Early-stage visual processing deficits in schizophrenia

Unveiling altered connectivity between cognitive networks and cerebellum in schizophrenia

Cognitive functioning is a crucial aspect in schizophrenia (SZ), and when altered it has devastating effects on patients' quality of life and treatment outcomes. Several studies suggested that they could result from altered communication between the cortex and cerebellum. However, the neural correlates underlying these impairments have not been identified. In this study, we investigated resting state functional connectivity (rsFC) in SZ patients, by considering the interactions between cortical networks supporting cognition and cerebellum. In addition, we investigated the relationship between SZ patients' rsFC and their symptoms. We used fMRI data from 74 SZ patients and 74 matched healthy controls (HC) downloaded from the publicly available database SchizConnect. We implemented a seed-based connectivity approach to identify altered functional connections between specific cortical networks and cerebellum. We considered ten commonly studied resting state networks, whose functioning encompasses specific cognitive functions, and the cerebellum, whose involvement in supporting cognition has been recently identified. We then explored the relationship between altered rsFC values and Positive and Negative Syndrome Scale (PANSS) scores. The SZ group showed increased connectivity values compared with HC group for cortical networks involved in attentive processes, which were also linked to PANSS items describing attention and language-related processing. We also showed decreased connectivity between cerebellar regions, and increased connectivity between them and attentive networks, suggesting the contribution of cerebellum to attentive and affective deficits. In conclusion, our findings highlighted the link between negative symptoms in SZ and altered connectivity within the cerebellum and between the same and cortical networks supporting cognition.

Visual contrast sensitivity in clinical high risk and first episode psychosis

BACKGROUND

Individuals at Clinical High Risk (CHR) for psychosis or in their First Episode (FE) of psychosis are in a pivotal time in adolescence or young adulthood when illness can greatly impact their functioning. Finding relevant biomarkers for psychosis in the early stages of illness can contribute to early diagnosis, therapeutic management and prediction of outcome. One such biomarker that has been studied in schizophrenia (SZ) is visual contrast sensitivity (VCS). VCS can be used to differentiate visual information processing function in the magnocellular versus parvocellular visual pathways. Few studies have assessed VCS in early psychosis.

METHODS

Participants included CHR (n = 68), FE psychosis (n = 34) and Healthy Comparison (HC) (n = 63). All were clinically assessed and completed a VCS paradigm that involved near threshold luminance and chromatic stimuli.

RESULTS

CHR and FE participants had lower VCS in the luminance condition (F[2166] = 3.42, p < 0.05) compared to HC. There was also a significant sex X group interaction (F[5163] = 4.3, p < 0.001) in the luminance condition (F[5163] = 4.3, p < 0.001) as FE males (p < 0.01) and CHR females (p < 0.01) had the greatest deficits compared to male and female HC participants respectively. VCS deficits in the luminance condition were associated with more thought disorder, slower processing speed, worse executive functioning and poor global functioning (r's 0.25-0.50, p < 0.05).

CONCLUSION

This study supports the hypothesis that there are deficits in visual information processing, particularly in tasks that emphasize the magnocellular pathway, in patients experiencing early psychosis. VCS therefore has the potential to be used as a biomarker in this population.

Static and Dynamic Dysconnectivity in Early Psychosis: Relationship With Symptom Dimensions

BACKGROUND AND HYPOTHESIS

Altered functional connectivity (FC) has been frequently reported in psychosis. Studying FC and its time-varying patterns in early-stage psychosis allows the investigation of the neural mechanisms of this disorder without the confounding effects of drug treatment or illness-related factors.

STUDY DESIGN

We employed resting-state functional magnetic resonance imaging (rs-fMRI) to explore FC in individuals with early psychosis (EP), who also underwent clinical and neuropsychological assessments. 96 EP and 56 demographically matched healthy controls (HC) from the Human Connectome Project for Early Psychosis database were included. Multivariate analyses using spatial group independent component analysis were used to compute static FC and dynamic functional network connectivity (dFNC). Partial correlations between FC measures and clinical and cognitive variables were performed to test brain-behavior associations.

