Neurological Soft Signs and Brain Network Abnormalities in Schizophrenia

The immediate alteration of cerebellar Glx/GABA and cerebello-thalamo-cortical connectivity in patients with schizophrenia after cerebellar TMS

Cerebellar dysfunction is a key aspect of schizophrenia, with the cerebello-thalamo-cortical (CTC) hyperconnectivity serving as a neural signature. Abnormalities in gamma-aminobutyric acid (GABA) and glutamate + glutamine (Glx) levels also contribute to this pathology. Transcranial magnetic stimulation (TMS) applied to the cerebellum shows potential in alleviating schizophrenia symptoms, possibly by modulating functional connectivity or neurotransmitter levels. This study aims to explore the immediate effects of cerebellar TMS on CTC circuitry and neurotransmitter levels to elucidate its therapeutic mechanisms in schizophrenia.The study involved 19 stable schizophrenia patients and 26 healthy controls, diagnosed according to DSM-V criteria and assessed for symptom severity using the Positive and Negative Syndrome Scale (PANSS). MRI scans were conducted pre- and post-TMS to detect changes in CTC functional connectivity, GABA, Glx, and Glx/GABA. Linear Mixed-Effects Model (LMEM) and two-sample tests were employed to analyze changes in these variables from baseline to post-TMS. Pearson's correlation analysis was conducted to examine the relationships among these variables and their association with PANSS scores. Mediation analyses were employed to investigate whether GABA and/or Glx serve as potential mediators of CTC hyperconnectivity in patients with schizophrenia. Schizophrenia patients exhibit CTC hyperconnectivity, which remains at a relatively stable level after cerebellar TMS. Compared to healthy controls, schizophrenia patients have significantly higher cerebellar GABA levels, and cerebellar GABA has a significant mediation effect on CTC hyperconnectivity in patients. The Glx/GABA ratio was associated with the severity of clinical symptoms in patients, and cerebellar TMS partially normalized this ratio. Our findings demonstrate that aberrant cerebellar GABA levels contribute to CTC hyperconnectivity in schizophrenia. Additionally, our study shows that cerebellar TMS can increase Glx levels in schizophrenia patients, leading to the normalization of the Glx/GABA ratio, which may contribute to the therapeutic effects of TMS in schizophrenia.

Neurological soft signs and olfactory dysfunction in patients with borderline personality disorder

BACKGROUND

Borderline personality disorder (BPD) is a serious disorder with a lifetime prevalence of 2.7-5.9% and is thought to correlate with altered neuroplasticity. The aim of the present study is to investigate possible associations of BPD (-severity) and alterations in neurological soft signs (NSS) and olfactory function.

METHODS

For the monocentric observational study, 39 female subjects with a BPD diagnosis and 19 female healthy control subjects were recruited. The groups were matched by age. Olfactory functions were examined using Sniffin' Sticks. NSS were assessed by a standardized test with 50 items.

RESULTS

BPD subjects have higher NSS scores in group comparison. By contrast, there are no alterations in the total score of olfactory function, while the BPD subjects scored higher in smell identification. Within the BPD group, the total NSS score was discovered to have a negative correlation with olfactory function. BPD subjects taking antipsychotics show more NSS than those without. We found no significant influence of posttraumatic stress disorder on the NSS or olfactory function. The BPD-severity correlates with NSS.

LIMITATIONS

Due to the cross-sectional design, we did not have a follow up examination. The sample size was small, and all patients had psychiatric comorbidities. Additionally, we did not perform MRI to connect our findings with possible structural abnormalities.

CONCLUSIONS

Our study confirmed altered NSS in BPD patients, whereas no impairment in the olfactory function was found. Further research is required to establish NSS and smell tests as clinical screening tools in BPD patients and to uncover the disorder's impact on neuroplasticity.

Altered structural covariance of the cortex and hippocampal formation in patients with lung cancer after chemotherapy

Objective

In this retrospective study, we aimed to investigate changes in brain morphology and structural topological networks in patients with lung cancer (LC) with or without chemotherapy.

Methods

We retrospectively recruited 191 participants for this cross-sectional study, including 113 patients with LC without chemotherapy (Ch-), 38 patients with LC with chemotherapy (Ch+), and 40 healthy controls (HC) matched for age, sex, and education. The gray matter volume (GMV) and cortical properties were compared among the three groups. We constructed the structural covariant network (SCN) based on cortical thickness, volumes of subcortical structures, and volumes of hippocampal subfields and the amygdala in all participants. The global and nodal topological properties of SCN were compared among groups. In addition, 23 patients with LC (8 Ch+ and 15 Ch-) who received two identical brain magnetic resonance scans were enrolled in the follow-up study. The paired t-test was used to compare group differences in brain morphology and topological properties in the structural network.

Results

The GMV of the bilateral caudate and thalamus were smaller in the Ch- and Ch + groups compared to the HC group using threshold-free cluster enhancement and permutation (P < 0.05, 5000 times permutations) for multiple comparison correction. The cortical SCN analysis suggested multiple enhanced nodal properties in several brain areas in Ch+ and Ch-compared to HC, mainly in the temporal gyrus, using permutations test and false discovery rate (FDR) (P < 0.05) corrections. Moreover, an increased sigma was found in the Ch + compared with HC (P = 0.0238). The reduced nodal degree (P = 0.0002) and betweenness (P = 0.0008) in the right amygdala of Ch + compared to HC were detected by subcortical SCN analysis. Furthermore, reduced gamma (P = 0.0342) and sigma (P < 0.0001) were found in Ch-compared with HC in the SCN analysis of subfields of the amygdala-hippocampal complex. In the follow-up study, reduced nodal degree (P < 0.0001) was found in the right anterior amygdala, and reduced clustering coefficient and local efficiency were found in patients with LC after the permutation test.

