)
- MOH Holdings Pte Ltd, 1 Maritime Square, Singapore 099253, Singapore
| | - U. Rajendra Acharya
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Clementi 599489, Singapore;
- Department of Biomedical Engineering, School of Science and Technology, Singapore University of Social Sciences, Clementi 599491, Singapore
- Department of Biomedical Informatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
| | - Kang Hao Cheong
- Science, Mathematics and Technology, Singapore University of Technology and Design, 8 Somapah Road, Singapore 487372, Singapore; (J.W.L.); (C.K.E.A.)
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11
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Pigoni A, Dwyer D, Squarcina L, Borgwardt S, Crespo-Facorro B, Dazzan P, Smesny S, Spaniel F, Spalletta G, Sanfelici R, Antonucci LA, Reuf A, Oeztuerk OF, Schmidt A, Ciufolini S, Schönborn-Harrisberger F, Langbein K, Gussew A, Reichenbach JR, Zaytseva Y, Piras F, Delvecchio G, Bellani M, Ruggeri M, Lasalvia A, Tordesillas-Gutiérrez D, Ortiz V, Murray RM, Reis-Marques T, Di Forti M, Koutsouleris N, Brambilla P. Classification of first-episode psychosis using cortical thickness: A large multicenter MRI study. Eur Neuropsychopharmacol 2021; 47:34-47. [PMID: 33957410 DOI: 10.1016/j.euroneuro.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/21/2021] [Accepted: 04/06/2021] [Indexed: 12/19/2022]
Abstract
Machine learning classifications of first-episode psychosis (FEP) using neuroimaging have predominantly analyzed brain volumes. Some studies examined cortical thickness, but most of them have used parcellation approaches with data from single sites, which limits claims of generalizability. To address these limitations, we conducted a large-scale, multi-site analysis of cortical thickness comparing parcellations and vertex-wise approaches. By leveraging the multi-site nature of the study, we further investigated how different demographical and site-dependent variables affected predictions. Finally, we assessed relationships between predictions and clinical variables. 428 subjects (147 females, mean age 27.14) with FEP and 448 (230 females, mean age 27.06) healthy controls were enrolled in 8 centers by the ClassiFEP group. All subjects underwent a structural MRI and were clinically assessed. Cortical thickness parcellation (68 areas) and full cortical maps (20,484 vertices) were extracted. Linear Support Vector Machine was used for classification within a repeated nested cross-validation framework. Vertex-wise thickness maps outperformed parcellation-based methods with a balanced accuracy of 66.2% and an Area Under the Curve of 72%. By stratifying our sample for MRI scanner, we increased generalizability across sites. Temporal brain areas resulted as the most influential in the classification. The predictive decision scores significantly correlated with age at onset, duration of treatment, and positive symptoms. In conclusion, although far from the threshold of clinical relevance, temporal cortical thickness proved to classify between FEP subjects and healthy individuals. The assessment of site-dependent variables permitted an increase in the across-site generalizability, thus attempting to address an important machine learning limitation.
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Affiliation(s)
- A Pigoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, via F. Sforza 35, 20122 Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - D Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - L Squarcina
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, via F. Sforza 35, 20122 Milan, Italy
| | - S Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland; Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | - B Crespo-Facorro
- Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain; University Hospital Virgen del Rocio, Department of Psychiatry, School of Medicine, University of Sevilla-IBiS, CIBERSAM, Sevilla, Spain
| | - P Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - S Smesny
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - F Spaniel
- Department of Applied Neurosciences and Brain Imaging, National Institute of Mental Health, Klecany Czechia
| | - G Spalletta
- Department of Clinical and Behavioural Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - R Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany; Max Planck School of Cognition, Stephanstrasse 1a, Leipzig, Germany
| | - L A Antonucci
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany; Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy
| | - A Reuf
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Oe F Oeztuerk
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Munich, Germany
| | - A Schmidt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - S Ciufolini
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - K Langbein
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - A Gussew
- Department of Radiology, University Hospital Halle (Saale), Germany
| | - J R Reichenbach
- Medical Physics Group, Department of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany
| | - Y Zaytseva
- Department of Applied Neurosciences and Brain Imaging, National Institute of Mental Health, Klecany Czechia
| | - F Piras
- Department of Clinical and Behavioural Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - G Delvecchio
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - M Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy; UOC of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) of Verona, Italy
| | - M Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy; UOC of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) of Verona, Italy
| | - A Lasalvia
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy; UOC of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) of Verona, Italy
| | - D Tordesillas-Gutiérrez
- Department of Radiology, Marqués de Valdecilla University Hospital, Valdecilla Biomedical Research Institute IDIVAL, Spain
| | - V Ortiz
- Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain
| | - R M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - T Reis-Marques
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - M Di Forti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - N Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - P Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, via F. Sforza 35, 20122 Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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12
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Podichetty JT, Silvola RM, Rodriguez-Romero V, Bergstrom RF, Vakilynejad M, Bies RR, Stratford RE. Application of machine learning to predict reduction in total PANSS score and enrich enrollment in schizophrenia clinical trials. Clin Transl Sci 2021; 14:1864-1874. [PMID: 33939284 PMCID: PMC8504834 DOI: 10.1111/cts.13035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/28/2021] [Accepted: 02/16/2021] [Indexed: 11/28/2022] Open
Abstract
Clinical trial efficiency, defined as facilitating patient enrollment, and reducing the time to reach safety and efficacy decision points, is a critical driving factor for making improvements in therapeutic development. The present work evaluated a machine learning (ML) approach to improve phase II or proof‐of‐concept trials designed to address unmet medical needs in treating schizophrenia. Diagnostic data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial were used to develop a binary classification ML model predicting individual patient response as either “improvement,” defined as greater than 20% reduction in total Positive and Negative Syndrome Scale (PANSS) score, or “no improvement,” defined as an inadequate treatment response (<20% reduction in total PANSS). A random forest algorithm performed best relative to other tree‐based approaches in model ability to classify patients after 6 months of treatment. Although model ability to identify true positives, a measure of model sensitivity, was poor (<0.2), its specificity, true negative rate, was high (0.948). A second model, adapted from the first, was subsequently applied as a proof‐of‐concept for the ML approach to supplement trial enrollment by identifying patients not expected to improve based on their baseline diagnostic scores. In three virtual trials applying this screening approach, the percentage of patients predicted to improve ranged from 46% to 48%, consistently approximately double the CATIE response rate of 22%. These results show the promising application of ML to improve clinical trial efficiency and, as such, ML models merit further consideration and development.
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Affiliation(s)
- Jagdeep T Podichetty
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rebecca M Silvola
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Violeta Rodriguez-Romero
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Richard F Bergstrom
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Robert R Bies
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.,Institute for Computational Data Science, University at Buffalo, State University of New York at Buffalo, Buffalo, New York, USA
| | - Robert E Stratford
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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13
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Najafpour Z, Fatemi A, Goudarzi Z, Goudarzi R, Shayanfard K, Noorizadeh F. Cost-effectiveness of neuroimaging technologies in management of psychiatric and insomnia disorders: A meta-analysis and prospective cost analysis. J Neuroradiol 2021; 48:348-358. [PMID: 33383065 DOI: 10.1016/j.neurad.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The optimal diagnostic strategy for patients with psychiatric and insomnia disorders has not been established yet. PURPOSE The purpose of this study was to perform cost-effectiveness analysis of six neuroimaging technologies in diagnosis of patients with psychiatric and insomnia disorders. METHODS An economic evaluation study was conducted in three parts, including a systematic review for determining diagnostic accuracy, a descriptive cross-sectional study with Activity-Based Costing (ABC) technique for tracing resource consumption, and a cost-effectiveness analysis using a short-term decision-analytic model. RESULTS In the first phase, 93 diagnostic accuracy studies were included in the systematic review. The accumulated results (meta-analysis) showed that the highest diagnostic accuracy for psychiatric and insomnia disorders was attributed to PET (sensitivity of 90% and specificity of 80%) and MRI (sensitivity of 76% and specificity of 78%) respectively. In the second phase of the study, we calculated the cost of each technology. The results showed that MRI has the lowest cost. Based on the results in the model of cost-effectiveness sMRI ($ 50.08 per accurate diagnosis) and MRI ($ 58.54 per accurate diagnosis) were more cost-effective neuroimaging technologies. CONCLUSION In psychiatric disorders, no single strategy was characterized by both low cost and high accuracy. However, MRI and PET scan had lower cost and higher accuracy for psychiatric disorders, respectively. MRI was the least costly with the highest diagnostic accuracy in insomnia disorders. Based on our model, sMRI in psychiatric disorders and MRI in insomnia disorders were the most cost-effective technologies.
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Affiliation(s)
- Zhila Najafpour
- Department of Health Care Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Asieh Fatemi
- Dpartment of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Faculty of Paramedical sciences, Rafsanjan University of Medical Sciences, Iran.
| | - Zahra Goudarzi
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Goudarzi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | | | - Farsad Noorizadeh
- Basir Eye Health Research Center, Exceptional Talents Development Center, Tehran University of Medical Sciences, Tehran, Iran.
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14
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Yamamoto M, Bagarinao E, Kushima I, Takahashi T, Sasabayashi D, Inada T, Suzuki M, Iidaka T, Ozaki N. Support vector machine-based classification of schizophrenia patients and healthy controls using structural magnetic resonance imaging from two independent sites. PLoS One 2020; 15:e0239615. [PMID: 33232334 PMCID: PMC7685428 DOI: 10.1371/journal.pone.0239615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/10/2020] [Indexed: 12/17/2022] Open
Abstract
Structural brain alterations have been repeatedly reported in schizophrenia; however, the pathophysiology of its alterations remains unclear. Multivariate pattern recognition analysis such as support vector machines can classify patients and healthy controls by detecting subtle and spatially distributed patterns of structural alterations. We aimed to use a support vector machine to distinguish patients with schizophrenia from control participants on the basis of structural magnetic resonance imaging data and delineate the patterns of structural alterations that significantly contributed to the classification performance. We used independent datasets from different sites with different magnetic resonance imaging scanners, protocols and clinical characteristics of the patient group to achieve a more accurate estimate of the classification performance of support vector machines. We developed a support vector machine classifier using the dataset from one site (101 participants) and evaluated the performance of the trained support vector machine using a dataset from the other site (97 participants) and vice versa. We assessed the performance of the trained support vector machines in each support vector machine classifier. Both support vector machine classifiers attained a classification accuracy of >70% with two independent datasets indicating a consistently high performance of support vector machines even when used to classify data from different sites, scanners and different acquisition protocols. The regions contributing to the classification accuracy included the bilateral medial frontal cortex, superior temporal cortex, insula, occipital cortex, cerebellum, and thalamus, which have been reported to be related to the pathogenesis of schizophrenia. These results indicated that the support vector machine could detect subtle structural brain alterations and might aid our understanding of the pathophysiology of these changes in schizophrenia, which could be one of the diagnostic findings of schizophrenia.
