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Le Boterff Q, Rabah A, Carment L, Bendjemaa N, Térémetz M, Alouit A, Levy A, Tanguy G, Morin V, Amado I, Cuenca M, Turc G, Maier MA, Krebs MO, Lindberg PG. A tablet-based quantitative assessment of manual dexterity for detection of early psychosis. Front Psychiatry 2023; 14:1200864. [PMID: 37435404 PMCID: PMC10330763 DOI: 10.3389/fpsyt.2023.1200864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/06/2023] [Indexed: 07/13/2023] Open
Abstract
Background We performed a pilot study on whether tablet-based measures of manual dexterity can provide behavioral markers for detection of first-episode psychosis (FEP), and whether cortical excitability/inhibition was altered in FEP. Methods Behavioral and neurophysiological testing was undertaken in persons diagnosed with FEP (N = 20), schizophrenia (SCZ, N = 20), autism spectrum disorder (ASD, N = 20), and in healthy control subjects (N = 20). Five tablet tasks assessed different motor and cognitive functions: Finger Recognition for effector (finger) selection and mental rotation, Rhythm Tapping for temporal control, Sequence Tapping for control/memorization of motor sequences, Multi Finger Tapping for finger individuation, and Line Tracking for visuomotor control. Discrimination of FEP (from other groups) based on tablet-based measures was compared to discrimination through clinical neurological soft signs (NSS). Cortical excitability/inhibition, and cerebellar brain inhibition were assessed with transcranial magnetic stimulation. Results Compared to controls, FEP patients showed slower reaction times and higher errors in Finger Recognition, and more variability in Rhythm Tapping. Variability in Rhythm Tapping showed highest specificity for the identification of FEP patients compared to all other groups (FEP vs. ASD/SCZ/Controls; 75% sensitivity, 90% specificity, AUC = 0.83) compared to clinical NSS (95% sensitivity, 22% specificity, AUC = 0.49). Random Forest analysis confirmed FEP discrimination vs. other groups based on dexterity variables (100% sensitivity, 85% specificity, balanced accuracy = 92%). The FEP group had reduced short-latency intra-cortical inhibition (but similar excitability) compared to controls, SCZ, and ASD. Cerebellar inhibition showed a non-significant tendency to be weaker in FEP. Conclusion FEP patients show a distinctive pattern of dexterity impairments and weaker cortical inhibition. Easy-to-use tablet-based measures of manual dexterity capture neurological deficits in FEP and are promising markers for detection of FEP in clinical practice.
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Affiliation(s)
- Quentin Le Boterff
- INSERM U1266 Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Ayah Rabah
- INSERM U1266 Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Loïc Carment
- INSERM U1266 Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Narjes Bendjemaa
- INSERM U1266 Institut de Psychiatrie et Neurosciences de Paris, Paris, France
- GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Maxime Térémetz
- INSERM U1266 Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Anaëlle Alouit
- INSERM U1266 Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Agnes Levy
- GHU Paris Psychiatrie & Neurosciences, Paris, France
| | | | | | | | | | - Guillaume Turc
- INSERM U1266 Institut de Psychiatrie et Neurosciences de Paris, Paris, France
- GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Marc A. Maier
- CNRS, Integrative Neuroscience and Cognition Center, Université Paris Cité, Paris, France
| | - Marie-Odile Krebs
- INSERM U1266 Institut de Psychiatrie et Neurosciences de Paris, Paris, France
- GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Påvel G. Lindberg
- INSERM U1266 Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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Pavlidou A, Gorisse G, Banakou D, Walther S. Using virtual reality to assess gesture performance deficits in schizophrenia patients. Front Psychiatry 2023; 14:1191601. [PMID: 37363173 PMCID: PMC10288366 DOI: 10.3389/fpsyt.2023.1191601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Gesture performance deficits are prevalent in schizophrenia patients and are strongly associated with poor social communication skills and community functioning, affecting their overall quality of life. Currently, video-recording technology is widely used in clinical settings to assess gesture production deficits in schizophrenia patients. Nevertheless, the subjective evaluation of video-recordings can encumber task assessment. The present study will aim to use virtual reality to examine its potential use as an alternative tool to objectively measure gesture performance accuracy in schizophrenia patients and healthy controls. Methods Gesture performance in the virtual reality setting will be based on the well-established Test of Upper Limb Apraxia. Participants will be immersed in a virtual environment where they will experience themselves being embodied in a collocated virtual body seen from a first-person perspective. Motion trackers will be placed on participants' hands and elbows to track upper body movements in real-time, and to record gesture movement for later analysis. Participants will see a virtual agent sitting across from them, with a virtual table in between. The agent will perform various types of gestures and the participants' task will be to imitate those gestures as accurately as possible. Measurements from the tracking devices will be stored and analyzed to address gesture performance accuracy across groups. Discussion This study aims to provide objective measurements of gesture performance accuracy in schizophrenia patients. If successful, the results will provide new knowledge to the gesture literature and offer the potential for novel therapeutic interventions using virtual reality technologies. Such interventions can improve gesturing and thus advance social communication skills in schizophrenia patients.
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Affiliation(s)
- Anastasia Pavlidou
- University of Bern, University Hospital of Psychiatry and Psychotherapy, Translation Research Centre, Bern, Switzerland
| | | | - Domna Banakou
- Arts and Humanities Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Sebastian Walther
- University of Bern, University Hospital of Psychiatry and Psychotherapy, Translation Research Centre, Bern, Switzerland
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3
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Lopes-Rocha AC, de Paula Ramos WH, Argolo F, Gondim JM, Mota NB, Andrade JC, Jafet AF, de Medeiros MW, Serpa MH, Cecchi G, Ara A, Gattaz WF, Corcoran CM, Loch AA. Gesticulation in individuals with at risk mental states for psychosis. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:30. [PMID: 37160916 PMCID: PMC10169854 DOI: 10.1038/s41537-023-00360-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023]
Abstract
Nonverbal communication (NVC) is a complex behavior that involves different modalities that are impaired in the schizophrenia spectrum, including gesticulation. However, there are few studies that evaluate it in individuals with at-risk mental states (ARMS) for psychosis, mostly in developed countries. Given our prior findings of reduced movement during speech seen in Brazilian individuals with ARMS, we now aim to determine if this can be accounted for by reduced gesticulation behavior. Fifty-six medication-naïve ARMS and 64 healthy controls were filmed during speech tasks. The frequency of specifically coded gestures across four categories (and self-stimulatory behaviors) were compared between groups and tested for correlations with prodromal symptoms of the Structured Interview for Prodromal Syndromes (SIPS) and with the variables previously published. ARMS individuals showed a reduction in one gesture category, but it did not survive Bonferroni's correction. Gesture frequency was negatively correlated with prodromal symptoms and positively correlated with the variables of the amount of movement previously analyzed. The lack of significant differences between ARMS and control contradicts literature findings in other cultural context, in which a reduction is usually seen in at-risk individuals. However, gesture frequency might be a visual proxy of prodromal symptoms, and of other movement abnormalities. Results show the importance of analyzing NVC in ARMS and of considering different cultural and sociodemographic contexts in the search for markers of these states.
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Affiliation(s)
- Ana Caroline Lopes-Rocha
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | | | - Felipe Argolo
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - João Medrado Gondim
- Instituto de Computação, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Natalia Bezerra Mota
- Instituto de Psiquiatria (IPUB), Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Research department at Motrix Lab - Motrix, Rio de Janeiro, Brazil
| | - Julio Cesar Andrade
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Andrea Fontes Jafet
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Matheus Wanderley de Medeiros
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Mauricio Henriques Serpa
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | | | - Anderson Ara
- Statistics Department, Federal University of Paraná, Curitiba, PR, Brazil
| | - Wagner Farid Gattaz
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | - Cheryl Mary Corcoran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Alexandre Andrade Loch
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Karp EL, Williams TF, Ellman LM, Strauss GP, Walker EF, Corlett PR, Woods SW, Powers AR, Gold JM, Schiffman JE, Waltz JA, Silverstein SM, Mittal VA. Self-reported Gesture Interpretation and Performance Deficits in Individuals at Clinical High Risk for Psychosis. Schizophr Bull 2023; 49:746-755. [PMID: 36939086 PMCID: PMC10154698 DOI: 10.1093/schbul/sbac197] [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] [Indexed: 03/21/2023]
Abstract
BACKGROUND AND HYPOTHESIS Deficits in performing and interpreting communicative nonverbal behaviors, such as gesture, have been linked to varied psychopathology and dysfunction. Some evidence suggests that individuals at risk for psychosis have deficits in gesture interpretation and performance; however, individuals with internalizing disorders (eg, depression) may have similar deficits. No previous studies have examined whether gesture deficits in performance and interpretation are specific to those at risk for psychosis. Additionally, the underlying mechanisms (eg, cognition) and consequences (eg, functioning) of these deficits are poorly understood. STUDY DESIGN This study examined self-reported gesture interpretation (SRGI) and performance (SRGP) in those at clinical high risk for psychosis (CHR; N = 88), those with internalizing disorders (INT; N = 51), and healthy controls (HC; N = 53). Participants completed questionnaires, clinical interviews, and neurocognitive tasks. STUDY RESULTS Results indicated that the CHR group was characterized by significantly lower SRGI scores than the HC or INT groups (d = 0.41); there were no differences among groups in SRGP. Within CHR participants, greater deficits in SRGP were associated with lower verbal learning and memory (r = -.33), but not general intelligence or processing speed. Furthermore, gesture deficits were associated with higher cross-sectional risk for conversion to a full psychotic disorder in the CHR group. CONCLUSIONS Overall, these findings suggest that specific subdomains of gesture may reflect unique vulnerability for psychosis, self-report may be a viable assessment tool in understanding these phenomena, and gesture dysfunction may signal risk for transition to psychosis.
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Affiliation(s)
- Erica L Karp
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
| | - Trevor F Williams
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA
| | - Gregory P Strauss
- Departments of Psychology and Neuroscience, University of Georgia, Athens, GA 30602, USA
| | - Elaine F Walker
- Department of Psychology and Program in Neuroscience, Emory University, Atlanta, GA 30322, USA
| | - Philip R Corlett
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Jason E Schiffman
- Department of Psychological Science, University of California, 4201 Social and Behavioral Sciences Gateway, Irvine, CA 92697, USA
| | - James A Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Steven M Silverstein
- Departments of Psychiatry, Neuroscience and Ophthalmology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Vijay A Mittal
- Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Departments of Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL 60208, USA
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Howes C, Lavelle M. Quirky conversations: how people with a diagnosis of schizophrenia do dialogue differently. Philos Trans R Soc Lond B Biol Sci 2023; 378:20210480. [PMID: 36871591 PMCID: PMC9985960 DOI: 10.1098/rstb.2021.0480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/11/2022] [Indexed: 03/07/2023] Open
Abstract
People with a diagnosis of schizophrenia (PSz) have difficulty engaging in social interaction, but little research has focused on dialogues involving PSz interacting with partners who are unaware of their diagnosis. Using quantitative and qualitative methods on a unique corpus of triadic dialogues of PSz first social encounters, we show that turn-taking is disrupted in dialogues involving a PSz. Specifically, there are on average longer gaps between turns in groups which contain a PSz compared to those which do not, particularly when the speaker switch occurs from one control (C) participant to the other. Furthermore, the expected link between gesture and repair is not present in dialogues with a PSz, particularly for C participants interacting with a PSz. As well as offering some insights into how the presence of a PSz affects an interaction, our results also demonstrate the flexibility of our mechanisms for interaction. This article is part of a discussion meeting issue 'Face2face: advancing the science of social interaction'.