Conclusions

Our study showed GMV defects and structural topological property abnormalities related to LC and chemotherapy. Such morphological changes associated with LC and chemotherapy could be used as imaging markers for clinical assessments and pathological indicators.

A Comparative Study of Frontal and Cerebellar Lobe Volumes Between Patients With First-Episode Schizophrenia and Healthy Controls and Its Association With Psychopathology and Neurological Soft Signs in Patients

Objectives Our study aimed to investigate the fronto-cerebellar volumes in both patients and controls, as well as explore their relationship with symptomatology. Our primary objectives were to compare the frontal and cerebellar lobe volumetric measurements between patients with first-episode schizophrenia (FES) and healthy controls and to assess the relationship of these volumes with psychopathology, cognition, and neurological soft signs in FES patients. The secondary objective was to explore the association of fronto-cerebellar lobe volumes with socio-demographic factors among patients and controls, as well as the duration of untreated illness (DUI) among patients. Materials and methods This was a cross-sectional, case-control study involving 60 participants, including 30 antipsychotic-naïve FES patients and 30 healthy controls. Participants underwent MRI scanning to measure frontal and cerebellar lobe volumes using the volBrain platform. Additionally, FES patients were assessed using the Positive and Negative Syndrome Scale (PANSS), Montreal Cognitive Assessment-Basic (MoCA-B), and Brief Motor Scale (BMS). Pearson's correlation, independent sample t-tests, multivariate linear regression, and binomial logistic regression were used to analyze the relationships between brain volumes, clinical assessments, and socio-demographic factors. Results No significant differences in frontal volumes were found between the two groups, while cerebellar volumes were significantly smaller in FES patients (p=0.004), particularly in younger males (p=0.026). Frontal volumes were negatively correlated with age in both groups (p=0.012), which remained robust in patients even after controlling for their gender, education, and DUI (p=0.012, aR2=0.221). Cerebellar volume reduction was associated with a higher likelihood of being classified as a patient (p=0.029). BMS was significantly correlated with frontal lobe volumes, especially in motor sequencing (MoSe), after adjusting for age, gender, and education (p=0.009). BMS MoSe scores were also significantly positively correlated with the DUI (r=0.415, p=0.023) and PANSS-General Psychopathology (GP) (r=0.494, p=0.005). MoCA-B scores were significantly lower in females than males (p=0.016), while PANSS-GP was significantly negatively correlated with age (r=-0.432, p=0.017). Conclusion Frontal and cerebellar volumes were differentially impacted in FES, with cerebellar atrophy being a significant distinguishing feature of the disorder. Frontal atrophy was associated with motor dysfunction but did not appear to influence psychopathology or cognition significantly in the early stages. The independent effects of frontal and cerebellar volumes, as shown by the lack of correlation between them, may suggest that these brain regions undergo separate pathological processes in schizophrenia, with frontal functional changes impacting motor function and cerebellar structural changes contributing to broader psychiatric symptoms, thereby warranting further exploration involving larger sample size.

Analyses of single-cell and bulk RNA sequencing combined with machine learning reveal the expression patterns of disrupted mitophagy in schizophrenia

Background

Mitochondrial dysfunction is an important factor in the pathogenesis of schizophrenia. However, the relationship between mitophagy and schizophrenia remains to be elucidated.

Methods

Single-cell RNA sequencing datasets of peripheral blood and brain organoids from SCZ patients and healthy controls were retrieved. Mitophagy-related genes that were differentially expressed between the two groups were screened. The diagnostic model based on key mitophagy genes was constructed using two machine learning methods, and the relationship between mitophagy and immune cells was analyzed. Single-cell RNA sequencing data of brain organoids was used to calculate the mitophagy score (Mitoscore).

Results

We found 7 key mitophagy genes to construct a diagnostic model. The mitophagy genes were related to the infiltration of neutrophils, activated dendritic cells, resting NK cells, regulatory T cells, resting memory T cells, and CD8 T cells. In addition, we identified 12 cell clusters based on the Mitoscore, and the most abundant neurons were further divided into three subgroups. Results at the single-cell level showed that Mitohigh_Neuron established a novel interaction with endothelial cells via SPP1 signaling pathway, suggesting their distinct roles in SCZ pathogenesis.

Conclusion

We identified a mitophagy signature for schizophrenia that provides new insights into disease pathogenesis and new possibilities for its diagnosis and treatment.