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Affiliation(s)
- Maeri Yamamoto
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | - Itaru Kushima
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Aichi, Japan
- Medical Genomics Center, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Toyama, Japan
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Toyama, Japan
| | - Toshiya Inada
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Toyama, Japan
| | - Tetsuya Iidaka
- Brain & Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
- * E-mail:
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Aichi, Japan
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15
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Hu M, Sim K, Zhou JH, Jiang X, Guan C. Brain MRI-based 3D Convolutional Neural Networks for Classification of Schizophrenia and Controls. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:1742-1745. [PMID: 33018334 DOI: 10.1109/embc44109.2020.9176610] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Convolutional Neural Network (CNN) has been successfully applied on classification of both natural images and medical images but limited studies applied it to differentiate patients with schizophrenia from healthy controls. Given the subtle, mixed, and sparsely distributed brain atrophy patterns of schizophrenia, the capability of automatic feature learning makes CNN a powerful tool for classifying schizophrenia from controls as it removes the subjectivity in selecting relevant spatial features. To examine the feasibility of applying CNN to classification of schizophrenia and controls based on structural Magnetic Resonance Imaging (MRI), we built 3D CNN models with different architectures and compared their performance with a handcrafted feature-based machine learning approach. Support vector machine (SVM) was used as classifier and Voxel-based Morphometry (VBM) was used as feature for handcrafted feature-based machine learning. 3D CNN models with sequential architecture, inception module and residual module were trained from scratch. CNN models achieved higher cross-validation accuracy than handcrafted feature-based machine learning. Moreover, testing on an independent dataset, 3D CNN models greatly outperformed handcrafted feature-based machine learning. This study underscored the potential of CNN for identifying patients with schizophrenia using 3D brain MR images and paved the way for imaging-based individual-level diagnosis and prognosis in psychiatric disorders.
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16
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Kapadia M, Desai M, Parikh R. Fractures in the framework: limitations of classification systems in psychiatry
. DIALOGUES IN CLINICAL NEUROSCIENCE 2020; 22:17-26. [PMID: 32699502 PMCID: PMC7365290 DOI: 10.31887/dcns.2020.22.1/rparikh] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article examines the limitations of existing classification systems from the
historical, cultural, political, and legal perspectives. It covers the evolution of
classification systems with particular emphasis on the DSM and
ICD systems. While pointing out the inherent Western bias in these
systems, it highlights the potential of misuse of these systems to subserve other
agendas. It raises concerns about the reliability, validity, comorbidity, and
heterogeneity within diagnostic categories of contemporary classification systems.
Finally, it postulates future directions in alternative methods of diagnosis and
classification factoring in advances in artificial intelligence, machine learning,
genetic testing, and brain imaging. In conclusion, it emphasizes the need to go beyond
the limitations inherent in classifications systems to provide more relevant diagnoses
and effective treatments.
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Affiliation(s)
- Munira Kapadia
- Department of Psychiatry, Jaslok Hospital & Research Centre, Mumbai, India
| | - Maherra Desai
- Department of Psychiatry, Jaslok Hospital & Research Centre, Mumbai, India
| | - Rajesh Parikh
- Department of Psychiatry, Jaslok Hospital & Research Centre, Mumbai, India
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17
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Treatment response prediction and individualized identification of first-episode drug-naïve schizophrenia using brain functional connectivity. Mol Psychiatry 2020; 25:906-913. [PMID: 29921920 DOI: 10.1038/s41380-018-0106-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/11/2018] [Accepted: 05/01/2018] [Indexed: 12/28/2022]
Abstract
Identifying biomarkers in schizophrenia during the first episode without the confounding effects of treatment has been challenging. Leveraging these biomarkers to establish diagnosis and make individualized predictions of future treatment responses to antipsychotics would be of great value, but there has been limited progress. In this study, by using machine learning algorithms and the functional connections of the superior temporal cortex, we successfully identified the first-episode drug-naive (FEDN) schizophrenia patients (accuracy 78.6%) and predict their responses to antipsychotic treatment (accuracy 82.5%) at an individual level. The functional connections (FC) were derived using the mutual information and the correlations, between the blood-oxygen-level dependent signals of the superior temporal cortex and other cortical regions acquired with the resting-state functional magnetic resonance imaging. We also found that the mutual information and correlation FC was informative in identifying individual FEDN schizophrenia and prediction of treatment response, respectively. The methods and findings in this paper could provide a critical step toward individualized identification and treatment response prediction in first-episode drug-naive schizophrenia, which could complement other biomarkers in the development of precision medicine approaches for this severe mental disorder.
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18
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Vieira S, Gong QY, Pinaya WHL, Scarpazza C, Tognin S, Crespo-Facorro B, Tordesillas-Gutierrez D, Ortiz-García V, Setien-Suero E, Scheepers FE, Van Haren NEM, Marques TR, Murray RM, David A, Dazzan P, McGuire P, Mechelli A. Using Machine Learning and Structural Neuroimaging to Detect First Episode Psychosis: Reconsidering the Evidence. Schizophr Bull 2020; 46:17-26. [PMID: 30809667 PMCID: PMC6942152 DOI: 10.1093/schbul/sby189] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Despite the high level of interest in the use of machine learning (ML) and neuroimaging to detect psychosis at the individual level, the reliability of the findings is unclear due to potential methodological issues that may have inflated the existing literature. This study aimed to elucidate the extent to which the application of ML to neuroanatomical data allows detection of first episode psychosis (FEP), while putting in place methodological precautions to avoid overoptimistic results. We tested both traditional ML and an emerging approach known as deep learning (DL) using 3 feature sets of interest: (1) surface-based regional volumes and cortical thickness, (2) voxel-based gray matter volume (GMV) and (3) voxel-based cortical thickness (VBCT). To assess the reliability of the findings, we repeated all analyses in 5 independent datasets, totaling 956 participants (514 FEP and 444 within-site matched controls). The performance was assessed via nested cross-validation (CV) and cross-site CV. Accuracies ranged from 50% to 70% for surfaced-based features; from 50% to 63% for GMV; and from 51% to 68% for VBCT. The best accuracies (70%) were achieved when DL was applied to surface-based features; however, these models generalized poorly to other sites. Findings from this study suggest that, when methodological precautions are adopted to avoid overoptimistic results, detection of individuals in the early stages of psychosis is more challenging than originally thought. In light of this, we argue that the current evidence for the diagnostic value of ML and structural neuroimaging should be reconsidered toward a more cautious interpretation.
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Affiliation(s)
- Sandra Vieira
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Qi-yong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
- Department of Psychoradiology, Chengdu Mental Health Center, Chengdu, China
| | - Walter H L Pinaya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
- Centre of Mathematics, Computation, and Cognition, Universidade Federal do ABC, São Paulo, Brazil
| | - Cristina Scarpazza
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
- Department of General Psychology, University of Padova, Padova, Italy
| | - Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Benedicto Crespo-Facorro
- Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
- Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain
| | - Diana Tordesillas-Gutierrez
- Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
- Neuroimaging Unit, Technological Facilities, Valdecilla Biomedical Research Institute IDIVAL, Santander, Cantabria, Spain
| | - Victor Ortiz-García
- Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
- Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain
| | - Esther Setien-Suero
- Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
- Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain
| | - Floortje E Scheepers
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Neeltje E M Van Haren
- Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Tiago R Marques
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Anthony David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Andrea Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
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19
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Winterburn JL, Voineskos AN, Devenyi GA, Plitman E, de la Fuente-Sandoval C, Bhagwat N, Graff-Guerrero A, Knight J, Chakravarty MM. Can we accurately classify schizophrenia patients from healthy controls using magnetic resonance imaging and machine learning? A multi-method and multi-dataset study. Schizophr Res 2019; 214:3-10. [PMID: 29274736 DOI: 10.1016/j.schres.2017.11.038] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 11/24/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
Machine learning is a powerful tool that has previously been used to classify schizophrenia (SZ) patients from healthy controls (HC) using magnetic resonance images. Each study, however, uses different datasets, classification algorithms, and validation techniques. Here, we perform a critical appraisal of the accuracy of machine learning methodologies used in SZ/HC classifications studies by comparing three machine learning algorithms (logistic regression [LR], support vector machines [SVMs], and linear discriminant analysis [LDA]) on three independent datasets (435 subjects total) using two tissue density estimates and cortical thickness (CT). Performance is assessed using 10-fold cross-validation, as well as a held-out validation set. Classification using CT outperformed tissue densities, but there was no clear effect of dataset. LR, SVMs, and LDA each yielded the highest accuracies for a different feature set and validation paradigm, but most accuracies were between 55 and 70%, well below previously reported values. The highest accuracy achieved was 73.5% using CT data and an SVM. Taken together, these results illustrate some of the obstacles to constructing effective disease classifiers, and suggest that tissue densities and CT may not be sufficiently sensitive for SZ/HC classification given current available methodologies and sample sizes.
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Affiliation(s)
- Julie L Winterburn
- Computational Brain Anatomy Laboratory, Douglas Mental Health Institute, McGill University, Montreal, Quebec, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Kimel Family Translational Imaging-Genetics Research Lab, Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Aristotle N Voineskos
- Kimel Family Translational Imaging-Genetics Research Lab, Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Gabriel A Devenyi
- Computational Brain Anatomy Laboratory, Douglas Mental Health Institute, McGill University, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Eric Plitman
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Camilo de la Fuente-Sandoval
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico; Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Nikhil Bhagwat
- Computational Brain Anatomy Laboratory, Douglas Mental Health Institute, McGill University, Montreal, Quebec, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Kimel Family Translational Imaging-Genetics Research Lab, Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jo Knight
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Data Science Institute and Medical School, Lancaster University, Bailrigg, United Kingdom
| | - M Mallar Chakravarty
- Computational Brain Anatomy Laboratory, Douglas Mental Health Institute, McGill University, Montreal, Quebec, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada.
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20
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Zarogianni E, Storkey AJ, Borgwardt S, Smieskova R, Studerus E, Riecher-Rössler A, Lawrie SM. Individualized prediction of psychosis in subjects with an at-risk mental state. Schizophr Res 2019; 214:18-23. [PMID: 28935170 DOI: 10.1016/j.schres.2017.08.061] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 11/19/2022]
Abstract
Early intervention strategies in psychosis would significantly benefit from the identification of reliable prognostic biomarkers. Pattern classification methods have shown the feasibility of an early diagnosis of psychosis onset both in clinical and familial high-risk populations. Here we were interested in replicating our previous classification findings using an independent cohort at clinical high risk for psychosis, drawn from the prospective FePsy (Fruherkennung von Psychosen) study. The same neuroanatomical-based pattern classification pipeline, consisting of a linear Support Vector Machine (SVM) and a Recursive Feature Selection (RFE) achieved 74% accuracy in predicting later onset of psychosis. The discriminative neuroanatomical pattern underlying this finding consisted of many brain areas across all four lobes and the cerebellum. These results provide proof-of-concept that the early diagnosis of psychosis is feasible using neuroanatomical-based pattern recognition.
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Affiliation(s)
- Eleni Zarogianni
- Division of Psychiatry, School of Clinical Sciences, University of Edinburgh, The Royal Edinburgh Hospital, Morningside Park, UK.
| | - Amos J Storkey
- Institute for Adaptive and Neural Computation, University of Edinburgh, UK
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Switzerland
| | - Renata Smieskova
- Department of Psychiatry (UPK), University of Basel, Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Switzerland
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Switzerland
| | - Stephen M Lawrie
- Division of Psychiatry, School of Clinical Sciences, University of Edinburgh, The Royal Edinburgh Hospital, Morningside Park, UK
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21
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Lei D, Pinaya WHL, Young J, van Amelsvoort T, Marcelis M, Donohoe G, Mothersill DO, Corvin A, Vieira S, Huang X, Lui S, Scarpazza C, Arango C, Bullmore E, Gong Q, McGuire P, Mechelli A. Integrating machining learning and multimodal neuroimaging to detect schizophrenia at the level of the individual. Hum Brain Mapp 2019; 41:1119-1135. [PMID: 31737978 PMCID: PMC7268084 DOI: 10.1002/hbm.24863] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/23/2019] [Accepted: 10/31/2019] [Indexed: 02/05/2023] Open
Abstract
Schizophrenia is a severe psychiatric disorder associated with both structural and functional brain abnormalities. In the past few years, there has been growing interest in the application of machine learning techniques to neuroimaging data for the diagnostic and prognostic assessment of this disorder. However, the vast majority of studies published so far have used either structural or functional neuroimaging data, without accounting for the multimodal nature of the disorder. Structural MRI and resting‐state functional MRI data were acquired from a total of 295 patients with schizophrenia and 452 healthy controls at five research centers. We extracted features from the data including gray matter volume, white matter volume, amplitude of low‐frequency fluctuation, regional homogeneity and two connectome‐wide based metrics: structural covariance matrices and functional connectivity matrices. A support vector machine classifier was trained on each dataset separately to distinguish the subjects at individual level using each of the single feature as well as their combination, and 10‐fold cross‐validation was used to assess the performance of the model. Functional data allow higher accuracy of classification than structural data (mean 82.75% vs. 75.84%). Within each modality, the combination of images and matrices improves performance, resulting in mean accuracies of 81.63% for structural data and 87.59% for functional data. The use of all combined structural and functional measures allows the highest accuracy of classification (90.83%). We conclude that combining multimodal measures within a single model is a promising direction for developing biologically informed diagnostic tools in schizophrenia.