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Affiliation(s)
- Christine Howes
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Mary Lavelle
- School of Psychology, Queens University, Belfast BT7 1NN, UK
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Riedl L, Nagels A, Sammer G, Choudhury M, Nonnenmann A, Sütterlin A, Feise C, Haslach M, Bitsch F, Straube B. Multimodal speech-gesture training in patients with schizophrenia spectrum disorder: Effects on quality of life and neural processing. Schizophr Res 2022; 246:112-125. [PMID: 35759877 DOI: 10.1016/j.schres.2022.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/25/2022] [Accepted: 06/11/2022] [Indexed: 12/30/2022]
Abstract
Dysfunctional social communication is one of the most stable characteristics in patients with schizophrenia spectrum disorder (SSD) that severely affects quality of life. Interpreting abstract speech and integrating nonverbal information is particularly affected. Considering the difficulty to treat communication dysfunctions with usual intervention, we investigated the possibility to apply a multimodal speech-gesture (MSG) training. In the MSG training, we offered 8 sessions (60 min each) including perceptive and expressive tasks as well as meta-learning elements and transfer exercises to 29 patients with SSD. In a within-group crossover design, patients were randomized to a TAU-first (treatment as usual first, then MSG training) group (N = 20) or a MSG-first (MSG training first, then TAU only) group (N = 9), and were compared to healthy controls (N = 17). Outcomes were quality of life and related changes in the neural processing of abstract speech-gesture information, which were measured pre-post training through standardized psychological questionnaires and functional Magnetic Resonance Imaging, respectively. Pre-training, patients showed reduced quality of life as compared to controls but improved significantly during the training. Strikingly, this improvement was correlated with neural activation changes in the middle temporal gyrus for the processing of abstract multimodal content. Improvement during training, self-report measures and ratings of relatives confirmed the MSG-related changes. Together, we provide first promising results of a novel multimodal speech-gesture training for patients with schizophrenia. We could link training induced changes in speech-gesture processing to changes in quality of life, demonstrating the relevance of intact communication skills and gesture processing for well-being.
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Affiliation(s)
- Lydia Riedl
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg and Justus Liebig University, Giessen, Germany.
| | - Arne Nagels
- Department of English and Linguistics, Johannes-Gutenberg-University, Mainz, Germany
| | - Gebhard Sammer
- Department of Psychiatry and Psychotherapy, Justus-Liebig-University, Giessen, Germany
| | - Momoko Choudhury
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Annika Nonnenmann
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Anne Sütterlin
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Chiara Feise
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Maxi Haslach
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Florian Bitsch
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Benjamin Straube
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg and Justus Liebig University, Giessen, Germany
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7
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Nadesalingam N, Chapellier V, Lefebvre S, Pavlidou A, Stegmayer K, Alexaki D, Gama DB, Maderthaner L, von Känel S, Wüthrich F, Walther S. Motor abnormalities are associated with poor social and functional outcomes in schizophrenia. Compr Psychiatry 2022; 115:152307. [PMID: 35303585 DOI: 10.1016/j.comppsych.2022.152307] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/26/2022] [Accepted: 03/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Up to 50% of patients with schizophrenia are suffering from motor abnormalities, which may contribute to decreased quality of life, impaired work capacity, and a reduced life expectancy by 10-20 years. However, the effect of motor abnormalities on social and global functioning, as well as, functional capacity is not clear. We hypothesized, that the presence of motor abnormalities is associated with poorer functional outcomes in patients with schizophrenia. METHODS We collected data on 5 different motor abnormalities in 156 patients suffering from schizophrenia spectrum disorders: parkinsonism, catatonia, dyskinesia, neurological soft signs and psychomotor slowing (PS). Additionally, we used three different scales to evaluate the functional outcomes in these patients: the Global Assessment of Functioning (GAF) and the Social and Occupational Functioning Assessment Scale (SOFAS) which use clinicians' judgment; and one using a performance-based measure of functional capacity, the brief version of the UCSD Performance-based Skills Assessment (UPSA-B). RESULTS Our analysis demonstrated that patients with catatonia (all F > 4.5; p < 0.035) and parkinsonism (all F > 4.9; p < 0.027) scored lower on GAF and SOFAS compared to patients without catatonia and parkinsonism. In contrast, no significant difference on functional outcomes between patients with dyskinesia versus without dyskinesia exist in our study. Furthermore, there are statistically significant negative correlations for parkinsonism and PS with GAF, SOFAS and UPSA-B (all tau are at least -0.152, p-value <0.036). We also found significant negative correlations between catatonia and both GAF & SOFAS (all tau are at least -0.203, p-value<0.001) and between NES and SOFAS (tau = -0.137, p-value = 0.033). CONCLUSION Here, we showed that four of the most common motor abnormalities observed in schizophrenia were associated with at least one of the patients' functional outcomes. The stronger the motor impairment was the worse the global and social functioning. Future studies need to test, whether amelioration of motor abnormalities is linked to improved community functioning.
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Affiliation(s)
- Niluja Nadesalingam
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.
| | - Victoria Chapellier
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Stephanie Lefebvre
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Anastasia Pavlidou
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Danai Alexaki
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Daniel Baumann Gama
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Lydia Maderthaner
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Sofie von Känel
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Florian Wüthrich
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
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Osiurak F, Reynaud E, Baumard J, Rossetti Y, Bartolo A, Lesourd M. Pantomime of tool use: looking beyond apraxia. Brain Commun 2022; 3:fcab263. [PMID: 35350708 PMCID: PMC8936430 DOI: 10.1093/braincomms/fcab263] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 11/22/2022] Open
Abstract
Pantomime has a long tradition in clinical neuropsychology of apraxia. It has been much more used by researchers and clinicians to assess tool-use disorders than real tool use. Nevertheless, it remains incompletely understood and has given rise to controversies, such as the involvement of the left inferior parietal lobe or the nature of the underlying cognitive processes. The present article offers a comprehensive framework, with the aim of specifying the neural and cognitive bases of pantomime. To do so, we conducted a series of meta-analyses of brain-lesion, neuroimaging and behavioural studies about pantomime and other related tasks (i.e. real tool use, imitation of meaningless postures and semantic knowledge). The first key finding is that the area PF (Area PF complex) within the left inferior parietal lobe is crucially involved in both pantomime and real tool use as well as in the kinematics component of pantomime. The second key finding is the absence of a well-defined neural substrate for the posture component of pantomime (both grip errors and body-part-as-tool responses). The third key finding is the role played by the intraparietal sulcus in both pantomime and imitation of meaningless postures. The fourth key finding is that the left angular gyrus seems to be critical in the production of motor actions directed towards the body. The fifth key finding is that performance on pantomime is strongly correlated with the severity of semantic deficits. Taken together, these findings invite us to offer a neurocognitive model of pantomime, which provides an integrated alternative to the two hypotheses that dominate the field: The gesture-engram hypothesis and the communicative hypothesis. More specifically, this model assumes that technical reasoning (notably the left area PF), the motor-control system (notably the intraparietal sulcus), body structural description (notably the left angular gyrus), semantic knowledge (notably the polar temporal lobes) and potentially theory of mind (notably the middle prefrontal cortex) work in concert to produce pantomime. The original features of this model open new avenues for understanding the neurocognitive bases of pantomime, emphasizing that pantomime is a communicative task that nevertheless originates in specific tool-use (not motor-related) cognitive processes. <Please insert Graphical abstract here>
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Affiliation(s)
- François Osiurak
- Laboratoire d'Etude des Mécanismes Cognitifs (EA3082), Université Lyon 2, 69676 Bron, France.,Institut Universitaire de France, 75231 Paris, France
| | - Emanuelle Reynaud
- Laboratoire d'Etude des Mécanismes Cognitifs (EA3082), Université Lyon 2, 69676 Bron, France
| | - Josselin Baumard
- Normandie University, UNIROUEN, CRFDP (EA7475), 76821 Mont Saint Aignan, France
| | - Yves Rossetti
- Centre de Recherche en Neurosciences de Lyon, Trajectoires Team, CNRS U5292, Inserm U1028, Université de Lyon, 69676 Bron, France.,Mouvement, Handicap, et Neuro-Immersion, Hospices Civils de Lyon et Centre de Recherche en Neurosciences de Lyon, Hôpital Henry Gabrielle, 69230 Saint-Genis-Laval, France
| | - Angela Bartolo
- Institut Universitaire de France, 75231 Paris, France.,Univ. Lille, CNRS, UMR9193, SCALab-Sciences Cognitives et Sciences Affectives, 59653 Villeneuve d'Ascq, France
| | - Mathieu Lesourd
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive (UR481), Université de Bourgogne Franche-Comté, 25030 Besançon, France.,MSHE Ledoux, CNRS, Université de Bourgogne Franche-Comté, 25000 Besançon, France
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9
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Chapellier V, Pavlidou A, Maderthaner L, von Känel S, Walther S. The Impact of Poor Nonverbal Social Perception on Functional Capacity in Schizophrenia. Front Psychol 2022; 13:804093. [PMID: 35282219 PMCID: PMC8904900 DOI: 10.3389/fpsyg.2022.804093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background Nonverbal social perception is the ability to interpret the intentions and dispositions of others by evaluating cues such as facial expressions, body movements, and emotional prosody. Nonverbal social perception plays a key role in social cognition and is fundamental for successful social interactions. Patients with schizophrenia have severe impairments in nonverbal social perception leading to social isolation and withdrawal. Collectively, these aforementioned deficits affect patients’ quality of life. Here, we compare nonverbal social perception in patients with schizophrenia and controls and examine how nonverbal social perception relates to daily functioning. Methods We compared nonverbal social perception in 41 stable outpatients with schizophrenia and 30 healthy controls using the Mini Profile of Nonverbal Sensitivity (Mini-PONS). The participants evaluated 64 video clips showing a female actor demonstrating various nonverbal social cues. Participants were asked to choose one of two options that best described the observed scenario. We correlated clinical ratings (Positive and Negative Syndrome Scale, Brief Negative Syndrome Scale), Self-report of Negative Symptoms, and functional assessments (functional capacity and functional outcome) with Mini-PONS scores. Results Patients performed significantly poorer in the Mini-PONS compared to controls, suggesting deficits in nonverbal social perception. These deficits were not associated with either positive symptoms or negative symptoms (including self-report). However, impaired nonverbal social perception correlated with distinctive domains of BNSS (mainly avolition and blunted affect), as well as functional capacity and functional outcome in patients. Conclusion We demonstrate that nonverbal social perception is impaired in stable outpatients with schizophrenia. Nonverbal social perception is directly related to specific negative symptom domains, functional capacity and functional outcome. These findings underline the importance of nonverbal social perception for patients’ everyday life and call for novel therapeutic approaches to alleviate nonverbal social perception deficits.
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Affiliation(s)
- Victoria Chapellier
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anastasia Pavlidou
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Lydia Maderthaner
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sofie von Känel
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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10
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Chapellier V, Pavlidou A, Mueller DR, Walther S. Brain Stimulation and Group Therapy to Improve Gesture and Social Skills in Schizophrenia-The Study Protocol of a Randomized, Sham-Controlled, Three-Arm, Double-Blind Trial. Front Psychiatry 2022; 13:909703. [PMID: 35873264 PMCID: PMC9301234 DOI: 10.3389/fpsyt.2022.909703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED An important component of nonverbal communication is gesture performance, which is strongly impaired in 2/3 of patients with schizophrenia. Gesture deficits in schizophrenia are linked to poor social functioning and reduced quality of life. Therefore, interventions that can help alleviate these deficits in schizophrenia are crucial. Here, we describe an ongoing randomized, double-blind 3-arm, sham-controlled trial that combines two interventions to reduce gesture deficits in schizophrenia patients. The combined interventions are continuous theta burst stimulation (cTBS) and social cognitive remediation therapy (SCRT). We will randomize 72 patients with schizophrenia spectrum disorders in three different groups of 24 patients. The first group will receive real cTBS and real SCRT, the second group will receive sham cTBS and real SCRT, and finally the third group will receive sham SCRT. Here, the sham treatments are, as per definition, inactive interventions that mimic as closely as possible the real treatments (similar to placebo). In addition, 24 age- and gender-matched controls with no interventions will be added for comparison. Measures of nonverbal communication, social cognition, and multimodal brain imaging will be applied at baseline and after intervention. The main research aim of this project will be to test whether the combination of cTBS and SCRT improves gesture performance and social functioning in schizophrenia patients more than standalone cTBS, SCRT or sham psychotherapy. We hypothesize that the patient group receiving the combined interventions will be superior in improving gesture performance. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NCT04106427].