Alterations in amygdala subregions-Default mode network connectivity after treatment in patients with schizophrenia

Disrupted connectivity in the default mode network (DMN) during resting-state functional MRI (rs-fMRI) is well-documented in schizophrenia (SCZ). The amygdala, a key component in the neurobiology of SCZ, comprises distinct subregions that may exert varying effects on the disorder. This study aimed to investigate variations in functional connectivity (FC) between distinct amygdala subregions and the DMN in SCZ individuals and explore the effects of treatment on these connections. Fifty-six SCZ patients and 51 healthy controls underwent FC analysis and questionnaire surveys during resting state. The amygdala was selected as the region of interest (ROI) and subdivided into four parts. Changes in FC were examined, and correlations between questionnaire scores and brain activity were explored. Pre-treatment, SCZ patients exhibited reduced FC between the amygdala and DMN compared to HCs. After treatment, significant differences persisted in the right medial amygdala, while other regions did not differ significantly from controls. In addition, PANSS scores positively correlated with FC between the Right Medial Amygdala and the left SMFC (r = .347, p = .009), while RBANS5A scores showed a positive correlation with FC between the Left Lateral Amygdala and the right MTG (rho = -.347, p = .009). The rsFC between the amygdala and the DMN plays a crucial role in the treatment mechanisms of SCZ. This could provide a promising predictive indicator for understanding the neural mechanisms behind treatment and symptomatic improvement.

Neurological soft signs as trait markers of a subset of patients with obsessive-compulsive disorder with low insight and altered cognitive abilities

Neurological soft signs (NSS) are subtle motor control impairments that include involuntary movements and abnormalities of motor coordination, sensory integration and lateralization. They engage different brain networks, including the prefrontal networks that support the higher cognitive functions that are dysfunctional in obsessive-compulsive disorder (OCD). This study investigated the relationships between the presence of NSS and patients' severity of OCD symptoms, insight, and treatment resistance in a sample of 63 patients. Treatment-resistance was assessed considering all the treatments the patients received during the course of their disease. The four dimensions of OCD defined in the dimensional obsessive-compulsive scale were considered. Links between the patients' cognitive abilities and NSS were assessed using tests targeting specifically the core components of executive functions. As expected, OCD patients displayed more NSS than individually matched control participants. In OCD patients, high NSS scores were associated with poor insight and lower cognitive abilities. Multiple regression analysis identified worse visuospatial working memory, attentional control, and verbal fluency as predictive factors of high NSS scores among cognitive functions. Unexpectedly, the patients displaying symptoms in the contamination/washing dimension displayed less NSS than the other patients. In contrast, neither the severity of OCD symptoms nor long-range treatment resistance was significantly related to patients' NSS scores. Altogether, our findings suggest that high NSS scores may be a trait marker of a subset of OCD patients with low insight and particularly altered cognitive abilities who would not express the contamination/washing dimension of the pathology.

The network characteristics in schizophrenia with prominent negative symptoms: a multimodal fusion study

Previous studies on putative neural mechanisms of negative symptoms in schizophrenia mainly used single modal imaging data, and seldom utilized schizophrenia patients with prominent negative symptoms (PNS).This study adopted the multimodal fusion method and recruited a homogeneous sample with PNS. We aimed to identify negative symptoms-related structural and functional neural correlates of schizophrenia. Structural magnetic resonance imaging (sMRI) and resting-state functional MRI (rs-fMRI) were performed in 31 schizophrenia patients with PNS and 33 demographically matched healthy controls.Compared to healthy controls, schizophrenia patients with PNS exhibited significantly altered functional activations in the default mode network (DMN) and had structural gray matter volume (GMV) alterations in the cerebello-thalamo-cortical network. Correlational analyses showed that negative symptoms severity was significantly correlated with the cerebello-thalamo-cortical structural network, but not with the DMN network in schizophrenia patients with PNS.Our findings highlight the important role of the cerebello-thalamo-cortical structural network underpinning the neuropathology of negative symptoms in schizophrenia. Future research should recruit a large sample and schizophrenia patients without PNS, and apply adjustments for multiple comparison, to verify our preliminary findings.

Abnormal Spatial and Temporal Overlap of Time-Varying Brain Functional Networks in Patients with Schizophrenia

Schizophrenia (SZ) is a complex psychiatric disorder with unclear etiology and pathological features. Neuroscientists are increasingly proposing that schizophrenia is an abnormality in the dynamic organization of brain networks. Previous studies have found that the dynamic brain networks of people with SZ are abnormal in both space and time. However, little is known about the interactions and overlaps between hubs of the brain underlying spatiotemporal dynamics. In this study, we aimed to investigate different patterns of spatial and temporal overlap of hubs between SZ patients and healthy individuals. Specifically, we obtained resting-state functional magnetic resonance imaging data from the public dataset for 43 SZ patients and 49 healthy individuals. We derived a representation of time-varying functional connectivity using the Jackknife Correlation (JC) method. We employed the Betweenness Centrality (BC) method to identify the hubs of the brain's functional connectivity network. We then applied measures of temporal overlap, spatial overlap, and hierarchical clustering to investigate differences in the organization of brain hubs between SZ patients and healthy controls. Our findings suggest significant differences between SZ patients and healthy controls at the whole-brain and subnetwork levels. Furthermore, spatial overlap and hierarchical clustering analysis showed that quasi-periodic patterns were disrupted in SZ patients. Analyses of temporal overlap revealed abnormal pairwise engagement preferences in the hubs of SZ patients. These results provide new insights into the dynamic characteristics of the network organization of the SZ brain.

Movement initiation and preparation in subjects with schizophrenia - The amplitude of the readiness potential as a biological marker for negative symptom severity

OBJECTIVE

Despite extensive research, the etiology of negative symptoms is not well understood. Preliminary findings are linking motor disturbances to negative symptom severity. We aimed to further the understanding to what extent motor movement preparation influences negative symptom severity.

