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Núñez C, Stephan-Otto C, Roldán A, Grasa EM, Escartí MJ, Aguilar García-Iturrospe EJ, García-Martí G, de la Iglesia-Vaya M, Nacher J, Portella MJ, Corripio I. Orbitofrontal cortex hypergyrification in hallucinating schizophrenia patients: Surface ratio as a promising brain biomarker. Eur Neuropsychopharmacol 2024; 89:47-55. [PMID: 39341083 DOI: 10.1016/j.euroneuro.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 09/13/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024]
Abstract
The study of brain gyrification may provide useful information on the cytoarchitecture and connectivity of the brain. One of the methods that have been developed to estimate brain gyrification, known as surface ratio (SR), has not yet been studied in schizophrenia. Here we aimed to assess whether SR could provide new insights on the brain structure of schizophrenia patients and the severity of symptoms. We also computed a more established brain gyrification measure, namely absolute mean curvature (AMC). We analyzed 63 magnetic resonance images, 25 from schizophrenia patients with treatment-resistant auditory verbal hallucinations (SCH-H), 18 from schizophrenia patients without hallucinations (SCH-NH), and 20 from healthy controls (HC). The SR measure revealed that SCH-H patients had a more folded orbitofrontal cortex than SCH-NH patients and HC. Gyrification in this region was also negatively associated with positive symptoms, specifically with the delusions and conceptual disorganization items, only in the SCH-H group. Regarding the AMC measure, we identified two areas where HC showed more gyrification than SCH-H patients, but no relationships arose with symptoms. The hypergyrification of the orbitofrontal cortex displayed by SCH-H patients, as captured by the SR measure, suggests aberrant and/or excessive wiring in these patients, which in turn could give rise to auditory verbal hallucinations. Alternatively, we comment on potential compensatory mechanisms that may better explain the negative association between orbitofrontal gyrification and positive symptomatology. The SR measure captured the most relevant differences and associations, making it a promising biomarker in schizophrenia.
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Affiliation(s)
- Christian Núñez
- Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Christian Stephan-Otto
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; CIBERSAM, ISCIII, Spanish National Network for Research in Mental Health, Madrid, Spain; Pediatric Computational Imaging Group (PeCIC), Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Alexandra Roldán
- Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBERSAM, ISCIII, Spanish National Network for Research in Mental Health, Madrid, Spain; Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Eva Mª Grasa
- Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBERSAM, ISCIII, Spanish National Network for Research in Mental Health, Madrid, Spain
| | - Mª José Escartí
- CIBERSAM, ISCIII, Spanish National Network for Research in Mental Health, Madrid, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Fundación Investigación Hospital Clínico de Valencia, INCLIVA, Valencia, Spain; Department of Medicine, University CEU-UCH, Valencia, Spain
| | - Eduardo J Aguilar García-Iturrospe
- CIBERSAM, ISCIII, Spanish National Network for Research in Mental Health, Madrid, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Fundación Investigación Hospital Clínico de Valencia, INCLIVA, Valencia, Spain; Department of Medicine, University CEU-UCH, Valencia, Spain
| | - Gracián García-Martí
- CIBERSAM, ISCIII, Spanish National Network for Research in Mental Health, Madrid, Spain; Biomedical Engineering Unit / Radiology Department, Quirónsalud Hospital, Valencia, Spain
| | - Maria de la Iglesia-Vaya
- CIBERSAM, ISCIII, Spanish National Network for Research in Mental Health, Madrid, Spain; Joint unit in Biomedical Imaging FISABIO-CIPF, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Spain
| | - Juan Nacher
- CIBERSAM, ISCIII, Spanish National Network for Research in Mental Health, Madrid, Spain; Fundación Investigación Hospital Clínico de Valencia, INCLIVA, Valencia, Spain; Neuroplasticity Unit, Institute of Biotechnology and Biomedicine, Universitat de València, Valencia, Spain
| | - Maria J Portella
- Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBERSAM, ISCIII, Spanish National Network for Research in Mental Health, Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Iluminada Corripio
- Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBERSAM, ISCIII, Spanish National Network for Research in Mental Health, Madrid, Spain; Psychiatry Department, Hospital Consortium of Vic, Barcelona, Spain; Institute of Health Research and Innovation at Central Catalonia (IRIS-CC). Central University of Catalonia (UVic-UCC), Barcelona, Spain
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Humpston CS, Woodward TS. Soundless voices, silenced selves: are auditory verbal hallucinations in schizophrenia truly perceptual? Lancet Psychiatry 2024; 11:658-664. [PMID: 38631367 DOI: 10.1016/s2215-0366(24)00061-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 04/19/2024]
Abstract