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Affiliation(s)
- Du Lei
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Walter H L Pinaya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Jonathan Young
- Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,Mental Health Care Institute Eindhoven (GGzE), Eindhoven, The Netherlands
| | - Gary Donohoe
- School of Psychology & Center for neuroimaging and Cognitive Genomics, NUI Galway University, Galway, Ireland
| | - David O Mothersill
- School of Psychology & Center for neuroimaging and Cognitive Genomics, NUI Galway University, Galway, Ireland
| | - Aiden Corvin
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sandra Vieira
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Su Lui
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Cristina Scarpazza
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.,Department of General Psychology, University of Padua, Padua, Italy
| | - Celso Arango
- Child and Adolescent Department of Psychiatry, Hospital General Universitario Gregorio Marañon, School of Medicine, Universidad Complutense Madrid, IiSGM, CIBERSAM, Madrid, Spain
| | - Ed Bullmore
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Andrea Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
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22
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Egloff L, Lenz C, Studerus E, Heitz U, Harrisberger F, Smieskova R, Schmidt A, Leanza L, Andreou C, Borgwardt S, Riecher‐Rössler A. No associations between medial temporal lobe volumes and verbal learning/memory in emerging psychosis. Eur J Neurosci 2019; 50:3060-3071. [DOI: 10.1111/ejn.14427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 03/26/2019] [Accepted: 04/07/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Laura Egloff
- Department of Psychiatry University of Basel Psychiatric Hospital Basel Switzerland
- Division of Clinical Psychology and Epidemiology Department of Psychology University of Basel Basel Switzerland
- Center for Gender Research and Early Detection University of Basel Psychiatric Hospital Basel Switzerland
| | - Claudia Lenz
- Institute of Forensic Medicine University of Basel Basel Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection University of Basel Psychiatric Hospital Basel Switzerland
| | - Ulrike Heitz
- Center for Gender Research and Early Detection University of Basel Psychiatric Hospital Basel Switzerland
| | | | - Renata Smieskova
- Department of Psychiatry University of Basel Psychiatric Hospital Basel Switzerland
| | - André Schmidt
- Department of Psychiatry University of Basel Psychiatric Hospital Basel Switzerland
| | - Letizia Leanza
- Division of Clinical Psychology and Epidemiology Department of Psychology University of Basel Basel Switzerland
- Center for Gender Research and Early Detection University of Basel Psychiatric Hospital Basel Switzerland
| | - Christina Andreou
- Department of Psychiatry University of Basel Psychiatric Hospital Basel Switzerland
- Center for Gender Research and Early Detection University of Basel Psychiatric Hospital Basel Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry University of Basel Psychiatric Hospital Basel Switzerland
| | - Anita Riecher‐Rössler
- Center for Gender Research and Early Detection University of Basel Psychiatric Hospital Basel Switzerland
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23
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Rahaman MA, Turner JA, Gupta CN, Rachakonda S, Chen J, Liu J, van Erp TGM, Potkin S, Ford J, Mathalon D, Lee HJ, Jiang W, Mueller BA, Andreassen O, Agartz I, Sponheim SR, Mayer AR, Stephen J, Jung RE, Canive J, Bustillo J, Calhoun VD. N-BiC: A Method for Multi-Component and Symptom Biclustering of Structural MRI Data: Application to Schizophrenia. IEEE Trans Biomed Eng 2019; 67:110-121. [PMID: 30946659 PMCID: PMC7906485 DOI: 10.1109/tbme.2019.2908815] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We propose and develop a novel biclustering (N-BiC) approach for performing N-way biclustering of neuroimaging data. Our approach is applicable to an arbitrary number of features from both imaging and behavioral data (e.g., symptoms). We applied it to structural MRI data from patients with schizophrenia. METHODS It uses a source-based morphometry approach [i.e., independent component analysis of gray matter segmentation maps] to decompose the data into a set of spatial maps, each of which includes regions that covary among individuals. Then, the loading parameters for components of interest are entered to an exhaustive search, which incorporates a modified depth-first search technique to carry out the biclustering, with the goal of obtaining submatrices where the selected rows (individuals) show homogeneity in their expressions of selected columns (components) and vice versa. RESULTS Findings demonstrate that multiple biclusters have an evident association with distinct brain networks for the different types of symptoms in schizophrenia. The study identifies two components: inferior temporal gyrus (16) and brainstem (7), which are related to positive (distortion/excess of normal function) and negative (diminution/loss of normal function) symptoms in schizophrenia, respectively. CONCLUSION N-BiC is a data-driven method of biclustering MRI data that can exhaustively explore relationships/substructures from a dataset without any prior information with a higher degree of robustness than earlier biclustering applications. SIGNIFICANCE The use of such approaches is important to investigate the underlying biological substrates of mental illness by grouping patients into homogeneous subjects, as the schizophrenia diagnosis is known to be relatively nonspecific and heterogeneous.
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24
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Liang S, Li Y, Zhang Z, Kong X, Wang Q, Deng W, Li X, Zhao L, Li M, Meng Y, Huang F, Ma X, Li XM, Greenshaw AJ, Shao J, Li T. Classification of First-Episode Schizophrenia Using Multimodal Brain Features: A Combined Structural and Diffusion Imaging Study. Schizophr Bull 2019; 45:591-599. [PMID: 29947804 PMCID: PMC6483586 DOI: 10.1093/schbul/sby091] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recent neuroanatomical pattern recognition studies have shown some promises for developing an objective neuroimaging-based classification related to schizophrenia. This study explored the feasibility of reliably identifying schizophrenia using single and multimodal multivariate neuroimaging features. Multiple brain measures including regional gray matter (GM) volume, cortical thickness, gyrification, fractional anisotropy (FA), and mean diffusivity (MD) were extracted using fully automated procedures. We used Gradient Boosting Decision Tree to identify the most frequently selected features of each set of neuroanatomical metric and fused multimodal measures. The current classification model was trained and validated based on 98 patients with first-episode schizophrenia (FES) and 106 matched healthy controls (HCs). The classification model was trained and tested in an independent dataset of 54 patients with FES and 48 HCs using imaging data acquired on a different magnetic resonance imaging scanner. Using the most frequently selected features from fused structural and diffusion tensor imaging metrics, a classification accuracy of 75.05% was achieved, which was higher than accuracy derived from a single imaging metric. Most prominent discriminative features included cortical thickness of left transverse temporal gyrus and right parahippocampal gyrus, the FA of left corticospinal tract and right external capsule. In the independent cohort, average accuracy was 76.54%, derived from combined features selected from cortical thickness, gyrification, FA, and MD. These features characterized by GM abnormalities and white matter disruptions have discriminative power with respect to the underlying pathological changes in the brain of individuals having schizophrenia. Our results further highlight the potential advantage of multimodal data fusion for identifying schizophrenia.
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Affiliation(s)
- Sugai Liang
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yinfei Li
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhong Zhang
- Big Data Research Center, School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiangzhen Kong
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
| | - Qiang Wang
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Deng
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaojing Li
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liansheng Zhao
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingli Li
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yajing Meng
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Feng Huang
- Big Data Research Center, School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaohong Ma
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin-min Li
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Junming Shao
- Big Data Research Center, School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Tao Li
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China,West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China,To whom correspondence should be addressed; West China Mental Health Centre, West China Hospital, Sichuan University, No. 28th Dianxin Nan Str., Chengdu, Sichuan 610041, China; tel.: 86-28-85423561, fax: 86-28-85422632, e-mail:
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25
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de Moura AM, Pinaya WHL, Gadelha A, Zugman A, Noto C, Cordeiro Q, Belangero SI, Jackowski AP, Bressan RA, Sato JR. Investigating brain structural patterns in first episode psychosis and schizophrenia using MRI and a machine learning approach. Psychiatry Res Neuroimaging 2018; 275:14-20. [PMID: 29548527 DOI: 10.1016/j.pscychresns.2018.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 02/27/2018] [Accepted: 03/02/2018] [Indexed: 01/16/2023]
Abstract
In this study, we employed the Maximum Uncertainty Linear Discriminant Analysis (MLDA) to investigate whether the structural brain patterns in first episode psychosis (FEP) patients would be more similar to patients with chronic schizophrenia (SCZ) or healthy controls (HC), from a schizophrenia model perspective. Brain regions volumetric data were estimated by using MRI images of SCZ and FEP patients and HC. First, we evaluated the MLDA performance in discriminating SCZ from controls, which provided a score based on a model for changes in brain structure in SCZ. In the following, we compared the volumetric patterns of FEP patients with patterns of SCZ and healthy controls using these scores. The FEP group had a score distribution more similar to patients with schizophrenia (p-value = .461; Cohen's d=-.15) in comparison with healthy subjects (p-value=.003; Cohen's d = .62). Structures related to the limbic system and the circuitry involved in goal-directed behaviours were the most discriminant regions. There is a distinct pattern of volumetric changes in patients with schizophrenia in contrast to healthy controls, and this pattern seem to be detectable already in FEP.
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Affiliation(s)
- Adriana Miyazaki de Moura
- Center of Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Walter Hugo Lopez Pinaya
- Center of Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Ary Gadelha
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - André Zugman
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Cristiano Noto
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Quirino Cordeiro
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil; Department of Psychiatry, Medical School of Santa Casa de São Paulo, São Paulo, Brazil
| | - Sintia Iole Belangero
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil; Department of Morphology and Genetics. Federal University of São Paulo, São Paulo, Brazil
| | - Andrea P Jackowski
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Rodrigo A Bressan
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - João Ricardo Sato
- Center of Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil; Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.
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26
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Hunter SA, Lawrie SM. Imaging and Genetic Biomarkers Predicting Transition to Psychosis. Curr Top Behav Neurosci 2018; 40:353-388. [PMID: 29626338 DOI: 10.1007/7854_2018_46] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The search for diagnostic and prognostic biomarkers in schizophrenia care and treatment is the focus of many within the research community. Longitudinal cohorts of patients presenting at elevated genetic and clinical risk have provided a wealth of data that has informed our understanding of the development of schizophrenia and related psychotic disorders.Imaging follow-up of high-risk cohorts has demonstrated changes in cerebral grey matter of those that eventually transition to schizophrenia that predate the onset of symptoms and evolve over the course of illness. Longitudinal follow-up studies demonstrate that observed grey matter changes can be employed to differentiate those who will transition to schizophrenia from those who will not prior to the onset of the disorder.In recent years our understanding of the genetic makeup of schizophrenia has advanced significantly. The development of modern analysis techniques offers researchers the ability to objectively quantify genetic risk; these have been successfully applied within a high-risk paradigm to assist in differentiating between high-risk individuals who will subsequently become unwell and those who will not.This chapter will discuss the application of imaging and genetic biomarkers within high-risk groups to predict future transition to schizophrenia and related psychotic disorders. We aim to provide an overview of current approaches focussing on grey matter changes that are predictive of future transition to illness, the developing field of genetic risk scores and other methods being developed to aid clinicians in diagnosis and prognosis.