METHODS

In a cohort of 31 subjects with schizophrenia and 20 control subjects we recorded the readiness potential amplitude over Cz during spontaneous movements of the right and left thumb. We further assessed negative and positive symptom severity (scale for the assessment of negative and positive symptoms) as well as neurological soft signs (NSS).

RESULTS

In subjects with schizophrenia the severity of negative symptoms was best predicted by the readiness potential amplitude and the NSS subdomain motor coordination. The correlation between deficits in motor coordination and negative symptom severity was partially mediated by the readiness potential amplitude in subjects with schizophrenia.

CONCLUSIONS

Deficits in motor processing are linked to negative symptom severity in schizophrenia. The readiness potential may represent a biological marker of these basal deficits. In combination with the assessment of NSS, the readiness potential may be a marker of the course of negative symptom severity and help clarifying interdependencies between (pre)frontal networks for action initiation and coordination, as well as negative symptoms.

Structural brain networks in schizophrenia based on nonnegative matrix factorization

Schizophrenia is a severe mental disease with significant morphometric reductions in gray matter volume and cortical thickness in a variety of brain regions. However, most studies only focused on the voxel level alterations in specific cerebral regions and ignored the spatial relationship between voxels. In the present study, we used a novel, data-driven technique-nonnegative matrix factorization (NMF) to group voxels with similar information into a network, and studied the structural covariance at the network level in schizophrenia. Our sample included 36 patients with schizophrenia and 21 healthy controls. Compared with healthy controls, patients with schizophrenia showed significant gray matter volume reductions in six structural covariance networks (dorsal striatum, thalamus, hippocampus-parahippocampus, supplementary motor area-fusiform, middle/inferior temporal network, frontal-parietal-occipital network). Our findings confirmed the assumption of a disturbance in the cortical-subcortical circuit in schizophrenia and suggested that NMF is a useful multivariate method to identify brain networks, which provides a new perspective to study the neural mechanism in schizophrenia.

Neurological soft signs in first episode psychosis among psychiatric hospital patients and its relationship with dimensions of psychopathology: A comparative study

Background

Neurological soft signs (NSS), as subtle, nonlocalising neurological abnormalities, are considered as the potential markers of psychosis. However, comparative studies of antipsychotic-naïve patients with first-episode psychosis (FEP) and first degree relatives (FDRs) are uncommon. We compared the prevalence and pattern of NSS in FEPs, their healthy FDRs and a healthy non-relatives' control group (HC), highlighted the relationship between NSS and psychopathology and proposed cut-off scores for prevalence studies.

Materials and Methods

Two hundred and two participants per group were recruited. The FEPs were consecutive attendees; FDRs were accompanying caregivers; while the HC were from hospital staff. The Brief Psychiatric Rating Scale and the Neurological Evaluation Scale were used to assess psychopathology dimensions and NSS, respectively.

Results

Using an item score of two ('substantial impairment'), the prevalence of at least one NSS was: 91.5% (95% confidence interval [CI]: 86.7%-94.9%), 16.8% (95% CI: 11.8%-22.7%) and 6.5% (95% CI: 3.5%-10.9%), respectively, for FEP, FDRs and HC. FEPs were impaired in a broad range of signs. The noteworthy relationships were as follows: (i) a significant correlation between the negative symptoms' dimension versus number of NSS (r = 0.4), and NSS total score (r = 0.3), (ii) the anxiety/depression dimension correlated negatively with number of NSS (r = -0.3) and (iii) NSS cut across psychosis categories. We propose a cut-off score of ≥ 4 for the number of signs signifying probable impairment.

Conclusion

The findings indicate that, subject to further studies, NSS could be regarded as a broader phenotype of neurologic dysfunction associated with psychosis proness.

Cerebellar Functional Dysconnectivity in Drug-Naïve Patients With First-Episode Schizophrenia

BACKGROUND

Cerebellar functional dysconnectivity has long been implicated in schizophrenia. However, the detailed dysconnectivity pattern and its underlying biological mechanisms have not been well-charted. This study aimed to conduct an in-depth characterization of cerebellar dysconnectivity maps in early schizophrenia.

STUDY DESIGN

Resting-state fMRI data were processed from 196 drug-naïve patients with first-episode schizophrenia and 167 demographically matched healthy controls. The cerebellum was parcellated into nine functional systems based on a state-of-the-art atlas, and seed-based connectivity for each cerebellar system was examined. The observed connectivity alterations were further associated with schizophrenia risk gene expressions using data from the Allen Human Brain Atlas.

STUDY RESULTS

Overall, we observed significantly increased cerebellar connectivity with the sensorimotor cortex, default-mode regions, ventral part of visual cortex, insula, and striatum. In contrast, decreased connectivity was shown chiefly within the cerebellum, and between the cerebellum and the lateral prefrontal cortex, temporal lobe, and dorsal visual areas. Such dysconnectivity pattern was statistically similar across seeds, with no significant group by seed interactions identified. Moreover, connectivity strengths of hypoconnected but not hyperconnected regions were significantly correlated with schizophrenia risk gene expressions, suggesting potential genetic underpinnings for the observed hypoconnectivity.

CONCLUSIONS

These findings suggest a common bidirectional dysconnectivity pattern across different cerebellar subsystems, and imply that such bidirectional alterations may relate to different biological mechanisms.