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Affiliation(s)
- Victoria Chapellier
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anastasia Pavlidou
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Daniel R Mueller
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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11
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Salesse RN, Casties JF, Capdevielle D, Raffard S. Socio-Motor Improvisation in Schizophrenia: A Case-Control Study in a Sample of Stable Patients. Front Hum Neurosci 2021; 15:676242. [PMID: 34744659 PMCID: PMC8567989 DOI: 10.3389/fnhum.2021.676242] [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] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Improvising is essential for human development and is one of the most important characteristics of being human. However, how mental illness affects improvisation remains largely unknown. In this study we focused on socio-motor improvisation in individuals with schizophrenia, one of the more debilitating mental disorder. This represents the ability to improvise gestures during an interaction to promote sustained communication and shared attention. Using a novel paradigm called the mirror game and recently introduced to study joint improvisation, we recorded hand motions of two people mirroring each other. Comparing Schizophrenia patients and healthy controls skills during the game, we found that improvisation was impaired in schizophrenia patients. Patients also exhibited significantly higher difficulties to being synchronized with someone they follow but not when they were leaders of the joint improvisation game. Considering the correlation between socio-motor synchronization and socio-motor improvisation, these results suggest that synchronization does not only promote affiliation but also improvisation, being therefore an interesting key factor to enhance social skills in a clinical context. Moreover, socio-motor improvisation abnormalities were not associated with executive functioning, one traditional underpinning of improvisation. Altogether, our results suggest that even if both mental illness and improvisation differ from normal thinking and behavior, they are not two sides of the same coin, providing a direct evidence that being able to improvise in individual situations is fundamentally different than being able to improvise in a social context.
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Affiliation(s)
- Robin N. Salesse
- University Department of Adult Psychiatry, Montpellier University Hospital, Montpellier, France
- CTIsuccess by Mooven, Contract Research Organisation, Montpellier, France
| | - Jean-François Casties
- University Department of Adult Psychiatry, Montpellier University Hospital, Montpellier, France
| | - Delphine Capdevielle
- University Department of Adult Psychiatry, Montpellier University Hospital, Montpellier, France
- INSERM U1061, Neuropsychiatrie Recherche Épidémiologique et Clinique, Université de Montpellier, Montpellier, France
| | - Stéphane Raffard
- University Department of Adult Psychiatry, Montpellier University Hospital, Montpellier, France
- Epsylon Laboratory EA 4556, University Paul Valéry Montpellier 3, Montpellier, France
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12
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Pavlidou A, Viher PV, Bachofner H, Weiss F, Stegmayer K, Shankman SA, Mittal VA, Walther S. Hand gesture performance is impaired in major depressive disorder: A matter of working memory performance? J Affect Disord 2021; 292:81-88. [PMID: 34107424 PMCID: PMC8797922 DOI: 10.1016/j.jad.2021.05.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 05/11/2021] [Accepted: 05/23/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Individuals with depression exhibit numerous interpersonal deficits. As effective use of gestures is critical for social communication, it is possible that depressed individuals' interpersonal deficits may be due to deficits in gesture performance. The present study thus compared gesture performance of depressed patients and controls and examined whether these deficits relate to cognitive and other domains of dysfunction. METHODS Gesture performance was evaluated in 30 depressed patients and 30 controls using the Test of Upper Limb Apraxia (TULIA). Clinical rating scales were assessed to determine if gesture deficits were associated with motor, cognitive or functional outcomes. RESULTS Compared to controls, depressed patients exhibited impaired gesture performance with 2/3 of the patients demonstrating gesture deficits. Within depressed patients, gesture performance was highly correlated with working memory abilities. In contrast, no association between gesture performance and gestural knowledge, psychomotor retardation, depression severity, or frontal dysfunction was observed in patients. LIMITATIONS This is a cross-sectional study and a larger size would have allowed for confident detection of more subtle, but potentially relevant effects. CONCLUSION Gesture performance is impaired in depressed patients, and appears to be related to poor working memory abilities, suggesting a disruption in the retrieval of gestural cues indicative of a distinct clinical phenomenon that might be related to social functioning.
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Affiliation(s)
- Anastasia Pavlidou
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland.
| | - Petra V Viher
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland
| | - Hanta Bachofner
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland
| | - Florian Weiss
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland
| | - Katharina Stegmayer
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland
| | - Stewart A Shankman
- Northwestern University, Department of Psychology, Evanston, IL, USA; Northwestern University, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA
| | - Vijay A Mittal
- Northwestern University, Department of Psychology, Evanston, IL, USA; Northwestern University, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA; Northwestern University, Department of Psychiatry, Institute for Policy Research, Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences (DevSci), Evanston, Chicago, IL, USA
| | - Sebastian Walther
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland
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13
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[The sensorimotor domain in the research domain criteria system: progress and perspectives]. DER NERVENARZT 2021; 92:915-924. [PMID: 34115150 DOI: 10.1007/s00115-021-01144-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
Over the past three decades research interest in hypokinetic, hyperkinetic, sensorimotor and psychomotor abnormalities in mental disorders has steadily increased. This development has led to an increasing number of scientific initiatives that have not only highlighted the clinical need for early detection of extrapyramidal motor symptoms, tardive dyskinesia and catatonia but also provided numerous neurobiological findings and clinically relevant results based on the pathology of the sensorimotor system in patients with mental disorders. In view of these developments in January 2019 the National Institute of Mental Health (NIMH) research domain criteria (RDoC) initiative introduced a sixth domain called the sensorimotor domain to address deficits in the sensorimotor system and associated behavioral abnormalities. To draw attention to the rapid progress just since the introduction of the sensorimotor domain, a 2-year (1 January 2019-18 February 2021) systematic review is presented highlighting recent neuroimaging findings and discussing challenges for future research. In summary, aberrant sensorimotor processing in mental disorders is associated with dysfunction of the cerebello-thalamo-motor cortex network, which interacts with (social)cognitive and affective systems. Initial longitudinal and interventional studies highlight the translational potential of the sensorimotor domain.
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14
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Choudhury M, Steines M, Nagels A, Riedl L, Kircher T, Straube B. Neural Basis of Speech-Gesture Mismatch Detection in Schizophrenia Spectrum Disorders. Schizophr Bull 2021; 47:1761-1771. [PMID: 34050672 PMCID: PMC8530401 DOI: 10.1093/schbul/sbab059] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with schizophrenia spectrum disorders (SSD) exhibit an aberrant perception and comprehension of abstract speech-gesture combinations associated with dysfunctional activation of the left inferior frontal gyrus (IFG). Recently, a significant deficit of speech-gesture mismatch detection was identified in SSD, but the underlying neural mechanisms have not yet been examined. A novel mismatch-detection fMRI paradigm was implemented manipulating speech-gesture abstractness (abstract/concrete) and relatedness (related/unrelated). During fMRI data acquisition, 42 SSD patients (schizophrenia, schizoaffective disorder, or other non-organic psychotic disorder [ICD-10: F20, F25, F28; DSM-IV: 295.X]) and 36 healthy controls were presented with short video clips of an actor reciting abstract or concrete sentences accompanied by either a semantically related or unrelated gesture. Participants indicated via button press whether they perceived each gesture as matching the speech content or not. Speech-gesture mismatch detection performance was significantly impaired in patients compared to controls. fMRI data analysis revealed that patients showed lower activation in bilateral frontal areas, including the IFG for all abstract > concrete speech-gesture pairs. In addition, they exhibited reduced engagement of the right supplementary motor area (SMA) and bilateral anterior cingulate cortices (ACC) for unrelated > related stimuli. We provide first evidence that impaired speech-gesture mismatch detection in SSD could be the result of dysfunctional activation of the SMA and ACC. Failure to activate the left IFG disrupts the integration of abstract speech-gesture combinations in particular. Future investigations should focus on brain stimulation of the SMA, ACC, and the IFG to improve communication and social functioning in SSD.
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Affiliation(s)
- Momoko Choudhury
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Miriam Steines
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany,Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg and Justus Liebig University Giessen, Marburg, Germany
| | - Arne Nagels
- Department of English and Linguistics, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lydia Riedl
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Tilo Kircher
- Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg and Justus Liebig University Giessen, Marburg, Germany,Systems Neuroscience, Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Benjamin Straube
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany,Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg and Justus Liebig University Giessen, Marburg, Germany,To whom correspondence should be addressed; Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Rudolf-Bultmann-Str. 8, D-35039 Marburg, Germany; tel: +49-(0)6421-58-66429, fax: +49-3212-75-86605, e-mail:
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15
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Abstract
Individuals diagnosed with psychotic disorders exhibit abnormalities in the perception of expressive behaviors, which are linked to symptoms and visual information processing domains. Specifically, literature suggests these groups have difficulties perceiving gestures that accompany speech. While our understanding of gesture perception in psychotic disorders is growing, gesture perception abnormalities and clues about potential causes and consequences among individuals meeting criteria for a clinical high-risk (CHR) syndrome is limited. Presently, 29 individuals with a CHR syndrome and 32 healthy controls completed an eye-tracking gesture perception paradigm. In this task, participants viewed an actor using abstract and literal gestures while presenting a story and eye gaze data (eg, fixation counts and total fixation time) was collected. Furthermore, relationships between fixation variables and both symptoms (positive, negative, anxiety, and depression) and measures of visual information processing (working memory and attention) were examined. Findings revealed that the CHR group gazed at abstract gestures fewer times than the control group. When individuals in the CHR group did gaze at abstract gestures, on average, they spent significantly less time fixating compared to controls. Furthermore, reduced fixation (ie, count and time) was related to depression and slower response time on an attentional task. While a similar pattern of group differences in the same direction appeared for literal gestures, the effect was not significant. These data highlight the importance of integrating gesture perception abnormalities into vulnerability models of psychosis and inform the development of targeted treatments for social communicative deficits.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL,To whom correspondence should be addressed; Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL 60208, US; tel: 847-467-5907, fax: 847-467-5707, e-mail:
| | | | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL
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16
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Damme KSF, Schiffman J, Ellman LM, Mittal VA. Sensorimotor and Activity Psychosis-Risk (SMAP-R) Scale: An Exploration of Scale Structure With Replication and Validation. Schizophr Bull 2021; 47:332-343. [PMID: 33047134 PMCID: PMC7965079 DOI: 10.1093/schbul/sbaa138] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sensorimotor abnormalities precede and predict the onset of psychosis. Despite the practical utility of sensorimotor abnormalities for early identification, prediction, and individualized medicine applications, there is currently no dedicated self-report instrument designed to capture these important behaviors. The current study assessed and validated a questionnaire designed for use in individuals at clinical high-risk for psychosis (CHR). METHODS The current study included both exploratory (n = 3009) and validation (n = 439) analytic datasets-that included individuals identified as meeting criteria for a CHR syndrome (n = 84)-who completed the novel Sensorimotor Abnormalities and Psychosis-Risk (SMAP-R) Scale, clinical interviews and a finger-tapping task. The structure of the scale and reliability of items were consistent across 2 analytic datasets. The resulting scales were assessed for discriminant validity across CHR, community sample non-psychiatric volunteer, and clinical groups. RESULTS The scale showed a consistent structure across 2 analytic datasets subscale structure. The resultant subscale structure was consistent with conceptual models of sensorimotor pathology in psychosis (coordination and dyskinesia) in both the exploratory and the validation analytic dataset. Further, these subscales showed discriminant, predictive, and convergent validity. The sensorimotor abnormality scales discriminated CHR from community sample non-psychiatric controls and clinical samples. Finally, these subscales predicted to risk calculator scores and showed convergent validity with sensorimotor performance on a finger-tapping task. CONCLUSION The SMAP-R scale demonstrated good internal, discriminant, predictive, and convergent validity, and subscales mapped on to conceptually relevant sensorimotor circuits. Features of the scale may facilitate widespread incorporation of sensorimotor screening into psychosis-risk research and practice.