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Affiliation(s)
- Stuart A Hunter
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK.
| | - Stephen M Lawrie
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
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27
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Suvisaari J, Mantere O, Keinänen J, Mäntylä T, Rikandi E, Lindgren M, Kieseppä T, Raij TT. Is It Possible to Predict the Future in First-Episode Psychosis? Front Psychiatry 2018; 9:580. [PMID: 30483163 PMCID: PMC6243124 DOI: 10.3389/fpsyt.2018.00580] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/23/2018] [Indexed: 12/26/2022] Open
Abstract
The outcome of first-episode psychosis (FEP) is highly variable, ranging from early sustained recovery to antipsychotic treatment resistance from the onset of illness. For clinicians, a possibility to predict patient outcomes would be highly valuable for the selection of antipsychotic treatment and in tailoring psychosocial treatments and psychoeducation. This selective review summarizes current knowledge of prognostic markers in FEP. We sought potential outcome predictors from clinical and sociodemographic factors, cognition, brain imaging, genetics, and blood-based biomarkers, and we considered different outcomes, like remission, recovery, physical comorbidities, and suicide risk. Based on the review, it is currently possible to predict the future for FEP patients to some extent. Some clinical features-like the longer duration of untreated psychosis (DUP), poor premorbid adjustment, the insidious mode of onset, the greater severity of negative symptoms, comorbid substance use disorders (SUDs), a history of suicide attempts and suicidal ideation and having non-affective psychosis-are associated with a worse outcome. Of the social and demographic factors, male gender, social disadvantage, neighborhood deprivation, dysfunctional family environment, and ethnicity may be relevant. Treatment non-adherence is a substantial risk factor for relapse, but a small minority of patients with acute onset of FEP and early remission may benefit from antipsychotic discontinuation. Cognitive functioning is associated with functional outcomes. Brain imaging currently has limited utility as an outcome predictor, but this may change with methodological advancements. Polygenic risk scores (PRSs) might be useful as one component of a predictive tool, and pharmacogenetic testing is already available and valuable for patients who have problems in treatment response or with side effects. Most blood-based biomarkers need further validation. None of the currently available predictive markers has adequate sensitivity or specificity used alone. However, personalized treatment of FEP will need predictive tools. We discuss some methodologies, such as machine learning (ML), and tools that could lead to the improved prediction and clinical utility of different prognostic markers in FEP. Combination of different markers in ML models with a user friendly interface, or novel findings from e.g., molecular genetics or neuroimaging, may result in computer-assisted clinical applications in the near future.
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Affiliation(s)
- Jaana Suvisaari
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Outi Mantere
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, McGill University, Montreal, QC, Canada.,Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jaakko Keinänen
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Teemu Mäntylä
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Eva Rikandi
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Maija Lindgren
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Tuula Kieseppä
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tuukka T Raij
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland
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28
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Fusté M, Pauls A, Worker A, Reinders AATS, Simmons A, Williams SCR, Haro JM, Hazelgrove K, Pawlby S, Conroy S, Vecchio C, Seneviratne G, Pariante CM, Mehta MA, Dazzan P. Brain structure in women at risk of postpartum psychosis: an MRI study. Transl Psychiatry 2017; 7:1286. [PMID: 29249808 PMCID: PMC5802701 DOI: 10.1038/s41398-017-0003-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 08/11/2017] [Accepted: 08/20/2017] [Indexed: 12/12/2022] Open
Abstract
Postpartum psychosis (PP) is the most severe psychiatric disorder associated with childbirth. The risk of PP is very high in women with a history of bipolar affective disorder or schizoaffective disorder. However, the neurobiological basis of PP remains poorly understood and no study has evaluated brain structure in women at risk of, or with, PP. We performed a cross-sectional study of 256 women at risk of PP and 21 healthy controls (HC) in the same postpartum period. Among women at risk, 11 who developed a recent episode of PP (PPE) (n = 2 with lifetime bipolar disorder; n = 9 psychotic disorder not otherwise specified) and 15 at risk women who did not develop an episode of PP (NPPE) (n = 10 with lifetime bipolar disorder; n = 1 with schizoaffective disorder; n = 1 with a history of PP in first-degree family member; n = 3 with previous PP). We obtained T1-weighted MRI scans at 3T and examined regional gray matter volumes with voxel-based morphometry and cortical thickness and surface area with Freesurfer. Women with PPE showed smaller anterior cingulate gyrus, superior temporal gyrus and parahippocampal gyrus compared to NPPE women. These regions also showed decreased surface area. Moreover, the NPPE group showed a larger superior and inferior frontal gyrus volume than the HC. These results should be interpreted with caution, as there were between-group differences in terms of duration of illness and interval between delivery and MRI acquisition. Nevertheless, these are the first findings to suggest that MRI can provide information on brain morphology that characterize those women at risk of PP more likely to develop an episode after childbirth.
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Affiliation(s)
- Montserrat Fusté
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, King's College London, De Crespigny Park, London, UK, SE5 8AF. .,CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.
| | - Astrid Pauls
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London, UK SE5 8AF
| | - Amanda Worker
- 0000 0001 2322 6764grid.13097.3cDepartment of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King’s College of London, De Crespigny Park, London, UK
| | - Antje A. T. S Reinders
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London, UK SE5 8AF
| | - Andrew Simmons
- 0000 0001 2322 6764grid.13097.3cDepartment of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King’s College of London, De Crespigny Park, London, UK ,0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Steven C. R. Williams
- 0000 0001 2322 6764grid.13097.3cDepartment of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King’s College of London, De Crespigny Park, London, UK ,0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Josep M. Haro
- CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Kate Hazelgrove
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London, UK SE5 8AF
| | - Susan Pawlby
- 0000 0001 2322 6764grid.13097.3cSection of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, London, UK
| | - Susan Conroy
- 0000 0001 2322 6764grid.13097.3cSection of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, London, UK
| | - Costanza Vecchio
- 0000 0001 2322 6764grid.13097.3cSection of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, London, UK
| | - Gertrude Seneviratne
- 0000 0001 2322 6764grid.13097.3cSection of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, London, UK
| | - Carmine M. Pariante
- 0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK ,0000 0001 2322 6764grid.13097.3cSection of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, London, UK
| | - Mitul A. Mehta
- 0000 0001 2322 6764grid.13097.3cDepartment of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King’s College of London, De Crespigny Park, London, UK
| | - Paola Dazzan
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London, UK SE5 8AF ,0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
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Du Y, Fryer SL, Fu Z, Lin D, Sui J, Chen J, Damaraju E, Mennigen E, Stuart B, Loewy RL, Mathalon DH, Calhoun VD. Dynamic functional connectivity impairments in early schizophrenia and clinical high-risk for psychosis. Neuroimage 2017; 180:632-645. [PMID: 29038030 DOI: 10.1016/j.neuroimage.2017.10.022] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/29/2017] [Accepted: 10/11/2017] [Indexed: 01/14/2023] Open
Abstract
Individuals at clinical high-risk (CHR) for psychosis are characterized by attenuated psychotic symptoms. Only a minority of CHR individuals convert to full-blown psychosis. Therefore, there is a strong interest in identifying neurobiological abnormalities underlying the psychosis risk syndrome. Dynamic functional connectivity (DFC) captures time-varying connectivity over short time scales, and has the potential to reveal complex brain functional organization. Based on resting-state functional magnetic resonance imaging (fMRI) data from 70 healthy controls (HCs), 53 CHR individuals, and 58 early illness schizophrenia (ESZ) patients, we applied a novel group information guided ICA (GIG-ICA) to estimate inherent connectivity states from DFC, and then investigated group differences. We found that ESZ patients showed more aberrant connectivities and greater alterations than CHR individuals. Results also suggested that disease-related connectivity states occurred in CHR and ESZ groups. Regarding the dominant state with the highest contribution to dynamic connectivity, ESZ patients exhibited greater impairments than CHR individuals primarily in the cerebellum, frontal cortex, thalamus and temporal cortex, while CHR and ESZ populations shared common aberrances mainly in the supplementary motor area, parahippocampal gyrus and postcentral cortex. CHR-specific changes were also found in the connections between the superior frontal gyrus and calcarine cortex in the dominant state. Our findings suggest that CHR individuals generally show an intermediate functional connectivity pattern between HCs and SZ patients but also have unique connectivity alterations.
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Affiliation(s)
- Yuhui Du
- The Mind Research Network, Albuquerque, NM, USA; School of Computer & Information Technology, Shanxi University, Taiyuan, China.
| | - Susanna L Fryer
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; The Mental Health Service, San Francisco VA Healthcare System, San Francisco, CA, USA
| | - Zening Fu
- The Mind Research Network, Albuquerque, NM, USA
| | | | - Jing Sui
- The Mind Research Network, Albuquerque, NM, USA; Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Jiayu Chen
- The Mind Research Network, Albuquerque, NM, USA
| | | | - Eva Mennigen
- The Mind Research Network, Albuquerque, NM, USA; Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, USA
| | - Barbara Stuart
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Rachel L Loewy
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Daniel H Mathalon
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; The Mental Health Service, San Francisco VA Healthcare System, San Francisco, CA, USA
| | - Vince D Calhoun
- The Mind Research Network, Albuquerque, NM, USA; Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, USA
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Lincoln TM, Dollfus S, Lyne J. Current developments and challenges in the assessment of negative symptoms. Schizophr Res 2017; 186:8-18. [PMID: 26960948 DOI: 10.1016/j.schres.2016.02.035] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/18/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
Reliable and valid assessment of negative symptoms is crucial to further develop etiological models and improve treatments. Our understanding of the concept of negative symptoms has undergone significant advances since the introduction of quantitative assessments of negative symptoms in the 1980s. These include the conceptualization of cognitive dysfunction as separate from negative symptoms and the distinction of two main negative symptom factors (avolition and diminished expression). In this review we provide an overview of existing negative symptom scales, focusing on both observer-rated and self-rated measurement of negative symptoms. We also distinguish between measures that assess negative symptoms as part of a broader assessment of schizophrenia symptoms, those specifically developed for negative symptoms and those that assess specific domains of negative symptoms within and beyond the context of psychotic disorders. We critically discuss strengths and limitations of these measures in the light of some existing challenges, i.e. observed and subjective symptom experiences, the challenge of distinguishing between primary and secondary negative symptoms, and the overlap between negative symptoms and related factors (e.g. personality traits and premorbid functioning). This review is aimed to inform the ongoing development of negative symptom scales.