Neurological and cerebellar soft signs in bipolar disorder: The role of staging, type and history of psychotic symptoms

AIM

Bipolar disorder (BD) patients show neurological abnormalities in form of neurological and cerebellar soft signs (NSS and CSS). NSS represents heterogeneous group of symptoms representing i.a. deficits of motor coordination, sequencing of complex motor acts and sensory integration. CSS were introduced as group of the neurological deficits of posture, gait, kinetic functions, eye movements and speech, associated more specifically to cerebellar abnormalities than NSS. Studies show significant effect size variability of those symptoms in BD group suggesting the existence of differing subpopulations. The aim of our study was to evaluate the effect of BD type, stage and the history of psychotic symptoms (HoPS) on the severity of CSS and NSS as none of the previous studies had verified the role of those categories.

METHODS

This study involved 181 participants: 116 euthymic BD patients (66 BD I, 50 BD II) and 65 healthy controls (HC). CSS was assessed with the International Cooperative Ataxia Rating Scale and NSS with Neurological Evaluation Scale. Patients were divided into early and late stage of the disorder according to Kapczinski's criteria. Rater was blind to patients' stage, type and HoPS.

RESULTS

Staging was related to vast majority of CSS and NSS scores. HoPS was related to oculomotor deficits. The effect of BD type was the least significant. Late stage BD showed more severe CSS and NSS than HC in every measure. There were no differences between early stage BD and HC, apart of posture and gait disturbances. Except of sensory integration scores, late stage BD showed higher CSS and NSS rates than early stage patients.

CONCLUSION

In this hitherto the largest study of neurological abnormalities in BD we have shown significant role of staging in CSS and NSS severity. Progression criteria based on inter-episode psychosocial functioning may stand as unrecognised factor responsible for variability observed in previous studies evaluating neurological abnormalities in BD. Our study suggests that in clinical practice NSS and CSS may be potentially used as easy-to-assess biological marker of BD staging. Observed severity of neurological impairments of BD patients may more likely correspond to the disease progression than to BD type and HoPS.

Neurological soft signs and structural network changes: a longitudinal analysis in first-episode schizophrenia

BACKGROUND

Neurological soft signs (NSS) are often reported in patients with schizophrenia and may vary with psychopathological symptoms during the course of disease. Many cross-sectional neuroimaging studies have shown that NSS are associated with disturbed network connectivity in schizophrenia. However, it remains unclear how these associations change over time during the course of disorder.

METHODS

In present study, 20 patients with first-episode schizophrenia and 20 controls underwent baseline structural magnetic resonance imaging (MRI) scan and at one-year follow-up. Structural network characteristics of patients and controls were analyzed using graph theoretical approach based on MRI data. NSS were assessed using the Heidelberg scale.

RESULTS

At baseline, patients demonstrated significant changes of the local network properties mainly involving regions of the cortical-subcortical-cerebellar circuits compared to healthy controls. For further analysis, the whole patient group was dichotomized into a NSS-persisting and NSS-decreasing subgroup. After one-year follow-up, the NSS-persisting subgroup showed decreased betweenness in right inferior opercular frontal cortex, left superior medial frontal cortex, left superior temporal cortex, right putamen and cerebellum vermis and increased betweenness in right lingual cortex. However, the NSS-decreasing subgroup exhibited only localized changes in right middle temporal cortex, right insula and right fusiform with decreased betweenness, and in left lingual cortex with increased betweenness.

CONCLUSIONS

These findings provide evidence for brain network reorganization subsequent to clinical disease manifestation in patients with first-episode schizophrenia, and support the hypothesis that persisting NSS refer to progressive brain network abnormalities in patients with schizophrenia. Therefore, NSS could help to establish a better prognosis in first-episode schizophrenia patients.

Association of cortical thickness and cognition with schizophrenia treatment resistance

AIM

Approximately a third of patients with schizophrenia fail to adequately respond to antipsychotic medications, a condition known as treatment resistance (TR). We aimed to assess cognitive and cortical thickness deficits and their relationship to TR in schizophrenia.

METHOD

We recruited patients with schizophrenia (n = 127), including patients at treatment initiation (n = 45), treatment-responsive patients (n = 40) and TR patients (n = 42), and healthy controls (n = 83). Clinical symptoms, neurocognitive function, and structural images were assessed. We performed group comparisons, and explored association of cortical thickness and cognition with TR.

RESULTS

The TR patients showed significantly more severe clinical symptoms and cognitive impairment relative to the treatment-responsive group. Compared to healthy controls, 56 of 68 brain regions showed significantly reduced cortical thickness in patients with schizophrenia. Reductions in five regions were significantly associated with TR (reduction in TR relative to treatment-responsive patients), i.e. in the right caudal middle frontal gyrus, superior frontal cortex, fusiform gyrus, pars opercularis of the inferior frontal cortex, and supramarginal cortex. Cognition deficits were also significantly correlated with cortical thickness in these five regions in patients with schizophrenia. Cortical thickness of the right caudal middle frontal gyrus, superior frontal cortex and pars opercularis of the inferior frontal cortex also significantly mediated effects of cognitive deficits on TR.

CONCLUSION

Treatment resistance in schizophrenia was associated with reduced thickness in the right caudal middle frontal gyrus, superior frontal cortex, fusiform gyrus, pars opercularis of the inferior frontal cortex, and supramarginal cortex. Cortical abnormalities further mediate cognitive deficits known to be associated with TR.