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Affiliation(s)
- Katherine S F Damme
- Department of Psychology, Northwestern University, Evanston, IL
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL
| | | | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL
- Department of Psychiatry, Northwestern University, Chicago, IL
- Medical Social Sciences, Northwestern University, Chicago, IL
- Institute for Policy Research (IPR), Northwestern University, Chicago, IL
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17
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He Y, Steines M, Sammer G, Nagels A, Kircher T, Straube B. Modality-specific dysfunctional neural processing of social-abstract and non-social-concrete information in schizophrenia. Neuroimage Clin 2021; 29:102568. [PMID: 33524805 PMCID: PMC7851842 DOI: 10.1016/j.nicl.2021.102568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 11/09/2022]
Abstract
Schizophrenia is characterized by marked communication dysfunctions encompassing potential impairments in the processing of social-abstract and non-social-concrete information, especially in everyday situations where multiple modalities are present in the form of speech and gesture. To date, the neurobiological basis of these deficits remains elusive. In a functional magnetic resonance imaging (fMRI) study, 17 patients with schizophrenia or schizoaffective disorder, and 18 matched controls watched videos of an actor speaking, gesturing (unimodal), and both speaking and gesturing (bimodal) about social or non-social events in a naturalistic way. Participants were asked to judge whether each video contains person-related (social) or object-related (non-social) information. When processing social-abstract content, patients showed reduced activation in the medial prefrontal cortex (mPFC) only in the gesture but not in the speech condition. For non-social-concrete content, remarkably, reduced neural activation for patients in the left postcentral gyrus and the right insula was observed only in the speech condition. Moreover, in the bimodal conditions, patients displayed improved task performance and comparable activation to controls in both social and non-social content. To conclude, patients with schizophrenia displayed modality-specific aberrant neural processing of social and non-social information, which is not present for the bimodal conditions. This finding provides novel insights into dysfunctional multimodal communication in schizophrenia, and may have potential therapeutic implications.
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Affiliation(s)
- Yifei He
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior - CMBB, Hans-Meerwein-Straße 6, 35032 Marburg, Germany.
| | - Miriam Steines
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior - CMBB, Hans-Meerwein-Straße 6, 35032 Marburg, Germany
| | - Gebhard Sammer
- Cognitive Neuroscience at Centre for Psychiatry, Justus-Liebig University Giessen, Giessen, Germany
| | - Arne Nagels
- Department of General Linguistics, Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior - CMBB, Hans-Meerwein-Straße 6, 35032 Marburg, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior - CMBB, Hans-Meerwein-Straße 6, 35032 Marburg, Germany
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18
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Pavlidou A, Walther S. Using Virtual Reality as a Tool in the Rehabilitation of Movement Abnormalities in Schizophrenia. Front Psychol 2021; 11:607312. [PMID: 33488466 PMCID: PMC7817610 DOI: 10.3389/fpsyg.2020.607312] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022] Open
Abstract
Movement abnormalities are prevalent across all stages of schizophrenia contributing to poor social functioning and reduced quality of life. To date, treatments are scarce, often involving pharmacological agents, but none have been shown to improve movement abnormalities effectively. Virtual reality (VR) is a tool used to simulate virtual environments where behavioral performance can be quantified safely across different tasks while exerting control over stimulus delivery, feedback and measurement in real time. Sensory information is transmitted via a head mounted display allowing users to directly interact with virtual objects and bodies using gestures and body movements in the real world to perform different actions, permitting a sense of immersion in the simulated virtual environment. Although, VR has been widely used for successful motor rehabilitation in a variety of different neurological domains, none have been exploited for motor rehabilitation in schizophrenia. The objectives of this article are to review movement abnormalities specific to schizophrenia, and how VR can be utilized to restore and improve motor functioning in patients with schizophrenia. Constructing VR-mediated motor-cognitive interventions that can help in retaining and transferring the learned outcomes to real life are also discussed.
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Affiliation(s)
- Anastasia Pavlidou
- Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland
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19
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Li Y, Zhang L, Zhang Y, Wen H, Huang J, Shen Y, Li H. A Random Forest Model for Predicting Social Functional Improvement in Chinese Patients with Schizophrenia After 3 Months of Atypical Antipsychotic Monopharmacy: A Cohort Study. Neuropsychiatr Dis Treat 2021; 17:847-857. [PMID: 33776440 PMCID: PMC7989048 DOI: 10.2147/ndt.s280757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/02/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Impaired social functions contribute to the burden of schizophrenia patients and their families, but predictive tools of social functioning prognosis and specific factors are undefined in Chinese clinical practice. This article explores a machine learning tool to identify whether patients will achieve significant social functional improvement after 3 months of atypical antipsychotic monopharmacy and finds the defined risk factors using a multicenter clinical study. PATIENTS AND METHODS A multicenter study on atypical antipsychotic (AAP) treatment in Chinese patients with schizophrenia (SALT-C) was conducted from July 2011 to August 2018. Data from 550 patients with AAP monopharmacy from their baseline to their 3-month follow-up were used to establish machine learning tools after screening. The positive outcome was an increase in the Personal and Social Performance (PSP) scale score by ≥10 points. The predictors were a range of investigator-rated assessments on symptoms, functioning, the safety of AAPs and illness history. The Least Absolute Shrinkage and Selection Operator (LASSO) was used for the feature screening and ranking of the predicted variables. The random forest algorithm and five-fold cross-validation for optimizing the model were selected to ensure the generalizability and precision. RESULTS There were 137 patients (mean [SD] age, 41.1 [16.8] years; 77 [58.8%] female) who had a good social functional prognosis. A lower PSP score, taking a mood stabilizer, a high total Positive and Negative Symptom Scale (PANSS) and PANSS general subscale score, unemployment, a hepatic injury with medication, comorbid cardiovascular disease and being male predicted poor PSP outcomes. The generalizability of the PSP predictive tool was estimated with the precision-recall curve (accuracy of 79.5%, negative predictive value of 92.6% and positive predictive value of 57.1%) and receiver operating characteristic curve (ROC) (specificity of 81.8% and sensitivity of 78.7%). CONCLUSION The machine learning tool established using our current real-world data could assist in predicting PSP outcome by several clinical factors.
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Affiliation(s)
- Yange Li
- Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Lei Zhang
- Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yan Zhang
- Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Hui Wen
- Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jingjing Huang
- Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Psychotic Disorders, Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yifeng Shen
- Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Psychotic Disorders, Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Shanghai Clinical Research Center for Mental Health, Shanghai, People's Republic of China
| | - Huafang Li
- Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Psychotic Disorders, Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Shanghai Clinical Research Center for Mental Health, Shanghai, People's Republic of China
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20
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Gesture deficits and apraxia in schizophrenia. Cortex 2020; 133:65-75. [PMID: 33099076 DOI: 10.1016/j.cortex.2020.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/10/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023]
Abstract
Aberrant performance of skilled action has long been noted in schizophrenia and relatedly, recent reports have demonstrated impaired use, performance, and perception of hand gestures in this group. Still, this deficit is not acknowledged as apraxia, which to the broader medical field, characterizes impairments in skilled actions. Understanding the relationship between apraxia and schizophrenia may shed an invaluable new perspective on disease mechanism, and highlight novel treatment opportunities as well. To examine this potential link, we reviewed the evidence for the types of praxis errors, associated psychopathology, and cerebral correlates of the praxis deficit in schizophrenia. Notably, the review indicated that gesture deficits are severe enough to be considered genuine apraxia in a substantial proportion of patients (about 25%). Further, other potential contributors (e.g., hypokinetic motor abnormalities, cognitive impairment) are indeed associated with gesture deficits in schizophrenia, but do not sufficiently explain the abnormality. Finally, patients with praxis deficits have altered brain structure and function including the left parieto-premotor praxis network and these neural correlates are specific to the praxis deficit. Therefore, we argue that the gestural disorder frequently observed in schizophrenia shares both the clinical and neurophysiological features of true apraxia, as in other neuropsychiatric disorders with impaired higher order motor control, such as Parkinson's disease.
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21
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Wüthrich F, Pavlidou A, Stegmayer K, Eisenhardt S, Moor J, Schäppi L, Vanbellingen T, Bohlhalter S, Walther S. Nonverbal communication remains untouched: No beneficial effect of symptomatic improvement on poor gesture performance in schizophrenia. Schizophr Res 2020; 223:258-264. [PMID: 32883557 PMCID: PMC7952214 DOI: 10.1016/j.schres.2020.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/06/2020] [Accepted: 08/15/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Gestures are an important part of communication. Patients with schizophrenia present gesture deficits that tend to deteriorate in the course of the disease and hamper functional outcome. This gesture deficit has been associated with motor abnormalities, cognitive impairment, and psychotic symptoms. Unaffected, first-degree relatives of schizophrenia patients share some subclinical motor and cognitive abnormalities. We aimed to investigate, whether gesture performance changes with symptomatic improvement in patients, and to test the longitudinal performance in unaffected, first-degree relatives. METHODS In this study, we measured gesture performance using a validated test in 33 patients, 29 first-degree relatives and 38 healthy controls. Measurements were completed shortly after admission and before discharge in patients. Performance was rated blindly by experts using video recordings of the gesture task. Additionally, we evaluated cognitive function and psychotic symptoms at both visits. RESULTS Gesture performance was poorer in relatives compared to controls and poorer in patients compared to both relatives and controls. Patients showed an improvement in psychopathology but a significant decrease in gesture performance at follow-up, while performance in the other groups remained stable. Proportional change of gesture performance correlated with change of cognitive function in patients, whereas there were no correlations with change of cognitive function in the other groups. CONCLUSION While symptom severity was reduced, the gesture deficit further deteriorated in schizophrenia. The finding argues for distinct processes contributing to poor nonverbal communication skills in patients, requiring novel alternative treatment efforts.
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Affiliation(s)
- Florian Wüthrich
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.
| | - Anastasia Pavlidou
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Sarah Eisenhardt
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Jeanne Moor
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland,Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland
| | - Lea Schäppi
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Tim Vanbellingen
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Switzerland,Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
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22
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Walther S, van Harten PN, Waddington JL, Cuesta MJ, Peralta V, Dupin L, Foucher JR, Sambataro F, Morrens M, Kubera KM, Pieters LE, Stegmayer K, Strik W, Wolf RC, Hirjak D. Movement disorder and sensorimotor abnormalities in schizophrenia and other psychoses - European consensus on assessment and perspectives. Eur Neuropsychopharmacol 2020; 38:25-39. [PMID: 32713718 DOI: 10.1016/j.euroneuro.2020.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/06/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
Over the last three decades, movement disorder as well as sensorimotor and psychomotor functioning in schizophrenia (SZ) and other psychoses has gained greater scientific and clinical relevance as an intrinsic component of the disease process of psychotic illness; this extends to early psychosis prediction, early detection of motor side effects of antipsychotic medication, clinical outcome monitoring, treatment of psychomotor syndromes (e.g. catatonia), and identification of new targets for non-invasive brain stimulation. In 2017, a systematic cooperation between working groups interested in movement disorder and sensorimotor/psychomotor functioning in psychoses was initiated across European universities. As a first step, the members of this group would like to introduce and define the theoretical aspects of the sensorimotor domain in SZ and other psychoses. This consensus paper is based on a synthesis of scientific evidence, good clinical practice and expert opinions that were discussed during recent conferences hosted by national and international psychiatric associations. While reviewing and discussing the recent theoretical and experimental work on neural mechanisms and clinical implications of sensorimotor behavior, we here seek to define the key principles and elements of research on movement disorder and sensorimotor/psychomotor functioning in psychotic illness. Finally, the members of this European group anticipate that this consensus paper will stimulate further multimodal and prospective studies on hypo- and hyperkinetic movement disorders and sensorimotor/psychomotor functioning in SZ and other psychotic disorders.