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Affiliation(s)
- Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Sonia Dollfus
- CHU de Caen, Service universitaire de Psychiatrie, Centre Esquirol, Avenue Côte de Nacre, Caen F-14000, France; UNICAEN, UFR Médecine, F-14074 Caen, France
| | - John Lyne
- Royal College of Surgeons in Ireland, North Dublin Mental Health Services, Ashlin Centre, Beaumont Road, Dublin 9, Ireland; Dublin and East Treatment and Early Care Team, Avila House, Blackrock Business Park, Blackrock, Co. Dublin, Ireland
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Rikandi E, Pamilo S, Mäntylä T, Suvisaari J, Kieseppä T, Hari R, Seppä M, Raij TT. Precuneus functioning differentiates first-episode psychosis patients during the fantasy movie Alice in Wonderland. Psychol Med 2017; 47:495-506. [PMID: 27776563 DOI: 10.1017/s0033291716002609] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND While group-level functional alterations have been identified in many brain regions of psychotic patients, multivariate machine-learning methods provide a tool to test whether some of such alterations could be used to differentiate an individual patient. Earlier machine-learning studies have focused on data collected from chronic patients during rest or simple tasks. We set out to unravel brain activation patterns during naturalistic stimulation in first-episode psychosis (FEP). METHOD We recorded brain activity from 46 FEP patients and 32 control subjects viewing scenes from the fantasy film Alice in Wonderland. Scenes with varying degrees of fantasy were selected based on the distortion of the 'sense of reality' in psychosis. After cleaning the data with a novel maxCorr method, we used machine learning to classify patients and healthy control subjects on the basis of voxel- and time-point patterns. RESULTS Most (136/194) of the voxels that best classified the groups were clustered in a bilateral region of the precuneus. Classification accuracies were up to 79.5% (p = 5.69 × 10-8), and correct classification was more likely the higher the patient's positive-symptom score. Precuneus functioning was related to the fantasy content of the movie, and the relationship was stronger in control subjects than patients. CONCLUSIONS These findings are the first to show abnormalities in precuneus functioning during naturalistic information processing in FEP patients. Correlational findings suggest that these alterations are associated with positive psychotic symptoms and processing of fantasy. The results may provide new insights into the neuronal basis of reality distortion in psychosis.
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Affiliation(s)
- E Rikandi
- Mental Health Unit,National Institute for Health and Welfare,Helsinki,Finland
| | - S Pamilo
- Department of Neuroscience and Biomedical Engineering, andAdvanced Magnetic Imaging Centre,Aalto NeuroImaging,Aalto University School of Science,Espoo,Finland
| | - T Mäntylä
- Mental Health Unit,National Institute for Health and Welfare,Helsinki,Finland
| | - J Suvisaari
- Mental Health Unit,National Institute for Health and Welfare,Helsinki,Finland
| | - T Kieseppä
- Mental Health Unit,National Institute for Health and Welfare,Helsinki,Finland
| | - R Hari
- Department of Neuroscience and Biomedical Engineering, andAdvanced Magnetic Imaging Centre,Aalto NeuroImaging,Aalto University School of Science,Espoo,Finland
| | - M Seppä
- Department of Neuroscience and Biomedical Engineering, andAdvanced Magnetic Imaging Centre,Aalto NeuroImaging,Aalto University School of Science,Espoo,Finland
| | - T T Raij
- Department of Neuroscience and Biomedical Engineering, andAdvanced Magnetic Imaging Centre,Aalto NeuroImaging,Aalto University School of Science,Espoo,Finland
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Janousova E, Montana G, Kasparek T, Schwarz D. Supervised, Multivariate, Whole-Brain Reduction Did Not Help to Achieve High Classification Performance in Schizophrenia Research. Front Neurosci 2016; 10:392. [PMID: 27610072 PMCID: PMC4997127 DOI: 10.3389/fnins.2016.00392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 08/10/2016] [Indexed: 01/20/2023] Open
Abstract
We examined how penalized linear discriminant analysis with resampling, which is a supervised, multivariate, whole-brain reduction technique, can help schizophrenia diagnostics and research. In an experiment with magnetic resonance brain images of 52 first-episode schizophrenia patients and 52 healthy controls, this method allowed us to select brain areas relevant to schizophrenia, such as the left prefrontal cortex, the anterior cingulum, the right anterior insula, the thalamus, and the hippocampus. Nevertheless, the classification performance based on such reduced data was not significantly better than the classification of data reduced by mass univariate selection using a t-test or unsupervised multivariate reduction using principal component analysis. Moreover, we found no important influence of the type of imaging features, namely local deformations or gray matter volumes, and the classification method, specifically linear discriminant analysis or linear support vector machines, on the classification results. However, we ascertained significant effect of a cross-validation setting on classification performance as classification results were overestimated even though the resampling was performed during the selection of brain imaging features. Therefore, it is critically important to perform cross-validation in all steps of the analysis (not only during classification) in case there is no external validation set to avoid optimistically biasing the results of classification studies.
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Affiliation(s)
- Eva Janousova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University Brno, Czech Republic
| | - Giovanni Montana
- Department of Biomedical Engineering, King's College London London, UK
| | - Tomas Kasparek
- Behavioural and Social Neuroscience Group, CEITEC - Central European Institute of Technology, Masaryk UniversityBrno, Czech Republic; Department of Psychiatry, University Hospital Brno and Masaryk UniversityBrno, Czech Republic
| | - Daniel Schwarz
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University Brno, Czech Republic
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Berger GE, Smesny S, Schäfer MR, Milleit B, Langbein K, Hipler UC, Milleit C, Klier CM, Schlögelhofer M, Holub M, Holzer I, Berk M, McGorry PD, Sauer H, Amminger GP. Niacin Skin Sensitivity Is Increased in Adolescents at Ultra-High Risk for Psychosis. PLoS One 2016; 11:e0148429. [PMID: 26894921 PMCID: PMC4764507 DOI: 10.1371/journal.pone.0148429] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 01/18/2016] [Indexed: 12/14/2022] Open
Abstract
Background Most studies provide evidence that the skin flush response to nicotinic acid (niacin) stimulation is impaired in schizophrenia. However, only little is known about niacin sensitivity in the ultra-high risk (UHR) phase of psychotic disorders. Methods We compared visual ratings of niacin sensitivity between adolescents at UHR for psychosis according to the one year transition outcome (UHR-T n = 11; UHR-NT n = 55) with healthy controls (HC n = 25) and first episode schizophrenia patients (FEP n = 25) treated with atypical antipsychotics. Results Contrary to our hypothesis niacin sensitivity of the entire UHR group was not attenuated, but significantly increased compared to the HC group, whereas no difference could be found between the UHR-T and UHR-NT groups. As expected, niacin sensitivity of FEP was attenuated compared to HC group. In UHR individuals niacin sensitivity was inversely correlated with omega-6 and -9 fatty acids (FA), but positively correlated with phospholipase A2 (inPLA2) activity, a marker of membrane lipid repair/remodelling. Conclusions Increased niacin sensitivity in UHR states likely indicates an impaired balance of eicosanoids and omega-6/-9 FA at a membrane level. Our findings suggest that the emergence of psychosis is associated with an increased mobilisation of eicosanoids prior to the transition to psychosis possibly reflecting a “pro-inflammatory state”, whereas thereafter eicosanoid mobilisation seems to be attenuated. Potential treatment implications for the UHR state should be further investigated.
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Affiliation(s)
- Gregor E. Berger
- University Hospital of Child and Adolescent Psychiatry, University of Zurich, Neumünsterallee 9, 8032 Zurich, Switzerland
- Orygen Youth Health Research Centre, The University of Melbourne, Locked Bag 10, 35 Poplar Road Parkville, Victoria 3052, Melbourne, Australia
| | - Stefan Smesny
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
- * E-mail:
| | - Miriam R. Schäfer
- Orygen Youth Health Research Centre, The University of Melbourne, Locked Bag 10, 35 Poplar Road Parkville, Victoria 3052, Melbourne, Australia
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währingergürtel 18–20, A–1090 Vienna, Austria
| | - Berko Milleit
- 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
| | - Uta-Christina Hipler
- Department of Dermatology, University Hospital Jena, Erfurter Straße 35, D-07743 Jena, Germany
| | - Christine Milleit
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
| | - Claudia M. Klier
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währingergürtel 18–20, A–1090 Vienna, Austria
| | - Monika Schlögelhofer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währingergürtel 18–20, A–1090 Vienna, Austria
| | - Magdalena Holub
- Department of Nutritional Sciences, University of Vienna, Althanstrasse 14, A-1090 Vienna, Austria
| | - Ingrid Holzer
- Department of Nutritional Sciences, University of Vienna, Althanstrasse 14, A-1090 Vienna, Austria
| | - Michael Berk
- Deakin University of Melbourne, School of Medicine, Barwon Health, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health, Parkville, Australia
| | - Patrick D. McGorry
- Orygen Youth Health Research Centre, The University of Melbourne, Locked Bag 10, 35 Poplar Road Parkville, Victoria 3052, Melbourne, Australia
| | - Heinrich Sauer
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
| | - G. Paul Amminger
- Orygen Youth Health Research Centre, The University of Melbourne, Locked Bag 10, 35 Poplar Road Parkville, Victoria 3052, Melbourne, Australia
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währingergürtel 18–20, A–1090 Vienna, Austria
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Fernandes O, Portugal LCL, Alves RDCS, Arruda-Sanchez T, Rao A, Volchan E, Pereira M, Oliveira L, Mourao-Miranda J. Decoding negative affect personality trait from patterns of brain activation to threat stimuli. Neuroimage 2016; 145:337-345. [PMID: 26767946 PMCID: PMC5193176 DOI: 10.1016/j.neuroimage.2015.12.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/23/2015] [Accepted: 12/30/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Pattern recognition analysis (PRA) applied to functional magnetic resonance imaging (fMRI) has been used to decode cognitive processes and identify possible biomarkers for mental illness. In the present study, we investigated whether the positive affect (PA) or negative affect (NA) personality traits could be decoded from patterns of brain activation in response to a human threat using a healthy sample. METHODS fMRI data from 34 volunteers (15 women) were acquired during a simple motor task while the volunteers viewed a set of threat stimuli that were directed either toward them or away from them and matched neutral pictures. For each participant, contrast images from a General Linear Model (GLM) between the threat versus neutral stimuli defined the spatial patterns used as input to the regression model. We applied a multiple kernel learning (MKL) regression combining information from different brain regions hierarchically in a whole brain model to decode the NA and PA from patterns of brain activation in response to threat stimuli. RESULTS The MKL model was able to decode NA but not PA from the contrast images between threat stimuli directed away versus neutral with a significance above chance. The correlation and the mean squared error (MSE) between predicted and actual NA were 0.52 (p-value=0.01) and 24.43 (p-value=0.01), respectively. The MKL pattern regression model identified a network with 37 regions that contributed to the predictions. Some of the regions were related to perception (e.g., occipital and temporal regions) while others were related to emotional evaluation (e.g., caudate and prefrontal regions). CONCLUSION These results suggest that there was an interaction between the individuals' NA and the brain response to the threat stimuli directed away, which enabled the MKL model to decode NA from the brain patterns. To our knowledge, this is the first evidence that PRA can be used to decode a personality trait from patterns of brain activation during emotional contexts.