Effectiveness and safety of Baduanjin for schizophrenia: A protocol for systematic review and meta-analysis

BACKGROUND

The cause of schizophrenia is still unknown, the course of the disease is long and its onset is thought to be related to neurodevelopmental, genetic, and oxidative stress factors and so on. There is no means of cure. Typical drug therapy is effective in treating the acute stage of schizophrenia, while the impaired social and life functions of patients are often neglected. Baduanjin is a traditional Chinese physical and breathing exercise that not only strengthens the muscles, and moves the joints, but also exercises the will. Many studies have been reported in the study on the application of Baduanjin to schizophrenic patients to promote recovery, but no research systematically evaluates the therapeutic effects and safety of Baduanjin for schizophrenic patients. This study aims to systematically investigate the efficacy and safety of Baduanjin in the treatment of schizophrenic patients.

METHODS

Reports of randomized controlled trials (RCTs) on Baduanjin for schizophrenia will be searched in the following data sources, including 3 English databases（PubMed, EMBASE, Cochrane Library）and 4 Chinese databases（China National Knowledge Infrastructure, Chinese Biomedical Literature, Wanfang, and China Clinical Trials Registry Database）, and their publication time is restricted from the establishment of the database to October 1, 2022. Two reviewers will independently perform study selection, data extraction, and quality assessment. RevMan V.5.4 software will be used for meta-analysis. The protocol will be performed according to preferred reporting items for systematic reviews and meta-analysis protocols (PRISMA-P) guidelines.

RESULTS

The results will provide a systematic overview of the current evidence on the use of Baduanjin to treat schizophrenia.

CONCLUSION

The conclusions of this study will help clarify whether Baduanjin is effective and safe for treating schizophrenia.

Structural network alterations and their association with neurological soft signs in schizophrenia: Evidence from clinical patients and unaffected siblings

BACKGROUND

Grey matter abnormalities and neurological soft signs (NSS) have been found in schizophrenia patients and their unaffected relatives. Evidence suggested that NSS are associated with grey matter morphometrical alterations in multiple regions in schizophrenia. However, the association between NSS and structural abnormalities at network level remains largely unexplored, especially in the schizophrenia and unaffected siblings.

METHOD

We used source-based morphometry (SBM) to examine the association of structural brain network characteristics with NSS in 62 schizophrenia patients, 25 unaffected siblings, and 60 healthy controls.

RESULTS

Two components, namely the IC-5 (superior temporal gyrus, inferior frontal gyrus and insula network) and the IC-10 (parahippocampal gyrus, fusiform, thalamus and insula network) showed significant grey matter reductions in schizophrenia patients compared to healthy controls and unaffected siblings. Further association analysis demonstrated separate NSS-related grey matter covarying patterns in schizophrenia, unaffected siblings and healthy controls. Specifically, NSS were negatively associated with IC-1 (hippocampus, caudate and thalamus network) and IC-5 in schizophrenia, but with IC-3 (caudate, superior and middle frontal cortices network) in unaffected siblings and with IC-5 in healthy controls.

CONCLUSION

Our results confirmed the key cortical and subcortical network abnormalities and NSS-related grey matter covarying patterns in the schizophrenia and unaffected siblings. Our findings suggest that brain regions implicating genetic liability to schizophrenia are partly separated from brain regions implicating neural abnormalities.

Abnormal corneal nerve morphology and brain volume in patients with schizophrenia

Neurodevelopmental and neurodegenerative pathology occur in Schizophrenia. This study compared the utility of corneal confocal microscopy (CCM), an ophthalmic imaging technique with MRI brain volumetry in quantifying neuronal pathology and its relationship to cognitive dysfunction and symptom severity in schizophrenia. Thirty-six subjects with schizophrenia and 26 controls underwent assessment of cognitive function, symptom severity, CCM and MRI brain volumetry. Subjects with schizophrenia had lower cognitive function (P ≤ 0.01), corneal nerve fiber density (CNFD), length (CNFL), branch density (CNBD), CNBD:CNFD ratio (P < 0.0001) and cingulate gyrus volume (P < 0.05) but comparable volume of whole brain (P = 0.61), cortical gray matter (P = 0.99), ventricle (P = 0.47), hippocampus (P = 0.10) and amygdala (P = 0.68). Corneal nerve measures and cingulate gyrus volume showed no association with symptom severity (P = 0.35–0.86 and P = 0.50) or cognitive function (P = 0.35–0.86 and P = 0.49). Corneal nerve measures were not associated with metabolic syndrome (P = 0.61–0.64) or diabetes (P = 0.057–0.54). The area under the ROC curve distinguishing subjects with schizophrenia from controls was 88% for CNFL, 84% for CNBD and CNBD:CNFD ratio, 79% for CNFD and 73% for the cingulate gyrus volume. This study has identified a reduction in corneal nerve fibers and cingulate gyrus volume in schizophrenia, but no association with symptom severity or cognitive dysfunction. Corneal nerve loss identified using CCM may act as a rapid non-invasive surrogate marker of neurodegeneration in patients with schizophrenia.

The role of neurological soft signs in different mathematical skills in second and third grade children

Neurological soft signs (NSSs) are subtle motor and sensory deficits, and are associated with poor cognitive abilities. Although cognitive ability has been found to be a significant predictor for academic performance in children, it remains unclear whether NSSs could contribute to academic abilities such as mathematical skills, and its contribution varies according to grade level. Therefore, in this cross-sectional study, we examined the relationships between NSSs and different mathematical skills (calculation fluency, numerical operations, and mathematical problem-solving) in 105 Chinese children (Mean age = 7.76 years, SD age = 0.67 years; 52 from second grade, 53 from third grade; 56 boys and 49 girls) recruited from a primary public school located in Shanghai. The results of regression analyses revealed that NSSs significantly predicted calculation fluency (β = -.32, p < .050), numerical operations (β = -.38, p < .050), and mathematical problem-solving (β = -0.40, p < .010) in second but not third grade, even controlling for cognitive processes. Our results implicate that NSSs could be a potential predictor for mathematical skills in the early years of primary school.