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Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Peter N van Harten
- Psychiatric Center GGz Centraal, Amersfoort, The Netherlands; Department of Psychiatry, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - John L Waddington
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Spain. Instituto de Investigación Sanitaria de Navarra (IdisNa), Spain
| | - Victor Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain, Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - Lucile Dupin
- Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université de Paris, Paris, France
| | - Jack R Foucher
- ICube - CNRS UMR 7357, Neurophysiology, FMTS, University of Strasbourg, Strasbourg, France; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, Strasbourg, France
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padua, Italy
| | - Manuel Morrens
- Department of Psychiatry, University Psychiatric Center Duffel, Duffel, Belgium; Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Lydia E Pieters
- Psychiatric Center GGz Centraal, Amersfoort, The Netherlands; Department of Psychiatry, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - R Christian Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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23
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Ferruccio NP, Tosato S, Lappin JM, Heslin M, Donoghue K, Giordano A, Lomas B, Reininghaus U, Onyejiaka A, Chan RCK, Croudace T, Jones PB, Murray RM, Fearon P, Doody GA, Morgan C, Dazzan P. Neurological Signs at the First Psychotic Episode as Correlates of Long-Term Outcome: Results From the AESOP-10 Study. Schizophr Bull 2020; 47:118-127. [PMID: 32656567 PMCID: PMC7824991 DOI: 10.1093/schbul/sbaa089] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Minor neurological signs are subtle deficits in sensory integration, motor coordination, and sequencing of complex motor acts present in excess in the early stages of psychosis. Still, it remains unclear whether at least some of these signs represent trait or state markers for psychosis and whether they are markers of long-term disease outcome of clinical utility. We examined the relationship between neurological function at illness onset assessed with the Neurological Evaluation Scale and subsequent illness course in 233 patients from AESOP-10 (Aetiology and Ethnicity in Schizophrenia and Other Psychoses), a 10-year follow-up study of a population-based cohort of individuals recruited at the time of their first episode of psychosis in the United Kingdom. In 56 of these patients, we also explored changes in neurological function over time. We included a group of 172 individuals without psychosis as controls. After 10 years, 147 (63%) patients had developed a non-remitting course of illness, and 86 (37%) a remitting course. Already at first presentation, patients who developed a non-remitting course had significantly more primary, motor coordination, and total signs than both remitting patients and healthy controls. While Motor Coordination signs did not change over time, rates of Primary, Sensory Integration, and Total signs increased, independently of illness course type. These findings suggest that motor coordination problems could be a useful early, quick, and easily detectable marker of subsequent clinical outcome. With other motor abnormalities, a measure of motor incoordination could contribute to the identification of the most vulnerable individuals, who could benefit from targeted and more assertive treatment approaches.
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Affiliation(s)
- Naika P Ferruccio
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sarah Tosato
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Julia M Lappin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Margaret Heslin
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kim Donoghue
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Annalisa Giordano
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ben Lomas
- Department of Psychiatry, University of Nottingham, Nottingham, UK
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Adanna Onyejiaka
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Tim Croudace
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Peter B Jones
- University of Cambridge, and Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Paul Fearon
- Discipline of Psychiatry, School of Medicine, Trinity College, Dublin, Ireland
| | - Gillian A Doody
- Department of Psychiatry, University of Nottingham, Nottingham, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,National 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,To whom correspondence should be addressed; tel: +44-(0)207-848-0700, fax: +44-(0)207-848-0287, e-mail:
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24
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Wüthrich F, Viher PV, Stegmayer K, Federspiel A, Bohlhalter S, Vanbellingen T, Wiest R, Walther S. Dysbalanced Resting-State Functional Connectivity Within the Praxis Network Is Linked to Gesture Deficits in Schizophrenia. Schizophr Bull 2020; 46:905-915. [PMID: 32052844 PMCID: PMC7342100 DOI: 10.1093/schbul/sbaa008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patients with schizophrenia frequently present deficits in gesture production and interpretation, greatly affecting their communication skills. As these gesture deficits can be found early in the course of illness and as they can predict later outcomes, exploring their neural basis may lead to a better understanding of schizophrenia. While gesturing has been reported to rely on a left lateralized network of brain regions, termed praxis network, in healthy subjects and lesioned patients, studies in patients with schizophrenia are sparse. It is currently unclear whether within-network connectivity at rest is linked to gesture deficit. Here, we compared the functional connectivity between regions of the praxis network at rest between 46 patients and 44 healthy controls. All participants completed a validated test of hand gesture performance before resting-state functional magnetic resonance imaging (fMRI) was acquired. Patients performed gestures poorer than controls in all categories and domains. In patients, we also found significantly higher resting-state functional connectivity between left precentral gyrus and bilateral superior and inferior parietal lobule. Likewise, patients had higher connectivity from right precentral gyrus to left inferior and bilateral superior parietal lobule (SPL). In contrast, they exhibited lower connectivity between bilateral superior temporal gyrus (STG). Connectivity between right precentral gyrus and left SPL, as well as connectivity between bilateral STG, correlated with gesture performance in healthy controls. We failed to detect similar correlations in patients. We suggest that altered resting-state functional connectivity within the praxis network perturbs correct gesture planning in patients, reflecting the gesture deficit often seen in schizophrenia.
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Affiliation(s)
- Florian Wüthrich
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,To whom correspondence should be addressed; University Hospital of Psychiatry, Translational Research Center, Bolligenstrasse 111, 3000 Bern 60, Switzerland; tel: +41-31-932-87-13, fax: +41 31 930 99 61, e-mail:
| | - Petra V Viher
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrea Federspiel
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland,Department of Clinical Research, University Hospital of Bern, Inselspital, Bern, Switzerland
| | - Tim Vanbellingen
- Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland,Department of Clinical Research, University Hospital of Bern, Inselspital, Bern, Switzerland
| | - Roland Wiest
- Institute of Neuroradiology, University Hospital of Bern, Inselspital, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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25
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Lefebvre S, Pavlidou A, Walther S. What is the potential of neurostimulation in the treatment of motor symptoms in schizophrenia? Expert Rev Neurother 2020; 20:697-706. [DOI: 10.1080/14737175.2020.1775586] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Stephanie Lefebvre
- Translational Research Centre, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Anastasia Pavlidou
- Translational Research Centre, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Centre, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
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26
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Carment L, Dupin L, Guedj L, Térémetz M, Krebs MO, Cuenca M, Maier MA, Amado I, Lindberg PG. Impaired attentional modulation of sensorimotor control and cortical excitability in schizophrenia. Brain 2020; 142:2149-2164. [PMID: 31099820 PMCID: PMC6598624 DOI: 10.1093/brain/awz127] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/29/2019] [Accepted: 03/10/2019] [Indexed: 11/14/2022] Open
Abstract
Impairments in attentional, working memory and sensorimotor processing have been consistently reported in schizophrenia. However, the interaction between cognitive and sensorimotor impairments and the underlying neural mechanisms remains largely uncharted. We hypothesized that altered attentional processing in patients with schizophrenia, probed through saccadic inhibition, would partly explain impaired sensorimotor control and would be reflected as altered task-dependent modulation of cortical excitability and inhibition. Twenty-five stabilized patients with schizophrenia, 17 unaffected siblings and 25 healthy control subjects were recruited. Subjects performed visuomotor grip force-tracking alone (single-task condition) and with increased cognitive load (dual-task condition). In the dual-task condition, two types of trials were randomly presented: trials with visual distractors (requiring inhibition of saccades) or trials with addition of numbers (requiring saccades and addition). Both dual-task trial types required divided visual attention to the force-tracking target and to the distractor or number. Gaze was measured during force-tracking tasks, and task-dependent modulation of cortical excitability and inhibition were assessed using transcranial magnetic stimulation. In the single-task, patients with schizophrenia showed increased force-tracking error. In dual-task distraction trials, force-tracking error increased further in patients, but not in the other two groups. Patients inhibited fewer saccades to distractors, and the capacity to inhibit saccades explained group differences in force-tracking performance. Cortical excitability at rest was not different between groups and increased for all groups during single-task force-tracking, although, to a greater extent in patients (80%) compared to controls (40%). Compared to single-task force-tracking, the dual-task increased cortical excitability in control subjects, whereas patients showed decreased excitability. Again, the group differences in cortical excitability were no longer significant when failure to inhibit saccades was included as a covariate. Cortical inhibition was reduced in patients in all conditions, and only healthy controls increased inhibition in the dual-task. Siblings had similar force-tracking and gaze performance as controls but showed altered task-related modulation of cortical excitability and inhibition in dual-task conditions. In patients, neuropsychological scores of attention correlated with visuomotor performance and with task-dependant modulation of cortical excitability. Disorganization symptoms were greatest in patients with weakest task-dependent modulation of cortical excitability. This study provides insights into neurobiological mechanisms of impaired sensorimotor control in schizophrenia showing that deficient divided visual attention contributes to impaired visuomotor performance and is reflected in impaired modulation of cortical excitability and inhibition. In siblings, altered modulation of cortical excitability and inhibition is consistent with a genetic risk for cortical abnormality.
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Affiliation(s)
- Loïc Carment
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Institut de Psychiatrie, CNRS GDR3557, Paris, France
| | - Lucile Dupin
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Institut de Psychiatrie, CNRS GDR3557, Paris, France
| | - Laura Guedj
- SHU, Resource Center for Cognitive Remediation and Psychosocial Rehabilitation, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France
| | - Maxime Térémetz
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Institut de Psychiatrie, CNRS GDR3557, Paris, France
| | - Marie-Odile Krebs
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Institut de Psychiatrie, CNRS GDR3557, Paris, France.,SHU, Resource Center for Cognitive Remediation and Psychosocial Rehabilitation, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France
| | - Macarena Cuenca
- SHU, Resource Center for Cognitive Remediation and Psychosocial Rehabilitation, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France.,Centre de Recherche Clinique, Hôpital Sainte-Anne, Paris, France.,Integrative Neuroscience and Cognition Center, UMR 8002, CNRS / Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marc A Maier
- Institut de Psychiatrie, CNRS GDR3557, Paris, France.,Integrative Neuroscience and Cognition Center, UMR 8002, CNRS / Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Life Sciences, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Isabelle Amado
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Institut de Psychiatrie, CNRS GDR3557, Paris, France.,SHU, Resource Center for Cognitive Remediation and Psychosocial Rehabilitation, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France
| | - Påvel G Lindberg
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Institut de Psychiatrie, CNRS GDR3557, Paris, France
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27
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Walther S, Kunz M, Müller M, Zürcher C, Vladimirova I, Bachofner H, Scherer KA, Nadesalingam N, Stegmayer K, Bohlhalter S, Viher PV. Single Session Transcranial Magnetic Stimulation Ameliorates Hand Gesture Deficits in Schizophrenia. Schizophr Bull 2020; 46:286-293. [PMID: 31634401 PMCID: PMC7442336 DOI: 10.1093/schbul/sbz078] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Social interaction is impaired in schizophrenia, including the use of hand gestures, which is linked to poor social perception and outcome. Brain imaging suggests reduced neural activity in a left-lateralized frontoparietal network during gesture preparation; therefore, gesturing might be improved through facilitation of left hemispheric brain areas or via disruption of interhemispheric inhibition from the right homolog. This study tested whether repetitive transcranial magnetic stimulation (rTMS) protocols would improve gesture performance in schizophrenia. This randomized, placebo-controlled, double-blind, crossover trial applied 3 different protocols of rTMS separated by 48 h. Twenty right-handed schizophrenia patients and 20 matched healthy controls received facilitatory intermittent theta burst stimulation (iTBS) over the left inferior frontal gyrus (IFG), inhibitory continuous theta burst stimulation (cTBS) over right inferior parietal lobe (IPL), and placebo over left IPL in randomized order. Primary outcome was change in the test of upper limb apraxia (TULIA), rated from video recordings of hand gesture performance. Secondary outcome was change in manual dexterity using the coin rotation task. Participants improved on both tasks following rTMS compared with baseline. Only patients improved gesture performance following right IPL cTBS compared with placebo (P = .013). The results of the coin rotation parallel those of the TULIA, with improvements following right IPL cTBS in patients (P = .001). Single sessions of cTBS on the right IPL substantially improved both gesture performance accuracy and manual dexterity. The findings point toward an inhibition of interhemispheric rivalry as a potential mechanism of action.