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Affiliation(s)
- Orlando Fernandes
- Department of Physiology and Pharmacology, Laboratory of Neurophysiology of Behaviour, Biomedical Institute, Federal Fluminense University, Niterói, RJ, Brazil.
| | - Liana C L Portugal
- Department of Physiology and Pharmacology, Laboratory of Neurophysiology of Behaviour, Biomedical Institute, Federal Fluminense University, Niterói, RJ, Brazil
| | - Rita de Cássia S Alves
- Department of Physiology and Pharmacology, Laboratory of Neurophysiology of Behaviour, Biomedical Institute, Federal Fluminense University, Niterói, RJ, Brazil
| | - Tiago Arruda-Sanchez
- Department of Radiology, Faculty of Medicine, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Anil Rao
- Department of Computer Science, Centre for Computational Statistics and Machine Learning, University College London, London, UK
| | - Eliane Volchan
- Laboratory of Neurobiology II, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Mirtes Pereira
- Department of Physiology and Pharmacology, Laboratory of Neurophysiology of Behaviour, Biomedical Institute, Federal Fluminense University, Niterói, RJ, Brazil
| | - Letícia Oliveira
- Department of Physiology and Pharmacology, Laboratory of Neurophysiology of Behaviour, Biomedical Institute, Federal Fluminense University, Niterói, RJ, Brazil
| | - Janaina Mourao-Miranda
- Department of Computer Science, Centre for Computational Statistics and Machine Learning, University College London, London, UK; Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
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Schnack HG, Kahn RS. Detecting Neuroimaging Biomarkers for Psychiatric Disorders: Sample Size Matters. Front Psychiatry 2016; 7:50. [PMID: 27064972 PMCID: PMC4814515 DOI: 10.3389/fpsyt.2016.00050] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/16/2016] [Indexed: 11/13/2022] Open
Abstract
In a recent review, it was suggested that much larger cohorts are needed to prove the diagnostic value of neuroimaging biomarkers in psychiatry. While within a sample, an increase of diagnostic accuracy of schizophrenia (SZ) with number of subjects (N) has been shown, the relationship between N and accuracy is completely different between studies. Using data from a recent meta-analysis of machine learning (ML) in imaging SZ, we found that while low-N studies can reach 90% and higher accuracy, above N/2 = 50 the maximum accuracy achieved steadily drops to below 70% for N/2 > 150. We investigate the role N plays in the wide variability in accuracy results in SZ studies (63-97%). We hypothesize that the underlying cause of the decrease in accuracy with increasing N is sample heterogeneity. While smaller studies more easily include a homogeneous group of subjects (strict inclusion criteria are easily met; subjects live close to study site), larger studies inevitably need to relax the criteria/recruit from large geographic areas. A SZ prediction model based on a heterogeneous group of patients with presumably a heterogeneous pattern of structural or functional brain changes will not be able to capture the whole variety of changes, thus being limited to patterns shared by most patients. In addition to heterogeneity (sample size), we investigate other factors influencing accuracy and introduce a ML effect size. We derive a simple model of how the different factors, such as sample heterogeneity and study setup determine this ML effect size, and explain the variation in prediction accuracies found from the literature, both in cross-validation and independent sample testing. From this, we argue that smaller-N studies may reach high prediction accuracy at the cost of lower generalizability to other samples. Higher-N studies, on the other hand, will have more generalization power, but at the cost of lower accuracy. In conclusion, when comparing results from different ML studies, the sample sizes should be taken into account. To assess the generalizability of the models, validation (by direct application) of the prediction models should be tested in independent samples. The prediction of more complex measures such as outcome, which are expected to have an underlying pattern of more subtle brain abnormalities (lower effect size), will require large samples.
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Affiliation(s)
- Hugo G Schnack
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht , Utrecht , Netherlands
| | - René S Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht , Utrecht , Netherlands
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Squarcina L, Castellani U, Bellani M, Perlini C, Lasalvia A, Dusi N, Bonetto C, Cristofalo D, Tosato S, Rambaldelli G, Alessandrini F, Zoccatelli G, Pozzi-Mucelli R, Lamonaca D, Ceccato E, Pileggi F, Mazzi F, Santonastaso P, Ruggeri M, Brambilla P. Classification of first-episode psychosis in a large cohort of patients using support vector machine and multiple kernel learning techniques. Neuroimage 2015; 145:238-245. [PMID: 26690803 DOI: 10.1016/j.neuroimage.2015.12.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/25/2015] [Accepted: 12/06/2015] [Indexed: 12/30/2022] Open
Abstract
First episode psychosis (FEP) patients are of particular interest for neuroimaging investigations because of the absence of confounding effects due to medications and chronicity. Nonetheless, imaging data are prone to heterogeneity because for example of age, gender or parameter setting differences. With this work, we wanted to take into account possible nuisance effects of age and gender differences across dataset, not correcting the data as a pre-processing step, but including the effect of nuisance covariates in the classification phase. To this aim, we developed a method which, based on multiple kernel learning (MKL), exploits the effect of these confounding variables with a subject-depending kernel weighting procedure. We applied this method to a dataset of cortical thickness obtained from structural magnetic resonance images (MRI) of 127 FEP patients and 127 healthy controls, who underwent either a 3Tesla (T) or a 1.5T MRI acquisition. We obtained good accuracies, notably better than those obtained with standard SVM or MKL methods, up to more than 80% for frontal and temporal areas. To our best knowledge, this is the largest classification study in FEP population, showing that fronto-temporal cortical thickness can be used as a potential marker to classify patients with psychosis.
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Affiliation(s)
- Letizia Squarcina
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy; InterUniversity Centre for Behavioural Neurosciences (ICBN), University of Verona, Verona, Italy
| | | | - Marcella Bellani
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy; InterUniversity Centre for Behavioural Neurosciences (ICBN), University of Verona, Verona, Italy
| | - Cinzia Perlini
- InterUniversity Centre for Behavioural Neurosciences (ICBN), University of Verona, Verona, Italy; Department of Public Health and Community Medicine, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Antonio Lasalvia
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy
| | - Nicola Dusi
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy; InterUniversity Centre for Behavioural Neurosciences (ICBN), University of Verona, Verona, Italy
| | - Chiara Bonetto
- Section of Psychiatry, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - Doriana Cristofalo
- Section of Psychiatry, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - Gianluca Rambaldelli
- InterUniversity Centre for Behavioural Neurosciences (ICBN), University of Verona, Verona, Italy; Section of Psychiatry, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | | | - Giada Zoccatelli
- Neuroradiology Department, Azienda Ospedaliera Universitaria, Verona, Italy
| | | | - Dario Lamonaca
- Department of Psychiatry, CSM AULSS 21 Legnago, Verona, Italy
| | - Enrico Ceccato
- Department of Mental Health, Hospital of Montecchio Maggiore, Vicenza, Italy
| | | | | | | | - Mirella Ruggeri
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy; Section of Psychiatry, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, TX, USA.
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Bendfeldt K, Smieskova R, Koutsouleris N, Klöppel S, Schmidt A, Walter A, Harrisberger F, Wrege J, Simon A, Taschler B, Nichols T, Riecher-Rössler A, Lang UE, Radue EW, Borgwardt S. Classifying individuals at high-risk for psychosis based on functional brain activity during working memory processing. NEUROIMAGE-CLINICAL 2015; 9:555-63. [PMID: 26640767 PMCID: PMC4625212 DOI: 10.1016/j.nicl.2015.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 11/04/2022]
Abstract
The psychosis high-risk state is accompanied by alterations in functional brain activity during working memory processing. We used binary automatic pattern-classification to discriminate between the at-risk mental state (ARMS), first episode psychosis (FEP) and healthy controls (HCs) based on n-back WM-induced brain activity. Linear support vector machines and leave-one-out-cross-validation were applied to fMRI data of matched ARMS, FEP and HC (19 subjects/group). The HC and ARMS were correctly classified, with an accuracy of 76.2% (sensitivity 89.5%, specificity 63.2%, p = 0.01) using a verbal working memory network mask. Only 50% and 47.4% of individuals were classified correctly for HC vs. FEP (p = 0.46) or ARMS vs. FEP (p = 0.62), respectively. Without mask, accuracy was 65.8% for HC vs. ARMS (p = 0.03) and 65.8% for HC vs. FEP (p = 0.0047), and 57.9% for ARMS vs. FEP (p = 0.18). Regions in the medial frontal, paracingulate, cingulate, inferior frontal and superior frontal gyri, inferior and superior parietal lobules, and precuneus were particularly important for group separation. These results suggest that FEP and HC or FEP and ARMS cannot be accurately separated in small samples under these conditions. However, ARMS can be identified with very high sensitivity in comparison to HC. This might aid classification and help to predict transition in the ARMS. The ARMS was accurately identified based on an individual patient's response within a WM network. Regional cortical activations were particularly important for group separation. Based on WM alterations, FEP and HC or FEP and ARMS could not be accurately separated in small samples.
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Affiliation(s)
- Kerstin Bendfeldt
- Medical Image Analysis Centre, University Hospital Basel, Mittlere Strasse 83, Basel 4031, Switzerland
| | - Renata Smieskova
- Medical Image Analysis Centre, University Hospital Basel, Mittlere Strasse 83, Basel 4031, Switzerland ; Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse, 27, Basel 4056, Switzerland
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Nussbaumstr. 7, Munich 80336, Germany
| | - Stefan Klöppel
- Department of Psychiatry and Psychotherapy, University Medical Center, Freiburg, Freiburg, Germany
| | - André Schmidt
- Medical Image Analysis Centre, University Hospital Basel, Mittlere Strasse 83, Basel 4031, Switzerland ; Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse, 27, Basel 4056, Switzerland
| | - Anna Walter
- Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse, 27, Basel 4056, Switzerland
| | - Fabienne Harrisberger
- Medical Image Analysis Centre, University Hospital Basel, Mittlere Strasse 83, Basel 4031, Switzerland ; Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse, 27, Basel 4056, Switzerland
| | - Johannes Wrege
- Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse, 27, Basel 4056, Switzerland
| | - Andor Simon
- University Hospital of Psychiatry, University of Bern, Bern 3010, Switzerland
| | - Bernd Taschler
- Dept. of Statistics, University of Warwick, Coventry, UK
| | - Thomas Nichols
- Dept. of Statistics, University of Warwick, Coventry, UK
| | - Anita Riecher-Rössler
- Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse, 27, Basel 4056, Switzerland
| | - Undine E Lang
- Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse, 27, Basel 4056, Switzerland
| | - Ernst-Wilhelm Radue
- Medical Image Analysis Centre, University Hospital Basel, Mittlere Strasse 83, Basel 4031, Switzerland
| | - Stefan Borgwardt
- Medical Image Analysis Centre, University Hospital Basel, Mittlere Strasse 83, Basel 4031, Switzerland ; Department of Psychiatry, University of Basel, Wilhelm Klein-Strasse, 27, Basel 4056, Switzerland ; Department of Psychosis Studies, King's College London, Institute of Psychiatry, De Crespigny Park 16, London SE58AF, UK
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Wolfers T, Buitelaar JK, Beckmann CF, Franke B, Marquand AF. From estimating activation locality to predicting disorder: A review of pattern recognition for neuroimaging-based psychiatric diagnostics. Neurosci Biobehav Rev 2015; 57:328-49. [PMID: 26254595 DOI: 10.1016/j.neubiorev.2015.08.001] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/29/2015] [Accepted: 08/02/2015] [Indexed: 12/19/2022]
Abstract
Psychiatric disorders are increasingly being recognised as having a biological basis, but their diagnosis is made exclusively behaviourally. A promising approach for 'biomarker' discovery has been based on pattern recognition methods applied to neuroimaging data, which could yield clinical utility in future. In this review we survey the literature on pattern recognition for making diagnostic predictions in psychiatric disorders, and evaluate progress made in translating such findings towards clinical application. We evaluate studies on many criteria, including data modalities used, the types of features extracted and algorithm applied. We identify problems common to many studies, such as a relatively small sample size and a primary focus on estimating generalisability within a single study. Furthermore, we highlight challenges that are not widely acknowledged in the field including the importance of accommodating disease prevalence, the necessity of more extensive validation using large carefully acquired samples, the need for methodological innovations to improve accuracy and to discriminate between multiple disorders simultaneously. Finally, we identify specific clinical contexts in which pattern recognition can add value in the short to medium term.