In much contemporary psychiatric training and practice, there is a strong emphasis on the audible or perceptual quality and externality of auditory verbal hallucinations in clinical assessments. A typical question during clinical assessment is asking whether the voices that a person hears sound identical to the way the clinician's voice is heard. In this Personal View, we argue that the most important factor in auditory verbal hallucinations in schizophrenia spectrum psychoses is a loss of first-person authority, and that a perceptual quality is not required for it to be this kind of hallucination. We draw on evidence from cognitive neuroscience showing that the activation of brain networks retrieved during capture of auditory verbal hallucinations that were experienced when a patient was in a functional MRI scanner does not match activation of networks retrieved during auditory perception. We propose that, despite early writings by Esquirol and Schneider that defined auditory verbal hallucinations as beliefs in perception rather than true perception, cognitive neuroscience, psychiatric training and practice, and patients adopting clinical vocabulary have been strongly influenced by the progression of the diagnostic criteria for schizophrenia, which increasingly place emphasis on language, such as the "full force" of a true perception. We hold that this change has resulted in an unhelpful top-down influence on the field, imposing perceptual qualities on auditory verbal hallucinations, and leading to misunderstandings and inaccuracies in clinical practice and patients' self-reports, and misinterpretations in cognitive neuroscience. We encourage a revision of the definition of auditory verbal hallucinations to move away from the necessity for auditory perception, and towards beliefs in perception due to the loss of first-person authority.
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Affiliation(s)
- Clara S Humpston
- Department of Psychology, University of York, York, UK; School of Psychology, University of Birmingham, Birmingham, UK.
| | - Todd S Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
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Chen G, Taylor PA, Reynolds RC, Leibenluft E, Pine DS, Brotman MA, Pagliaccio D, Haller SP. BOLD Response is more than just magnitude: Improving detection sensitivity through capturing hemodynamic profiles. Neuroimage 2023; 277:120224. [PMID: 37327955 PMCID: PMC10527035 DOI: 10.1016/j.neuroimage.2023.120224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/21/2023] [Accepted: 06/11/2023] [Indexed: 06/18/2023] Open
Abstract
Typical fMRI analyses often assume a canonical hemodynamic response function (HRF) that primarily focuses on the peak height of the overshoot, neglecting other morphological aspects. Consequently, reported analyses often reduce the overall response curve to a single scalar value. In this study, we take a data-driven approach to HRF estimation at the whole-brain voxel level, without assuming a response profile at the individual level. We then employ a roughness penalty at the population level to estimate the response curve, aiming to enhance predictive accuracy, inferential efficiency, and cross-study reproducibility. By examining a fast event-related FMRI dataset, we demonstrate the shortcomings and information loss associated with adopting the canonical approach. Furthermore, we address the following key questions: 1) To what extent does the HRF shape vary across different regions, conditions, and participant groups? 2) Does the data-driven approach improve detection sensitivity compared to the canonical approach? 3) Can analyzing the HRF shape help validate the presence of an effect in conjunction with statistical evidence? 4) Does analyzing the HRF shape offer evidence for whole-brain response during a simple task?
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Affiliation(s)
- Gang Chen
- Scientific and Statistical Computing Core, National Institute of Mental Health, USA.
| | - Paul A Taylor
- Scientific and Statistical Computing Core, National Institute of Mental Health, USA
| | - Richard C Reynolds
- Scientific and Statistical Computing Core, National Institute of Mental Health, USA
| | - Ellen Leibenluft
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, USA
| | - Daniel S Pine
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, USA
| | - Melissa A Brotman
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, USA
| | | | - Simone P Haller
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, USA
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Rossell S. Understanding and treating body dysmorphic disorder. Psychiatry Res 2023; 319:114980. [PMID: 36470162 DOI: 10.1016/j.psychres.2022.114980] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
Body dysmorphic disorder (BDD) is a mental disorder that involves a distressing preoccupation with a perceived defect in physical appearance, associated with excessive or repetitive behaviours or mental acts aimed at camouflaging, checking or 'improving' the perceived area of concern. BDD is relatively common, affecting at least 2% of the population world-wide, yet is poorly understood. Professor Susan Rossell has produced a substantial body of influential research, which has improved our understanding of BDD. This includes a more comprehensive understanding of the phenomenology, neurocognition and neurobiology, as well as significant treatment advances. This work will be reviewed in this commentary.
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Affiliation(s)
- Susan Rossell
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia.
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