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Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland,To whom correspondence should be addressed; Translational Research Center, University Hospital of Psychiatry, University of Bern, Murtenstrasse 21, 3008 Bern, Switzerland; tel: 41-31-632-8979, fax: +41 31 632 8950, e-mail:
| | - Maribel Kunz
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Manuela Müller
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Caroline Zürcher
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Irena Vladimirova
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Hanta Bachofner
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Konstantin A Scherer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Niluja Nadesalingam
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | | | - Petra V Viher
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
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28
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Wroblewski A, He Y, Straube B. Dynamic Causal Modelling suggests impaired effective connectivity in patients with schizophrenia spectrum disorders during gesture-speech integration. Schizophr Res 2020; 216:175-183. [PMID: 31882274 DOI: 10.1016/j.schres.2019.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/26/2019] [Accepted: 12/15/2019] [Indexed: 12/18/2022]
Abstract
Integrating visual and auditory information during gesture-speech integration (GSI) is important for successful social communication, which is often impaired in schizophrenia. Several studies suggested the posterior superior temporal sulcus (pSTS) to be a relevant multisensory integration site. However, intact STS activation patterns were often reported in patients. Thus, here we used Dynamic Causal Modelling (DCM) to analyze whether information processing in schizophrenia spectrum disorders (SSD) is impaired during GSI on network level. We investigated GSI in three different samples. First, we replicated a recently published connectivity model for GSI in a healthy subject group (n = 19). Second, we investigated differences between patients with SSD and a matched healthy control group (n = 17 each). Participants were presented videos of an actor performing intrinsically meaningful gestures accompanied by spoken sentences in German or Russian, or just telling a German sentence without gestures. Across all groups, fMRI analyses revealed similar activation patterns, and DCM analyses resulted in the same winning model for GSI. This finding directly replicates previous results. However, patients revealed significantly reduced connectivity in the verbal pathway (from left middle temporal gyrus (MTG) to left STS). The clinical significance of this connection is supported by its correlations with the severity of concretism and a subscale of negative symptoms (SANS). Our model confirms the importance of the pSTS as integration site during audio-visual integration. Patients showed generally intact connectivity during GSI, but revealed impaired information transfer via the verbal pathway. This might be the basis of interpersonal communication problems in patients with SSD.
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Affiliation(s)
- Adrian Wroblewski
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy, University of Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany.
| | - Yifei He
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy, University of Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany; Faculty of Translation, Language, and Cultural Studies, University of Mainz, Germersheim, Germany
| | - Benjamin Straube
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy, University of Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany
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Walther S, Alexaki D, Stegmayer K, Vanbellingen T, Bohlhalter S. Conceptual disorganization impairs hand gesture performance in schizophrenia. Schizophr Res 2020; 215:467-468. [PMID: 31500999 DOI: 10.1016/j.schres.2019.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland.
| | - Danai Alexaki
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
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Riedl L, Nagels A, Sammer G, Straube B. A Multimodal Speech-Gesture Training Intervention for Patients With Schizophrenia and Its Neural Underpinnings - the Study Protocol of a Randomized Controlled Pilot Trial. Front Psychiatry 2020; 11:110. [PMID: 32210849 PMCID: PMC7068208 DOI: 10.3389/fpsyt.2020.00110] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 02/07/2020] [Indexed: 01/02/2023] Open
Abstract
UNLABELLED Dysfunctional social communication is one of the most stable characteristics in patients with schizophrenia that also affects quality of life. Interpreting abstract speech and integrating nonverbal modalities is particularly affected. Considering the impact of communication on social life but failure to treat communication dysfunctions with usual treatment, we will investigate the possibility to improve verbal and non-verbal communication in schizophrenia by applying a multimodal speech-gesture training (MSG training). Here we describe the newly developed MSG training program and the study design for the first clinical investigation. The intervention contains perceptive rating (match/mismatch of sentence and gesture) and memory tasks (n-back tasks), imitation and productive tasks (e.g., SG fluency-similar to verbal fluency where words are accompanied by gesture). In addition, we offer information about gesture as meta-learning element as well as homework for reasons of transfer to everyday life as part of every session. In the MSG training intervention, we offer eight sessions (60 min each) of training. The first pilot study is currently conducted as a single-center, randomized controlled trial of speech-gesture intervention versus wait-list control with a follow-up. Outcomes are measured through pre-post-fMRI and standardized psychological questionnaires comparing two subject groups (30 patients with schizophrenia and 30 healthy controls). Patients and healthy controls are randomized in two intervention groups (with 20 being in the wait-training group and 10 in the training-follow-up group). With our study design we will be able to demonstrate the beneficial effect of the MSG training intervention on behavioral and neural levels. CLINICAL TRIAL REGISTRATION DRKS.de, identifier DRKS00015118.
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Affiliation(s)
- Lydia Riedl
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Arne Nagels
- Department of English and Linguistics, Johannes-Gutenberg-University, Mainz, Germany
| | - Gebhard Sammer
- Department of Psychiatry and Psychotherapy, Justus-Liebig-University, Gießen, Germany
| | - Benjamin Straube
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
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Mittal VA, Walther S. As Motor System Pathophysiology Returns to the Forefront of Psychosis Research, Clinical Implications Should Hold Center Stage. Schizophr Bull 2019; 45:495-497. [PMID: 30496514 PMCID: PMC6483576 DOI: 10.1093/schbul/sby176] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Vijay A Mittal
- Departments of Psychology, Psychiatry, and Medical Social Sciences, Institute for Policy Research and Institute for Innovations in Developmental Sciences, Northwestern University, Evanston and Chicago, IL
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
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Schülke R, Straube B. Transcranial Direct Current Stimulation Improves Semantic Speech-Gesture Matching in Patients With Schizophrenia Spectrum Disorder. Schizophr Bull 2019; 45:522-530. [PMID: 30304518 PMCID: PMC6483581 DOI: 10.1093/schbul/sby144] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with schizophrenia spectrum disorders (SSD) have severe deficits in speech and gesture processing that contribute considerably to the burden of this disorder. Brain imaging shows left inferior frontal gyrus involvement for impaired processing of co-verbal gestures in patients with schizophrenia. Recently, transcranial direct current stimulation (tDCS) of the left frontal lobe has been shown to modulate processing of co-verbal gestures in healthy subjects. Although tDCS has been used to reduce symptoms of patients with SSD, the effects of tDCS on gesture processing deficits remain hitherto unexplored. OBJECTIVE Here we tested the hypothesis that inhibitory cathodal tDCS of the left frontal lobe decreases pathological dysfunction and improves semantic processing of co-verbal gestures in patients with SSD. METHODS We measured ratings and reaction times in a speech-gesture semantic relatedness assessment task during application of frontal, frontoparietal, parietal, and sham tDCS to 20 patients with SSD and 29 healthy controls. RESULTS We found a specific effect of tDCS on speech-gesture relatedness ratings of patients. Frontal compared to parietal and sham stimulation significantly improved the differentiation between related and unrelated gestures. Placement of the second electrode (right frontal vs parietal) did not affect the effect of left frontal stimulation, which reduced the preexisting difference between patients and healthy controls. CONCLUSION Here we show that left frontal tDCS can improve semantic co-verbal gesture processing in patients with SSD. tDCS could be a viable tool to normalize processing in the left frontal lobe and facilitate direct social communicative functioning in patients with SSD.
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Affiliation(s)
- Rasmus Schülke
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy and Marburg Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Marburg, Germany
| | - Benjamin Straube
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy and Marburg Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Marburg, Germany,To whom correspondence should be addressed; Rudolf-Bultmann-Str. 8, Marburg 35039, Germany; tel: +49-(0)-6421-58-66429, fax: +49-(0)-6421-5865406, e-mail:
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Cuesta MJ, Moreno-Izco L, Ribeiro M, López-Ilundain JM, Lecumberri P, Cabada T, Lorente-Omeñaca R, Sánchez-Torres AM, Gómez MS, Peralta V. Motor abnormalities and cognitive impairment in first-episode psychosis patients, their unaffected siblings and healthy controls. Schizophr Res 2018; 200:50-55. [PMID: 29097000 DOI: 10.1016/j.schres.2017.10.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 10/20/2017] [Accepted: 10/23/2017] [Indexed: 12/13/2022]
Abstract
Motor abnormalities (MAs) may be already evidenced long before the beginning of illness and are highly prevalent in psychosis. However, the extent to which the whole range of MAs are related to cognitive impairment in psychosis remains understudied. This study aimed to examine comparatively the relationships between the whole range of motor abnormalities and cognitive impairments in the first-episode of psychosis (FEP), their unaffected siblings and healthy control subjects. Fifty FEP patients, 21 of their healthy siblings and 24 age- and sex matched healthy controls were included. Motor assessment included catatonic, extrapyramidal and neurological soft signs (NSS) by means of standardized instruments. An exhaustive neuropsychological battery was also performed to extract the 7 cognitive dimensions of MATRICS initiative. Higher scores on NSS but not on extrapyramidal and catatonic signs showed significant associations with worse cognitive performance in the three study groups. However, the pattern of associations regarding specific cognitive functions was different among the three groups. Moreover, extrapyramidal signs showed significant associations with cognitive impairment only in FEP patients but not in their unaffected siblings and healthy controls. Catatonic signs did not show any significant association with cognitive functioning in the three study groups. These findings add evidence to the associations between motor abnormalities, particularly NSS and extrapyramidal signs, and cognitive impairment in first-episode psychosis patients. In addition, our results suggest that the specific pattern of associations between MAs and cognitive functioning is different in FEP patients from those of the unaffected siblings and healthy subjects.