Cerebellar gray matter volume changes in patients with schizophrenia: A voxel-based meta-analysis

BACKGROUND

In schizophrenia, the structural changes in the cerebellum are associated with patients' cognition and motor deficits. However, the findings are inconsistent owing to the heterogeneity in sample size, magnetic resonance imaging (MRI) scanners, and other factors among them. In this study, we conducted a meta-analysis to characterize the anatomical changes in cerebellar subfields in patients with schizophrenia.

METHODS

Systematic research was conducted to identify studies that compare the gray matter volume (GMV) differences in the cerebellum between patients with schizophrenia and healthy controls with a voxel-based morphometry (VBM) method. A coordinate-based meta-analysis was adopted based on seed-based d mapping (SDM) software. An exploratory meta-regression analysis was conducted to associate clinical and demographic features with cerebellar changes.

RESULTS

Of note, 25 studies comprising 996 patients with schizophrenia and 1,109 healthy controls were included in the present meta-analysis. In patients with schizophrenia, decreased GMVs were demonstrated in the left Crus II, right lobule VI, and right lobule VIII, while no increased GMV was identified. In the meta-regression analysis, the mean age and illness duration were negatively associated with the GMV in the left Crus II in patients with schizophrenia.

CONCLUSION

The most significant structural changes in the cerebellum are mainly located in the posterior cerebellar hemisphere in patients with schizophrenia. The decreased GMVs of these regions might partly explain the cognitive deficits and motor symptoms in patients with schizophrenia.

Relationship between neurological and cerebellar soft signs, and implicit motor learning in schizophrenia and bipolar disorder

BACKGROUND

Schizophrenia (SZ) and bipolar disorder (BD) patients share deficits in motor functions in the form of neurological (NSS) and cerebellar soft signs (CSS), and implicit motor learning disturbances. Here, we use cluster analysis method to assess (1) the relationship between those abnormalities in SZ and BD and (2) the differences between those groups.

METHODS

33 SZ patients, 33 BD patients as well as 31 healthy controls (HC) took part in the study. We assessed CSS with the International Cooperative Ataxia Rating Scale (ICARS) and NSS with the Neurological Evaluation Scale (NES). Implicit motor learning was evaluated with the Serial Reaction Time Task (SRTT). Participants were divided into clusters (Ward's method) based on the mean response time and mean error rate in SRTT. The difference in ICARS and NES scores, and SRTT variables between clusters were evaluated. We have measured associations between SRTT parameters and both ICARS and NES total scores and subscores.

RESULTS

Cluster analysis based on the SRTT parameters allowed to extract three clusters. Those were characterized by the increasing disruption of motor functioning (psychomotor retardation, the severity of NSS and CSS) regardless of the diagnosis. Cluster 1 covered almost all of HC and was characterized by faster reaction times and small number of errors. BD and SZ patients represented in cluster 1, although fully functional in performing the SRTT, showed higher rates of NSS and CSS. Patients with BD and SZ were set apart in clusters 2 and 3 in a similar proportion. Cluster 2 presented significantly slower reaction times but with the comparable number of errors to cluster 1. Cluster 3 consisted of participants with normal or decreased reaction time and significantly increased number of errors. None of the clusters were predominantly composed of the patients representing one psychiatric diagnosis.

CONCLUSIONS

To our best knowledge, we are presenting the first data indicating the relationship between implicit motor learning and NSS and CSS in SZ and BD patients' groups. Lack of clusters predominantly represented by patients with the diagnosis of SZ or BD may refer to the model of schizophrenia-bipolar disorder boundary, pointing out the similarities between those two disorders.

Progress in sensorimotor neuroscience of schizophrenia spectrum disorders: Lessons learned and future directions

The number of neuroimaging studies on movement disorders, sensorimotor, and psychomotor functioning in schizophrenia spectrum disorders (SSD) has steadily increased over the last two decades. Accelerated by the addition of the "sensorimotor domain" to the Research Domain Criteria (RDoC) framework in January 2019, neuroscience research on the role of sensorimotor dysfunction in SSD has gained greater scientific and clinical relevance. To draw attention to recent rapid progress in the field, we performed a triennial systematic review (PubMed search from January 1st^, 2018 through December 31st^, 2020), in which we highlight recent neuroimaging findings and discuss methodological pitfalls as well as challenges for future research. The identified magnetic resonance imaging (MRI) studies suggest that sensorimotor abnormalities in SSD are related to cerebello-thalamo-cortico-cerebellar network dysfunction. Longitudinal and interventional studies highlight the translational potential of the sensorimotor domain as putative biomarkers for treatment response and as targets for non-invasive neurostimulation techniques in SSD.