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Affiliation(s)
- Thomas Wolfers
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands; Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands; Karakter Child and Adolescent Psychiatry University Centre, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Christian F Beckmann
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, PO Box 9101, 6500 HB Nijmegen, The Netherlands; Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands; Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Oxford, United Kingdom
| | - Barbara Franke
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands; Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andre F Marquand
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, PO Box 9101, 6500 HB Nijmegen, The Netherlands; Department of Neuroimaging, Institute of Psychiatry, King's College London, LondonUnited Kingdom
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Squarcina L, Perlini C, Peruzzo D, Castellani U, Marinelli V, Bellani M, Rambaldelli G, Lasalvia A, Tosato S, De Santi K, Spagnolli F, Cerini R, Ruggeri M, Brambilla P. The use of dynamic susceptibility contrast (DSC) MRI to automatically classify patients with first episode psychosis. Schizophr Res 2015; 165:38-44. [PMID: 25888338 DOI: 10.1016/j.schres.2015.03.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 03/18/2015] [Accepted: 03/22/2015] [Indexed: 12/22/2022]
Abstract
Hemodynamic changes in the brain have been reported in major psychosis in respect to healthy controls, and could unveil the basis of structural brain modifications happening in patients. The study of first episode psychosis is of particular interest because the confounding role of chronicity and medication can be excluded. The aim of this work is to automatically discriminate first episode psychosis patients and normal controls on the basis of brain perfusion employing a support vector machine (SVM) classifier. 35 normal controls and 35 first episode psychosis underwent dynamic susceptibility contrast magnetic resonance imaging, and cerebral blood flow and volume, along with mean transit time were obtained. We investigated their behavior in the whole brain and in selected regions of interest, in particular the left and right frontal, parietal, temporal and occipital lobes, insula, caudate and cerebellum. The distribution of values of perfusion indexes were used as features in a support vector machine classifier. Mean values of blood flow and volume were slightly lower in patients, and the difference reached statistical significance in the right caudate, left and right frontal lobes, and in left cerebellum. Linear SVM reached an accuracy of 83% in the classification of patients and normal controls, with the highest accuracy associated with the right frontal lobe and left parietal lobe. In conclusion, we found evidence that brain perfusion could be used as a potential marker to classify patients with psychosis, who show reduced blood flow and volume in respect to normal controls.
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Affiliation(s)
- Letizia Squarcina
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy; InterUniversity Centre for Behavioural Neurosciences (ICBN), University of Verona, Verona, Italy
| | - Cinzia Perlini
- InterUniversity Centre for Behavioural Neurosciences (ICBN), University of Verona, Verona, Italy; Department of Public Health and Community Medicine, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Denis Peruzzo
- Department of Informatics, University of Verona, Verona, Italy; Scientific Institute IRCCS "E. Medea", Bosisio Parini (Lc), Italy
| | | | - Veronica Marinelli
- Department of Experimental & Clinical Medical Sciences (DISM), InterUniversity Center for Behavioral Neurosciences, University of Udine, Udine, Italy
| | - Marcella Bellani
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy; InterUniversity Centre for Behavioural Neurosciences (ICBN), University of Verona, Verona, Italy
| | - Gianluca Rambaldelli
- InterUniversity Centre for Behavioural Neurosciences (ICBN), University of Verona, Verona, Italy; Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Antonio Lasalvia
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy; Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Sarah Tosato
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Katia De Santi
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy
| | - Federica Spagnolli
- Department of Morphological and Biomedical Sciences, Section of Radiology, University of Verona, Italy
| | - Roberto Cerini
- Department of Morphological and Biomedical Sciences, Section of Radiology, University of Verona, Italy
| | - Mirella Ruggeri
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy; Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Psychiatric Clinic, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, TX, USA.
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40
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Koutsouleris N, Meisenzahl EM, Borgwardt S, Riecher-Rössler A, Frodl T, Kambeitz J, Köhler Y, Falkai P, Möller HJ, Reiser M, Davatzikos C. Individualized differential diagnosis of schizophrenia and mood disorders using neuroanatomical biomarkers. BRAIN : A JOURNAL OF NEUROLOGY 2015. [PMID: 25935725 DOI: 10.1093/brain/awv111)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Magnetic resonance imaging-based markers of schizophrenia have been repeatedly shown to separate patients from healthy controls at the single-subject level, but it remains unclear whether these markers reliably distinguish schizophrenia from mood disorders across the life span and generalize to new patients as well as to early stages of these illnesses. The current study used structural MRI-based multivariate pattern classification to (i) identify and cross-validate a differential diagnostic signature separating patients with first-episode and recurrent stages of schizophrenia (n = 158) from patients with major depression (n = 104); and (ii) quantify the impact of major clinical variables, including disease stage, age of disease onset and accelerated brain ageing on the signature's classification performance. This diagnostic magnetic resonance imaging signature was then evaluated in an independent patient cohort from two different centres to test its generalizability to individuals with bipolar disorder (n = 35), first-episode psychosis (n = 23) and clinically defined at-risk mental states for psychosis (n = 89). Neuroanatomical diagnosis was correct in 80% and 72% of patients with major depression and schizophrenia, respectively, and involved a pattern of prefronto-temporo-limbic volume reductions and premotor, somatosensory and subcortical increments in schizophrenia versus major depression. Diagnostic performance was not influenced by the presence of depressive symptoms in schizophrenia or psychotic symptoms in major depression, but earlier disease onset and accelerated brain ageing promoted misclassification in major depression due to an increased neuroanatomical schizophrenia likeness of these patients. Furthermore, disease stage significantly moderated neuroanatomical diagnosis as recurrently-ill patients had higher misclassification rates (major depression: 23%; schizophrenia: 29%) than first-episode patients (major depression: 15%; schizophrenia: 12%). Finally, the trained biomarker assigned 74% of the bipolar patients to the major depression group, while 83% of the first-episode psychosis patients and 77% and 61% of the individuals with an ultra-high risk and low-risk state, respectively, were labelled with schizophrenia. Our findings suggest that neuroanatomical information may provide generalizable diagnostic tools distinguishing schizophrenia from mood disorders early in the course of psychosis. Disease course-related variables such as age of disease onset and disease stage as well alterations of structural brain maturation may strongly impact on the neuroanatomical separability of major depression and schizophrenia.
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Affiliation(s)
| | - Eva M Meisenzahl
- 1 Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Germany
| | | | | | - Thomas Frodl
- 1 Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Germany 3 Department of Psychiatry and Psychotherapy, University of Regensburg, Germany 4 Department of Psychiatry, University Dublin, Trinity College Dublin, Ireland
| | - Joseph Kambeitz
- 1 Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Germany
| | - Yanis Köhler
- 1 Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Germany
| | - Peter Falkai
- 2 Department of Psychiatry, University of Basel, Switzerland
| | - Hans-Jürgen Möller
- 1 Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Germany
| | - Maximilian Reiser
- 5 Department of Radiology, Ludwig-Maximilian-University, Munich, Germany
| | - Christos Davatzikos
- 6 Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, USA
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41
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Koutsouleris N, Meisenzahl EM, Borgwardt S, Riecher-Rössler A, Frodl T, Kambeitz J, Köhler Y, Falkai P, Möller HJ, Reiser M, Davatzikos C. Individualized differential diagnosis of schizophrenia and mood disorders using neuroanatomical biomarkers. Brain 2015; 138:2059-73. [PMID: 25935725 DOI: 10.1093/brain/awv111] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 02/28/2015] [Indexed: 12/13/2022] Open
Abstract
Magnetic resonance imaging-based markers of schizophrenia have been repeatedly shown to separate patients from healthy controls at the single-subject level, but it remains unclear whether these markers reliably distinguish schizophrenia from mood disorders across the life span and generalize to new patients as well as to early stages of these illnesses. The current study used structural MRI-based multivariate pattern classification to (i) identify and cross-validate a differential diagnostic signature separating patients with first-episode and recurrent stages of schizophrenia (n = 158) from patients with major depression (n = 104); and (ii) quantify the impact of major clinical variables, including disease stage, age of disease onset and accelerated brain ageing on the signature's classification performance. This diagnostic magnetic resonance imaging signature was then evaluated in an independent patient cohort from two different centres to test its generalizability to individuals with bipolar disorder (n = 35), first-episode psychosis (n = 23) and clinically defined at-risk mental states for psychosis (n = 89). Neuroanatomical diagnosis was correct in 80% and 72% of patients with major depression and schizophrenia, respectively, and involved a pattern of prefronto-temporo-limbic volume reductions and premotor, somatosensory and subcortical increments in schizophrenia versus major depression. Diagnostic performance was not influenced by the presence of depressive symptoms in schizophrenia or psychotic symptoms in major depression, but earlier disease onset and accelerated brain ageing promoted misclassification in major depression due to an increased neuroanatomical schizophrenia likeness of these patients. Furthermore, disease stage significantly moderated neuroanatomical diagnosis as recurrently-ill patients had higher misclassification rates (major depression: 23%; schizophrenia: 29%) than first-episode patients (major depression: 15%; schizophrenia: 12%). Finally, the trained biomarker assigned 74% of the bipolar patients to the major depression group, while 83% of the first-episode psychosis patients and 77% and 61% of the individuals with an ultra-high risk and low-risk state, respectively, were labelled with schizophrenia. Our findings suggest that neuroanatomical information may provide generalizable diagnostic tools distinguishing schizophrenia from mood disorders early in the course of psychosis. Disease course-related variables such as age of disease onset and disease stage as well alterations of structural brain maturation may strongly impact on the neuroanatomical separability of major depression and schizophrenia.
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Affiliation(s)
| | - Eva M Meisenzahl
- 1 Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Germany
| | | | | | - Thomas Frodl
- 1 Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Germany 3 Department of Psychiatry and Psychotherapy, University of Regensburg, Germany 4 Department of Psychiatry, University Dublin, Trinity College Dublin, Ireland
| | - Joseph Kambeitz
- 1 Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Germany
| | - Yanis Köhler
- 1 Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Germany
| | - Peter Falkai
- 2 Department of Psychiatry, University of Basel, Switzerland
| | - Hans-Jürgen Möller
- 1 Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Germany
| | - Maximilian Reiser
- 5 Department of Radiology, Ludwig-Maximilian-University, Munich, Germany
| | - Christos Davatzikos
- 6 Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, USA
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Koutsouleris N, Riecher-Rössler A, Meisenzahl EM, Smieskova R, Studerus E, Kambeitz-Ilankovic L, von Saldern S, Cabral C, Reiser M, Falkai P, Borgwardt S. Detecting the psychosis prodrome across high-risk populations using neuroanatomical biomarkers. Schizophr Bull 2015; 41:471-82. [PMID: 24914177 PMCID: PMC4332937 DOI: 10.1093/schbul/sbu078] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
To date, the MRI-based individualized prediction of psychosis has only been demonstrated in single-site studies. It remains unclear if MRI biomarkers generalize across different centers and MR scanners and represent accurate surrogates of the risk for developing this devastating illness. Therefore, we assessed whether a MRI-based prediction system identified patients with a later disease transition among 73 clinically defined high-risk persons recruited at two different early recognition centers. Prognostic performance was measured using cross-validation, independent test validation, and Kaplan-Meier survival analysis. Transition outcomes were correctly predicted in 80% of test cases (sensitivity: 76%, specificity: 85%, positive likelihood ratio: 5.1). Thus, given a 54-month transition risk of 45% across both centers, MRI-based predictors provided a 36%-increase of prognostic certainty. After stratifying individuals into low-, intermediate-, and high-risk groups using the predictor's decision score, the high- vs low-risk groups had median psychosis-free survival times of 5 vs 51 months and transition rates of 88% vs 8%. The predictor's decision function involved gray matter volume alterations in prefrontal, perisylvian, and subcortical structures. Our results support the existence of a cross-center neuroanatomical signature of emerging psychosis enabling individualized risk staging across different high-risk populations. Supplementary results revealed that (1) potentially confounding between-site differences were effectively mitigated using statistical correction methods, and (2) the detection of the prodromal signature considerably depended on the available sample sizes. These observations pave the way for future multicenter studies, which may ultimately facilitate the neurobiological refinement of risk criteria and personalized preventive therapies based on individualized risk profiling tools.