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Affiliation(s)
- Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Lucia Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - María Ribeiro
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Jose M López-Ilundain
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Pablo Lecumberri
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Department of Mathematics, Universidad Pública de Navarra, Pamplona, Spain
| | - Teresa Cabada
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Department of Neuroradiology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ruth Lorente-Omeñaca
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - M Sol Gómez
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Department of Mathematics, Universidad Pública de Navarra, Pamplona, Spain
| | - Victor Peralta
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Mental Health Department, Servicio Navarro de Salud, Spain
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Cuesta MJ, Peralta V. Modeling neuromotor pathology in schizophrenia: A window to brain mechanisms and clinical insight into the syndrome. Schizophr Res 2018; 200:1-4. [PMID: 29884551 DOI: 10.1016/j.schres.2018.05.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/27/2018] [Indexed: 01/09/2023]
Affiliation(s)
- M J Cuesta
- Department of Psychiatry, Complejo Hospitalario of Navarra, Pamplona, Spain; Navarra Institute for Health Research, IdiSNA, Pamplona, Spain.
| | - V Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain; Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
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Dutschke LL, Stegmayer K, Ramseyer F, Bohlhalter S, Vanbellingen T, Strik W, Walther S. Gesture impairments in schizophrenia are linked to increased movement and prolonged motor planning and execution. Schizophr Res 2018; 200:42-49. [PMID: 28709771 DOI: 10.1016/j.schres.2017.07.012] [Citation(s) in RCA: 24] [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: 04/04/2017] [Revised: 07/02/2017] [Accepted: 07/05/2017] [Indexed: 11/17/2022]
Abstract
Schizophrenia patients present with a variety of impaired nonverbal communication skills. Performance of hand gestures is frequently impaired and associated with ratings of motor abnormalities. However, the impact of motor abnormalities to gesture performance remains unclear. To test the association between quantitative measures of motor behavior and qualitative ratings of gesture performance, we quantified movement parameters semi-automatically in videotaped recordings of gesture assessment. Thirty-one patients with schizophrenia (77.4%), schizophreniform (19.4%) or schizoaffective disorder (3.2%) and 32 healthy controls matched for age, gender and education underwent clinical assessment. Performance of the test of upper limb apraxia (TULIA) was video-taped in all subjects. The videos were analyzed with motion energy analysis software (MEA) to determine motion and time parameters. Patients and controls differed significantly in quantitative gesture performance: patients required more movement and more time to complete the tasks. Differences increased in patients with qualitatively impaired gesture production ratings (p<0.01). Group differences were most pronounced in the pantomime domain, when gestures are performed following verbal instruction. In patients, ratings of motor abnormalities correlated with duration of movement, while behavioral disorganization correlated with the amount of movements during gesture performance. Disorder related motor symptoms, aberrant action observation, planning and monitoring as well as internal clock abnormalities may explain the poor performance of hand gestures in schizophrenia. Quantitative video analysis offers a unique possibility to analyze movement patterns as a direct functional output of the motor system. In the future, it may assist monitoring, staging and prognosis in schizophrenia.
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Affiliation(s)
- Lars Levi Dutschke
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Fabian Ramseyer
- Department for Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Tim Vanbellingen
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland.
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36
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Riehle M, Mehl S, Lincoln TM. The specific social costs of expressive negative symptoms in schizophrenia: reduced smiling predicts interactional outcome. Acta Psychiatr Scand 2018; 138:133-144. [PMID: 29667181 DOI: 10.1111/acps.12892] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We tested whether people with schizophrenia and prominent expressive negative symptoms (ENS) show reduced facial expressions in face-to-face social interactions and whether this expressive reduction explains negative social evaluations of these persons. METHOD We compared participants with schizophrenia with high ENS (n = 18) with participants with schizophrenia with low ENS (n = 30) and with healthy controls (n = 39). Participants engaged in an affiliative role-play that was coded for the frequency of positive and negative facial expression and rated for social performance skills and willingness for future interactions with the respective role-play partner. RESULTS Participants with schizophrenia with high ENS showed significantly fewer positive facial expressions than those with low ENS and controls and were also rated significantly lower on social performance skills and willingness for future interactions. Participants with schizophrenia with low ENS did not differ from controls on these measures. The group difference in willingness for future interactions was significantly and independently mediated by the reduced positive facial expressions and social performance skills. CONCLUSION Reduced facial expressiveness in schizophrenia is specifically related to ENS and has negative social consequences. These findings highlight the need to develop aetiological models and targeted interventions for ENS and its social consequences.
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Affiliation(s)
- M Riehle
- Institute of Psychology, Clinical Psychology & Psychotherapy, University of Hamburg, Hamburg, Germany
| | - S Mehl
- Department of Psychiatry and Psychotherapy & Marburg Center for Mind, Brain and Behavior (MCMBB), University of Marburg, Marburg, Germany.,Department of Health & Social Work, University of Applied Sciences, Frankfurt, Germany
| | - T M Lincoln
- Institute of Psychology, Clinical Psychology & Psychotherapy, University of Hamburg, Hamburg, Germany
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Strik W, Stegmayer K, Walther S, Dierks T. Systems Neuroscience of Psychosis: Mapping Schizophrenia Symptoms onto Brain Systems. Neuropsychobiology 2018; 75:100-116. [PMID: 29258073 DOI: 10.1159/000485221] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Schizophrenia research has been in a deadlock for many decades. Despite important advances in clinical treatment, there are still major concerns regarding long-term psychosocial reintegration and disease management, biological heterogeneity, unsatisfactory predictors of individual course and treatment strategies, and a confusing variety of controversial theories about its etiology and pathophysiological mechanisms. In the present perspective on schizophrenia research, we first discuss a methodological pitfall in contemporary schizophrenia research inherent in the attempt to link mental phenomena with the brain: we claim that the time-honored phenomenological method of defining mental symptoms should not be contaminated with the naturalistic approach of modern neuroscience. We then describe our Systems Neuroscience of Psychosis (SyNoPsis) project, which aims to overcome this intrinsic problem of psychiatric research. Considering schizophrenia primarily as a disorder of interindividual communication, we developed a neurobiologically informed semiotics of psychotic disorders, as well as an operational clinical rating scale. The novel psychopathology allows disentangling the clinical manifestations of schizophrenia into behavioral domains matching the functions of three well-described higher-order corticobasal brain systems involved in interindividual human communication, namely, the limbic, associative, and motor loops, including their corticocortical sensorimotor connections. The results of several empirical studies support the hypothesis that the proposed three-dimensional symptom structure, segregated into the affective, the language, and the motor domain, can be specifically mapped onto structural and functional abnormalities of the respective brain systems. New pathophysiological hypotheses derived from this brain system-oriented approach have helped to develop and improve novel treatment strategies with noninvasive brain stimulation and practicable clinical parameters. In clinical practice, the novel psychopathology allows confining the communication deficits of the individual patient, shifting attention from the symptoms to the intact resources. We have studied this approach and observed important advantages for therapeutic alliances, personalized treatment, and de-escalation strategies. Future studies will further conjoin clinical definitions of psychotic symptoms with brain structures and functions, and disentangle structural and functional deficit patterns within these systems to identify neurobiologically distinct subsyndromes. Neurobiologically homogeneous patient groups may provide new momentum for treatment research. Finally, lessons learned from schizophrenia research may contribute to developing a comprehensive perspective on human experience and behavior that integrates methodologically distinct, but internally consistent, insights from humanities and neuroscience.
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Stegmayer K, Bohlhalter S, Vanbellingen T, Federspiel A, Wiest R, Müri RM, Strik W, Walther S. Limbic Interference During Social Action Planning in Schizophrenia. Schizophr Bull 2018; 44:359-368. [PMID: 28575506 PMCID: PMC5814975 DOI: 10.1093/schbul/sbx059] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Schizophrenia is characterized by social interaction deficits contributing to poor functional outcome. Hand gesture use is particularly impaired, linked to frontal lobe dysfunction and frontal grey matter deficits. The functional neural correlates of impaired gesturing are currently unclear. We therefore investigated aberrant brain activity during impaired gesturing in schizophrenia. We included 22 patients with schizophrenia and 25 healthy control participants matched for age, gender, and education level. We obtained functional magnetic resonance imaging data using an event-related paradigm to assess brain activation during gesture planning and execution. Group differences in whole brain effects were calculated using factorial designs. Gesture ratings were performed by a single rater, blind to diagnoses and clinical presentation. During gesture planning and execution both groups activated brain areas of the praxis network. However, patients had reduced dorsolateral prefrontal cortex (DLPFC) and increased inferior parietal lobe (IPL) activity. Performance accuracy was associated with IPL activity in patients. Furthermore, patients activated temporal poles, amygdala and hippocampus during gesture planning, which was associated with delusion severity. Finally, patients demonstrated increased dorsomedial prefrontal cortex activity during planning of novel gestures. We demonstrate less prefrontal, but more IPL and limbic activity during gesturing in schizophrenia. IPL activity was associated with performance accuracy, whereas limbic activity was linked to delusion severity. These findings may reflect impaired social action planning and a limbic interference with gestures in schizophrenia contributing to poor gesture performance and consequently poor social functioning in schizophrenia.
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Affiliation(s)
- Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland,To whom correspondence should be addressed; University Hospital of Psychiatry, Bolligenstrasse 111, 3060 Bern, Switzerland; tel: +41-31-930-9757, fax: +41-31-930-9404, e-mail:
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland,Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland
| | - Tim Vanbellingen
- Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland,Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland
| | - Andrea Federspiel
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
| | - Roland Wiest
- Department of Neuroradiology, University Hospital, Inselspital, Bern, Switzerland
| | - René M Müri
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland,Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
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Schäppi L, Stegmayer K, Viher PV, Walther S. Distinct Associations of Motor Domains in Relatives of Schizophrenia Patients-Different Pathways to Motor Abnormalities in Schizophrenia? Front Psychiatry 2018; 9:129. [PMID: 29740353 PMCID: PMC5924816 DOI: 10.3389/fpsyt.2018.00129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/26/2018] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Aberrant motor function is an integral part of schizophrenia. In fact, abnormalities are frequently found in patients, in populations at risk, and in unaffected relatives. Motor abnormalities are suspected to be relevant for the clinical outcome and could probably predict the conversion from at-risk individuals to schizophrenia. Furthermore, motor function has been argued as endophenotype of the disorder. Yet, which particular motor domain may classify as a potential endophenotype is unknown. We aimed to compare schizophrenia patients, unaffected first-degree relatives and healthy controls for different motor domains. We expected impairments in all domains in patients and in some domains in relatives. METHOD We included 43 schizophrenia patients, 34 unaffected first-degree relatives of schizophrenia patients, and 29 healthy control subjects, matched for age, gender, and education level. We compared motor function of four motor domains between the groups. The domains comprise neurological soft signs (NSS), abnormal involuntary movements (dyskinesia), Parkinsonism, and fine motor function including simple [finger tapping (FT)] and complex fine motor function, (i.e., dexterity as measured with the coin rotation test). Furthermore, we tested the association of motor function of the four domains with working memory, frontal lobe function, and nonverbal intelligence for each group separately using within-group bivariate correlations. RESULTS Schizophrenia patients showed poorer motor function in all tested domains compared to healthy controls. First-degree relatives had intermediate ratings with aberrant function in two motor domains. In detail, relatives had significantly more NSS and performed poorer in the FT task than controls. In contrast, complex fine motor function was intact in relatives. Relatives did not differ from controls in dyskinesia or Parkinsonism severity. DISCUSSION Taken together, schizophrenia patients have motor abnormalities in all tested domains. Thus, motor abnormalities are a key element of the disorder. Likewise, first-degree relatives presented motor deficits in two domains. A clear difference between relatives and healthy controls was found for NSS and FT. Thus, NSS and FT may be potential markers of vulnerability for schizophrenia. The lack of association between genetic risk and dyskinesia or Parkinsonism suggests distinct pathobiological mechanisms in the various motor abnormalities in schizophrenia.
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Affiliation(s)
- Lea Schäppi
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | | | - Petra V Viher
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland
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Mittal VA. Systems Neuroscience of Psychosis (SyNoPsis) Provides a Promising Framework for Advancing the Field. Neuropsychobiology 2017; 75:119-121. [PMID: 29258110 PMCID: PMC5801155 DOI: 10.1159/000485215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Vijay A. Mittal
- Departments of Psychology, Psychiatry, Institute for Policy Research, Medical Social Sciences, Institute for Innovations in Developmental Sciences, Northwestern University, Swift Hall 102, 2029 Sheridan Road, Evanston, IL 60208 (USA)
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Abstract
PURPOSE OF REVIEW Motor abnormalities are an intrinsic feature of psychosis. Neurological soft signs, Parkinsonism, dyskinesia, and other motor phenomena are frequently observed in subjects at clinical or genetic risk for psychosis as well as first-episode patients, chronic patients. Here, we review the most recent literature on motor assessments and pathophysiology in psychosis. RECENT FINDINGS Instrumental measures of fine motor performance, balance, spontaneous motor activity, and gesture indicated motor abnormalities in subjects at risk and across stages of schizophrenia. Motor phenomena are associated with distinct symptom dimensions and may indicate poor outcomes. Neuroimaging studies demonstrated altered neural maturation within critical motor networks in subjects at risk. Furthermore, specific categories of motor dysfunction were associated with distinct structural and functional alterations in the motor system in schizophrenia. Motor abnormalities provide a unique window into the pathobiology of psychosis and have the potential to guide screening, staging, and outcome prediction.