Investigation of structural brain correlates of neurological soft signs in individuals at ultra-high risk for psychosis

Increased severity of neurological soft signs (NSS) in schizophrenia have been associated with abnormal brain morphology in cerebello-thalamo-cortical structures, but it is unclear whether similar structures underlie NSS prior to the onset of psychosis. The present study investigated the relationship between severity of NSS and grey matter volume (GMV) in individuals at ultra-high risk for psychosis (UHR) stratified for later conversion to psychosis. Structural T1-weighted MRI scans were obtained from 56 antipsychotic-naïve UHR individuals and 35 healthy controls (HC). The UHR individuals had follow-up data (mean follow-up: 5.2 years) to ascertain clinical outcome. Using whole-brain voxel-based morphometry, the relationship between NSS and GMV at baseline was assessed in UHR, HC, as well as individuals who later transitioned (UHR-P, n = 25) and did not transition (UHR-NP, n = 31) to psychosis. NSS total and subscale scores except motor coordination were significantly higher in UHR compared to HC. Higher signs were also found in UHR-P, but not UHR-NP. Total NSS was not associated with GMV in the whole sample or in each group. However, in UHR-P individuals, greater deficits in sensory integration was associated with lower GMV in the left cerebellum, right insula, and right middle frontal gyrus. In conclusion, NSS are present in UHR individuals, particularly those who later transitioned to a psychotic disorder. While these signs show little overall variation with GMV, the association of sensory integration deficits with lower GMV in UHR-P suggests that certain brain areas may be implicated in the development of specific neurological abnormalities in the psychosis prodrome.

Neurological Soft Signs (NSS) in Census-Based, Decade-Adjusted Healthy Adults, 20 to >70 Years of Age

Neurological soft signs (NSS) represent minor neurological features and have been widely studied in psychiatric disease. The assessment is easily performed. Quantity and quality may provide useful information concerning the disease course. Mostly, NSS scores differ significantly between patients and controls. However, literature does not give reference values. In this pilot study, we recruited 120 healthy women and men to build a cross-sectional, census-based sample of healthy individuals, aged 20 to >70 years, subdivided in 10-year blocks for a close approach to the human lifeline. Testing for NSS and neurocognitive functioning was performed following the exclusion of mental and severe physical illness. NSS scores increased significantly between ages 50+ and 60+, which was primarily accountable to motor signs. Gender and cognitive functioning were not related to changes of scores. Although the number of individuals is small, study results may lay a foundation for further validation of NSS in healthy individuals.

[The sensorimotor domain in the research domain criteria system: progress and perspectives]

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.

Different trajectories of neurological soft signs progression between treatment-responsive and treatment-resistant schizophrenia patients

Schizophrenia patients exhibit subtle and non-localizing neurological abnormalities, known as neurological soft signs (NSS). Life-span evidence suggests that NSS vary along the course of schizophrenia. An association between NSS and treatment response has been proposed, suggesting that NSS reflect the underlying neuropathology development in schizophrenia. However, few studies have investigated the relationship between NSS and treatment resistance in first-episode schizophrenia patients. We conducted a longitudinal study on 52 first-episode schizophrenia patients, who were assessed at baseline, the sixth month, and the fifth year using the abridged version of the Cambridge Neurological Inventory. The trajectories of NSS between 29 treatment-responsive patients (with full symptomatic remission) and 23 treatment-resistant patients (who received clozapine) were compared using mixed model ANOVA. We also controlled for the effect of age and estimated IQ, using a mixed ANCOVA model. Although the two schizophrenia groups had comparable NSS at the baseline, their trajectories of NSS differed significantly. Compared with their treatment-responsive counterparts, treatment-resistant schizophrenia patients had worsening of NSS over time. Our findings support the potential utility of NSS in identifying treatment resistance in first-episode schizophrenia. Progressive worsening of NSS in treatment-resistant schizophrenia patients may reflect the development of underlying neuropathology. Further studies using large samples of treatment-resistant schizophrenia patients are needed.

Cerebral and behavioral signs of impaired cognitive flexibility and stability in schizophrenia spectrum disorders

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Patients are impaired regarding both, cognitive flexibility and stability.

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Deficient prediction error discrimination is related to reduced striatal activation.

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Decreased ACC and hippocampus activation predicts impaired rule switch detection.

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Decreased frontal and insular activation predicts impaired distractor shielding.

Background

Manifold cognitive deficits have been reported in schizophrenia spectrum disorders, including disturbances in flexible updating to altered circumstances as well as stabilization deficits in the face of distractors. In this functional magnetic resonance imaging study, we examined the neural correlates of these deficits as two complementary components of predictive processing.

Methods

In 22 patients with schizophrenia spectrum disorders and 22 healthy matched control participants, we applied a serial predictive switch-drift task to assess flexibility as successful detection of prediction-rule switches, and stability as successfully ignoring distractors (“drifts”).

Results

Patients compared with controls less reliably detected rule switches and also less efficiently inhibited drifts. A reduced striatal response to switches or drifts correlated with weaker switch-drift-discrimination in patients, suggesting impaired gating of prediction errors. The increase in activity in anterior cingulate cortex and hippocampus for detected vs. undetected switches was reduced in patients compared to controls, which may reflect impaired behavioral adaptation following prediction errors. The comparison between shielding against distractions and undetected switches showed increased activity in the inferior frontal cortex and posterior insula in controls but not in patients.

Conclusion

Our results suggest new insights into the specific disruption of predictive flexibility and stability in schizophrenia spectrum disorders, which is characterized by impaired striatal gating and inadequate cortical encoding of predictive errors.

Neurological Signs at the First Psychotic Episode as Correlates of Long-Term Outcome: Results From the AESOP-10 Study

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.