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Affiliation(s)
- Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany;
| | - Anita Riecher-Rössler
- Department of Psychiatry, University of Basel, Basel, Switzerland;,This author contributed equally to this article
| | - Eva M. Meisenzahl
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Renata Smieskova
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Erich Studerus
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | | | - Sebastian von Saldern
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Carlos Cabral
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Maximilian Reiser
- Department of Radiology, Ludwig-Maximilian-University, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel, Basel, Switzerland
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Schmidt A, Diwadkar VA, Smieskova R, Harrisberger F, Lang UE, McGuire P, Fusar-Poli P, Borgwardt S. Approaching a network connectivity-driven classification of the psychosis continuum: a selective review and suggestions for future research. Front Hum Neurosci 2015; 8:1047. [PMID: 25628553 PMCID: PMC4292722 DOI: 10.3389/fnhum.2014.01047] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/15/2014] [Indexed: 01/07/2023] Open
Abstract
Brain changes in schizophrenia evolve along a dynamic trajectory, emerging before disease onset and proceeding with ongoing illness. Recent investigations have focused attention on functional brain interactions, with experimental imaging studies supporting the disconnection hypothesis of schizophrenia. These studies have revealed a broad spectrum of abnormalities in brain connectivity in patients, particularly for connections integrating the frontal cortex. A critical point is that brain connectivity abnormalities, including altered resting state connectivity within the fronto-parietal (FP) network, are already observed in non-help-seeking individuals with psychotic-like experiences. If we consider psychosis as a continuum, with individuals with psychotic-like experiences at the lower and psychotic patients at the upper ends, individuals with psychotic-like experiences represent a key population for investigating the validity of putative biomarkers underlying the onset of psychosis. This paper selectively addresses the role played by FP connectivity in the psychosis continuum, which includes patients with chronic psychosis, early psychosis, clinical high risk, genetic high risk, as well as the general population with psychotic experiences. We first discuss structural connectivity changes among the FP pathway in each domain in the psychosis continuum. This may provide a basis for us to gain an understanding of the subsequent changes in functional FP connectivity. We further indicate that abnormal FP connectivity may arise from glutamatergic disturbances of this pathway, in particular from abnormal NMDA receptor-mediated plasticity. In the second part of this paper we propose some concepts for further research on the use of network connectivity in the classification of the psychosis continuum. These concepts are consistent with recent efforts to enhance the role of data in driving the diagnosis of psychiatric spectrum diseases.
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Affiliation(s)
- André Schmidt
- Department of Psychiatry (UPK), University of Basel Basel, Switzerland
| | - Vaibhav A Diwadkar
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University Detroit, Michigan, USA
| | - Renata Smieskova
- Department of Psychiatry (UPK), University of Basel Basel, Switzerland
| | | | - Undine E Lang
- Department of Psychiatry (UPK), University of Basel Basel, Switzerland
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King's College London London, UK
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London London, UK
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel Basel, Switzerland ; Department of Psychosis Studies, Institute of Psychiatry, King's College London London, UK
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Borgwardt S, Lang UE. [Alterations of brain volumes by antipsychotic drugs in schizophrenia? New evidence from meta-analyses of structural imaging studies]. DER NERVENARZT 2014; 86:74-6. [PMID: 25223366 DOI: 10.1007/s00115-014-4158-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- S Borgwardt
- Universitäre Psychiatrische Kliniken (UPK), Wilhelm Klein-Str. 27, 4012, Basel, Schweiz
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Koutsouleris N, Davatzikos C, Borgwardt S, Gaser C, Bottlender R, Frodl T, Falkai P, Riecher-Rössler A, Möller HJ, Reiser M, Pantelis C, Meisenzahl E. Accelerated brain aging in schizophrenia and beyond: a neuroanatomical marker of psychiatric disorders. Schizophr Bull 2014; 40:1140-53. [PMID: 24126515 PMCID: PMC4133663 DOI: 10.1093/schbul/sbt142] [Citation(s) in RCA: 295] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Structural brain abnormalities are central to schizophrenia (SZ), but it remains unknown whether they are linked to dysmaturational processes crossing diagnostic boundaries, aggravating across disease stages, and driving the neurodiagnostic signature of the illness. Therefore, we investigated whether patients with SZ (N = 141), major depression (MD; N = 104), borderline personality disorder (BPD; N = 57), and individuals in at-risk mental states for psychosis (ARMS; N = 89) deviated from the trajectory of normal brain maturation. This deviation was measured as difference between chronological and the neuroanatomical age (brain age gap estimation [BrainAGE]). Neuroanatomical age was determined by a machine learning system trained to individually estimate age from the structural magnetic resonance imagings of 800 healthy controls. Group-level analyses showed that BrainAGE was highest in SZ (+5.5 y) group, followed by MD (+4.0), BPD (+3.1), and the ARMS (+1.7) groups. Earlier disease onset in MD and BPD groups correlated with more pronounced BrainAGE, reaching effect sizes of the SZ group. Second, BrainAGE increased across at-risk, recent onset, and recurrent states of SZ. Finally, BrainAGE predicted both patient status as well as negative and disorganized symptoms. These findings suggest that an individually quantifiable "accelerated aging" effect may particularly impact on the neuroanatomical signature of SZ but may extend also to other mental disorders.
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Affiliation(s)
- Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany;
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Christian Gaser
- Structural Brain Imaging Group, Department of Psychiatry and Neurology, FriedrichSchillerUniversity, Jena, Germany
| | - Ronald Bottlender
- Department of Psychiatry and Psychotherapy, Ludwig-MaximilianUniversity, Munich, Germany
| | - Thomas Frodl
- Department of Psychiatry and Psychotherapy, Ludwig-MaximilianUniversity, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-MaximilianUniversity, Munich, Germany
| | | | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-MaximilianUniversity, Munich, Germany
| | - Maximilian Reiser
- Department of Radiology, Ludwig-MaximilianUniversity, Munich, Germany
| | - Christos Pantelis
- Melbourne Neuropsychiatry Center, University of Melbourne, Melbourne, Victoria, Australia
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Ludwig-MaximilianUniversity, Munich, Germany
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46
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[Neuroimaging in psychiatry: multivariate analysis techniques for diagnosis and prognosis]. DER NERVENARZT 2014; 85:714-9. [PMID: 24849118 DOI: 10.1007/s00115-014-4022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Multiple studies successfully applied multivariate analysis to neuroimaging data demonstrating the potential utility of neuroimaging for clinical diagnostic and prognostic purposes. OBJECTIVES Summary of the current state of research regarding the application of neuroimaging in the field of psychiatry. MATERIAL AND METHODS Literature review of current studies. RESULTS Results of current studies indicate the potential application of neuroimaging data across various diagnoses, such as depression, schizophrenia, bipolar disorder and dementia. Potential applications include disease classification, differential diagnosis and prediction of disease course. CONCLUSION The results of the studies are heterogeneous although some studies report promising findings. Further multicentre studies are needed with clearly specified patient populations to systematically investigate the potential utility of neuroimaging for the clinical routine.
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Koutsouleris N, Ruhrmann S, Falkai P, Maier W. [Personalised medicine in psychiatry and psychotherapy. A review of the current state-of-the-art in the biomarker-based early recognition of psychoses]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 56:1522-30. [PMID: 24170081 DOI: 10.1007/s00103-013-1840-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The main goal of psychiatric high-risk research--the personalised early recognition and intervention of schizophrenic and affective psychoses--is one of the biggest challenges of current clinical psychiatry due to the immense socioeconomic burden of these disorders. In this regard, this review discusses the prospects and caveats of new clinical, neuropsychological, neurophysiological and imaging-based concepts aimed at optimising the current state-of-the-art of early recognition. Finally, multivariate modelling and machine learning methods are presented as a novel methodological framework facilitating the decoding of early psychosis into different intermediate phenotypes. In the future, these phenotypes could be employed for a more objective risk stratification that operates at the single-subject level. This could allow us to generate clinically applicable prognostic biomarkers for these disorders that would propel the individualised prevention of disease transition, chronification and psychopharmacological treatment resistance of psychotic disorders.
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Affiliation(s)
- N Koutsouleris
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, Nussbaumstr. 7, 80336, München, Deutschland,
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Facial emotion perception differs in young persons at genetic and clinical high-risk for psychosis. Psychiatry Res 2014; 216:206-12. [PMID: 24582775 DOI: 10.1016/j.psychres.2014.01.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 01/10/2014] [Accepted: 01/15/2014] [Indexed: 12/14/2022]
Abstract
A large body of literature has documented facial emotion perception impairments in schizophrenia. More recently, emotion perception has been investigated in persons at genetic and clinical high-risk for psychosis. This study compared emotion perception abilities in groups of young persons with schizophrenia, clinical high-risk, genetic risk and healthy controls. Groups, ages 13-25, included 24 persons at clinical high-risk, 52 first-degree relatives at genetic risk, 91 persons with schizophrenia and 90 low risk persons who completed computerized testing of emotion recognition and differentiation. Groups differed by overall emotion recognition abilities and recognition of happy, sad, anger and fear expressions. Pairwise comparisons revealed comparable impairments in recognition of happy, angry, and fearful expressions for persons at clinical high-risk and schizophrenia, while genetic risk participants were less impaired, showing reduced recognition of fearful expressions. Groups also differed for differentiation of happy and sad expressions, but differences were mainly between schizophrenia and control groups. Emotion perception impairments are observable in young persons at-risk for psychosis. Preliminary results with clinical high-risk participants, when considered along findings in genetic risk relatives, suggest social cognition abilities to reflect pathophysiological processes involved in risk of schizophrenia.
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Scariati E, Schaer M, Richiardi J, Schneider M, Debbané M, Van De Ville D, Eliez S. Identifying 22q11.2 Deletion Syndrome and Psychosis Using Resting-State Connectivity Patterns. Brain Topogr 2014; 27:808-21. [DOI: 10.1007/s10548-014-0356-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 02/12/2014] [Indexed: 11/30/2022]
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Zarogianni E, Moorhead TW, Lawrie SM. Towards the identification of imaging biomarkers in schizophrenia, using multivariate pattern classification at a single-subject level. Neuroimage Clin 2013; 3:279-89. [PMID: 24273713 PMCID: PMC3814947 DOI: 10.1016/j.nicl.2013.09.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 09/05/2013] [Accepted: 09/06/2013] [Indexed: 12/23/2022]
Abstract
Standard univariate analyses of brain imaging data have revealed a host of structural and functional brain alterations in schizophrenia. However, these analyses typically involve examining each voxel separately and making inferences at group-level, thus limiting clinical translation of their findings. Taking into account the fact that brain alterations in schizophrenia expand over a widely distributed network of brain regions, univariate analysis methods may not be the most suited choice for imaging data analysis. To address these limitations, the neuroimaging community has turned to machine learning methods both because of their ability to examine voxels jointly and their potential for making inferences at a single-subject level. This article provides a critical overview of the current and foreseeable applications of machine learning, in identifying imaging-based biomarkers that could be used for the diagnosis, early detection and treatment response of schizophrenia, and could, thus, be of high clinical relevance. We discuss promising future research directions and the main difficulties facing machine learning researchers as far as their potential translation into clinical practice is concerned.
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Affiliation(s)
- Eleni Zarogianni
- Division of Psychiatry, School of Clinical Sciences, University of Edinburgh, The Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5HF, Scotland, UK
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