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Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Murtenstrasse 21, 3008, Bern, Switzerland.
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA.,Department of Psychiatry, Northwestern University, Evanston, IL, USA.,Department of Medical Social Sciences, Northwestern University, Evanston, IL, USA.,Institute for Policy Research, Northwestern University, Evanston, IL, USA.,Institute for Developmental Science, Northwestern University, Evanston, IL, USA
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Viher PV, Stegmayer K, Kubicki M, Karmacharya S, Lyall AE, Federspiel A, Vanbellingen T, Bohlhalter S, Wiest R, Strik W, Walther S. The cortical signature of impaired gesturing: Findings from schizophrenia. NEUROIMAGE-CLINICAL 2017; 17:213-221. [PMID: 29159038 PMCID: PMC5683189 DOI: 10.1016/j.nicl.2017.10.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/18/2017] [Accepted: 10/18/2017] [Indexed: 01/09/2023]
Abstract
Schizophrenia is characterized by deficits in gesturing that is important for nonverbal communication. Research in healthy participants and brain-damaged patients revealed a left-lateralized fronto-parieto-temporal network underlying gesture performance. First evidence from structural imaging studies in schizophrenia corroborates these results. However, as of yet, it is unclear if cortical thickness abnormalities contribute to impairments in gesture performance. We hypothesized that patients with deficits in gesture production show cortical thinning in 12 regions of interest (ROIs) of a gesture network relevant for gesture performance and recognition. Forty patients with schizophrenia and 41 healthy controls performed hand and finger gestures as either imitation or pantomime. Group differences in cortical thickness between patients with deficits, patients without deficits, and controls were explored using a multivariate analysis of covariance. In addition, the relationship between gesture recognition and cortical thickness was investigated. Patients with deficits in gesture production had reduced cortical thickness in eight ROIs, including the pars opercularis of the inferior frontal gyrus, the superior and inferior parietal lobes, and the superior and middle temporal gyri. Gesture recognition correlated with cortical thickness in fewer, but mainly the same, ROIs within the patient sample. In conclusion, our results show that impaired gesture production and recognition in schizophrenia is associated with cortical thinning in distinct areas of the gesture network. Impairments in gesture production and recognition in schizophrenia are related to altered brain structure. Brain alterations in schizophrenia are located in areas that are generally damaged in apraxia. Schizophrenia patients with gesture deficits show cortical thinning of several regions in the gesture network. Deficits of gesture production and recognition are both related to a fronto-parieto-temporal gesture network.
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Affiliation(s)
- Petra Verena Viher
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland; Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Marek Kubicki
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Sarina Karmacharya
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Amanda Ellis Lyall
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Andrea Federspiel
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Tim Vanbellingen
- Department of Clinical Research, Inselspital, Bern, Switzerland; Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland; Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Roland Wiest
- Support Center of Advanced Neuroimaging, Institute of Neuroradiology, University of Bern, Bern, Switzerland
| | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
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Mittal VA, Bernard JA, Northoff G. What Can Different Motor Circuits Tell Us About Psychosis? An RDoC Perspective. Schizophr Bull 2017; 43:949-955. [PMID: 28911048 PMCID: PMC5581904 DOI: 10.1093/schbul/sbx087] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Signs of motor dysfunction are evidenced across a range of psychiatric disorders including schizophrenia. Historically, these features have been neglected but emerging theoretical and methodological advancements have shed new light on the utility of considering movement abnormalities. Indeed, the National Institute of Mental Health Research Domain Criteria initiative has recently met to develop a Motor Systems Domain. This reflects a growing appreciation for the enhanced reliability and validity that can come along with evaluating disturbances relevant to psychiatric illnesses from multiple levels of analysis, and conceptualizing these domains with respect to the complexity of their role in a broader integrated system (ie, weighing contributions and interactions between the cognitive, affective, and motor domains). This article discusses motor behaviors and seeks to explain how research into basal ganglia, cerebellar, and cortico-motor circuit function/dysfunction, grounded in brain circuit-motor behavior relationships, can elucidate our understanding of pathophysiology, provide vital links to other key systems of interest, significantly improve identification and classification, and drive development of targeted individualized treatments.
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Affiliation(s)
- Vijay A Mittal
- Department of Psychology, Department of Psychiatry, Institute for Policy Research, Department of Medical Social Sciences, Northwestern University, Evanston, IL;,To whom correspondence should be addressed; Department of Psychology, Department of Psychiatry, Northwestern University, 2029 Sheridan Road, Evanston, IL 60208, US; e-mail:
| | - Jessica A Bernard
- Department of Psychology, Texas A&M Institute for Neuroscience, Texas A&M University, College Station, TX
| | - Georg Northoff
- Institute of Mental Health Research, University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada;,Mental Health Centre, Zhejiang University School of Medicine, Hangzhou, China;,Centre for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China;,Centre for Brain and Consciousness, College for Humanities and Medicine, Taipei Medical University (TMU), Taipei, Taiwan
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van Harten PN, Walther S, Kent JS, Sponheim SR, Mittal VA. The clinical and prognostic value of motor abnormalities in psychosis, and the importance of instrumental assessment. Neurosci Biobehav Rev 2017; 80:476-487. [PMID: 28711662 DOI: 10.1016/j.neubiorev.2017.06.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 06/06/2017] [Accepted: 06/13/2017] [Indexed: 01/15/2023]
Abstract
Motor abnormalities comprise several clinical signs intrinsic to psychosis. Critically, these features are of prognostic value in individuals at-risk for psychosis, and for those in early stages of psychotic disorders. Motor abnormalities such as tremor, rigidity, and neurological soft signs often go unrecognized. Currently, advances in this area are limited by a paucity of theoretical conceptions categorizing or linking these behaviours to underlying neurobiology affected in psychosis. However, emerging technological advances have significantly improved the ability to detect and assess motor abnormalities with objective instruments in a timely and reliable manner. Further, converging evidence has laid the groundwork for theoretically and empirically derived categorization and conceptualization. This review summarizes these advances, stressing the importance of motor abnormalities for understanding vulnerability across different stages of psychosis and introducing these innovative instrumental approaches. Patients, researchers and clinicians will benefit from these new developments, as better assessment aids the development of targeted interventions to ultimately improve the care for individuals experiencing psychosis.
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Affiliation(s)
- Peter N van Harten
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands; Psychiatric Centre GGz Central, Amersfoort, The Netherlands.
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | | | | | - Vijay A Mittal
- Northwestern University, Department of Psychology, Department of Psychiatry, Institute for Policy Research, Department of Medical Social Sciences, Evanston/Chicago, USA
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Osborne KJ, Bernard JA, Gupta T, Dean DJ, Millman Z, Vargas T, Ristanovic I, Schiffman J, Mittal VA. Beat gestures and postural control in youth at ultrahigh risk for psychosis. Schizophr Res 2017; 185:197-199. [PMID: 27914727 PMCID: PMC5449260 DOI: 10.1016/j.schres.2016.11.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 11/16/2022]
Abstract
Beat gestures, rhythmic hand movements that co-occur with speech, appear to be uniquely associated with the cerebellum in healthy individuals. This behavior may also have relevance for psychosis-risk youth, a group characterized by cerebellar dysfunction. This study examined beat gesture frequency and postural sway (a sensitive index of cerebellar functioning) in youth at ultrahigh risk (UHR) for psychosis. Results indicated that decreased beat gesture frequency, but not self-regulatory movement, is associated with elevated postural sway, suggesting that beat gestures may be an important biomarker in this critical population.
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Affiliation(s)
- K Juston Osborne
- Northwestern University, Department of Psychology, Evanston, Chicago, IL, USA.
| | - Jessica A Bernard
- Texas A&M University, Department of Psychology, College Station, TX, USA; Texas A&M Institute for Neuroscience, College Station, TX, USA
| | - Tina Gupta
- Northwestern University, Department of Psychology, Evanston, Chicago, IL, USA
| | - Derek J Dean
- University of Colorado Boulder, Department of Psychology, Boulder, CO, USA; University of Colorado Boulder, Center for Neuroscience, Boulder, CO, USA
| | - Zachary Millman
- University of Maryland Baltimore, Department of Psychology, Baltimore, MD, USA
| | - Teresa Vargas
- Northwestern University, Department of Psychology, Evanston, Chicago, IL, USA
| | - Ivanka Ristanovic
- Northwestern University, Department of Psychology, Evanston, Chicago, IL, USA
| | - Jason Schiffman
- University of Maryland Baltimore, Department of Psychology, Baltimore, MD, USA
| | - Vijay A Mittal
- Northwestern University, Department of Psychology, Department of Psychiatry, Institute for Policy Research, Department of Medical Social Sciences, Evanston, Chicago, IL, USA
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Riehle M, Lincoln TM. Social consequences of subclinical negative symptoms: An EMG study of facial expressions within a social interaction. J Behav Ther Exp Psychiatry 2017; 55:90-98. [PMID: 28092781 DOI: 10.1016/j.jbtep.2017.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES The negative symptoms of schizophrenia are related to lower social functioning even in non-clinical samples, but little is known about the distinct social consequences of motivational and expressive negative symptoms. In this study we focused on expressive negative symptoms and examined how these symptoms and varying degrees of pro-social facial expressiveness (smiling and mimicry of smiling) relate to the social evaluations by face-to-face interaction partners and to social support. METHODS We examined 30 dyadic interactions within a sample of non-clinical participants (N = 60) who were rated on motivational and expressive negative symptoms with the Clinical Assessment Interview for Negative Symptoms (CAINS). We collected data on both interaction partners' smiling-muscle (zygomaticus major) activation simultaneously with electromyography and assessed the general amount of smiling and the synchrony of smiling muscle activations between interaction partners (mimicry of smiling). Interaction partners rated their willingness for future interactions with each other after the interactions. RESULTS Interaction partners of participants scoring higher on expressive negative symptoms expressed less willingness for future interactions with these participants (r = -0.37; p = 0.01). Smiling behavior was negatively related to expressive negative symptoms but also explained by motivational negative symptoms. Mimicry of smiling and both negative symptom domains were also associated with participants' satisfaction with their social support network. LIMITATIONS Non-clinical sample with (relatively) low levels of symptoms. CONCLUSIONS Expressive negative symptoms have tangible negative interpersonal consequences and directly relate to diminished pro-social behavior and social support, even in non-clinical samples.
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Affiliation(s)
- Marcel Riehle
- Universität Hamburg, Department of Psychology, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Tania M Lincoln
- Universität Hamburg, Department of Psychology, Von-Melle-Park 5, 20146 Hamburg, Germany
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Strik W. Toward a neurobiologically informed psychiatry. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2017. [DOI: 10.1177/2514183x17714097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Schizophrenia is a severe and, at the same time fascinating disorder. It is traditionally defined as a «dissociation» of higher brain functions, which implies a modular organization of the brain up to its highest levels of organization. This short review shows how the study of the disorder is still flawed by fundamentally different definitions of the disorder, and that a consistent naturalistic approach may help to revise the vocabulary of psychiatric disorders, opening the way towards a neurobiologically informed psychiatry. Empirical studies and clinical importance supporting this novel approach are summarized.
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Affiliation(s)
- Werner Strik
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland
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Affiliation(s)
- Vijay A. Mittal
- *To whom correspondence should be addressed; tel: 847-467-3880, fax: 847-491-7859, e-mail:
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