STUDY RESULTS

Compared to HC, EP showed higher static FC in the striatum and temporal, frontal, and parietal cortex, as well as lower FC in the frontal, parietal, and occipital gyrus. We found a negative correlation in EP between cognitive function and FC in the right striatum FC (pFWE = 0.009). All dFNC parameters, including dynamism and fluidity measures, were altered in EP, and positive symptoms were negatively correlated with the meta-state changes and the total distance (pFWE = 0.040 and pFWE = 0.049).

CONCLUSIONS

Our findings support the view that psychosis is characterized from the early stages by complex alterations in intrinsic static and dynamic FC, that may ultimately result in positive symptoms and cognitive deficits.

The Relationship between Clinical and Psychophysical Assessments of Visual Perceptual Disturbances in Individuals at Clinical High Risk for Psychosis: A Preliminary Study

This study investigated relations between a measure of early-stage visual function and self-reported visual anomalies in individuals at clinical high risk for psychosis (CHR-P). Eleven individuals at CHR identified via the Structured Interview for Psychosis-Risk Syndromes (SIPS) were recruited from a CHR-P research program in NYC. The sample was ~36% female, ranging from 16 to 33 years old (M = 23.90, SD = 6.14). Participants completed a contrast sensitivity task on an iPad with five spatial frequencies (0.41-13 cycles/degree) and completed the self-report Audio-Visual Abnormalities Questionnaire. Higher contrast sensitivity (better performance) to low spatial frequencies was associated with higher perceptual (r = 0.616, p = 0.044) and visual disturbances (r = 0.667, p = 0.025); lower contrast sensitivity to a middle spatial frequency was also associated with higher perceptual (r = -0.604, p = 0.049) and visual disturbances (r = -0.606, p = 0.048). This relation between the questionnaire and contrast sensitivity to low spatial frequency may be indicative of a reduction in lateral inhibition and "flooding" of environmental stimuli. The association with middle spatial frequencies, which play a critical role in face processing, may result in a range of perceptual abnormalities. These findings demonstrate that self-reported perceptual anomalies occur in these individuals and are linked to performance on a measure of early visual processing.

Structure-function coupling in macroscale human brain networks

Precisely how the anatomical structure of the brain gives rise to a repertoire of complex functions remains incompletely understood. A promising manifestation of this mapping from structure to function is the dependency of the functional activity of a brain region on the underlying white matter architecture. Here, we review the literature examining the macroscale coupling between structural and functional connectivity, and we establish how this structure-function coupling (SFC) can provide more information about the underlying workings of the brain than either feature alone. We begin by defining SFC and describing the computational methods used to quantify it. We then review empirical studies that examine the heterogeneous expression of SFC across different brain regions, among individuals, in the context of the cognitive task being performed, and over time, as well as its role in fostering flexible cognition. Last, we investigate how the coupling between structure and function is affected in neurological and psychiatric conditions, and we report how aberrant SFC is associated with disease duration and disease-specific cognitive impairment. By elucidating how the dynamic relationship between the structure and function of the brain is altered in the presence of neurological and psychiatric conditions, we aim to not only further our understanding of their aetiology but also establish SFC as a new and sensitive marker of disease symptomatology and cognitive performance. Overall, this Review collates the current knowledge regarding the regional interdependency between the macroscale structure and function of the human brain in both neurotypical and neuroatypical individuals.

Brain-wide Anatomical Connectivity and Prediction of Longitudinal Outcomes in Antipsychotic-Naïve First Episode Psychosis

BACKGROUND

Disruptions of axonal connectivity are thought to be a core pathophysiological feature of psychotic illness, but whether they are present early in the illness, prior to antipsychotic exposure, and whether they can predict clinical outcome remains unknown.

METHODS

We acquired diffusion-weighted MRI to map structural connectivity between each pair of 319 parcellated brain regions in 61 antipsychotic-naive individuals with First Episode Psychosis (FEP; 15-25 years, 46% female) and a demographically matched sample of 27 control participants, along with clinical follow-up data in patients three months and 12 months after the scan. We used connectome-wide analyses to map disruptions of inter-regional pairwise connectivity and connectome-based predictive modelling to predict longitudinal change in symptoms and functioning.

RESULTS

Individuals with FEP showed disrupted connectivity in a brain-wide network linking all brain regions when compared with controls (pFWE=.03). Baseline structural connectivity significantly predicted change in functioning over 12 months (r=.44;pFWE=.041), such that lower connectivity within fronto-striato-thalamic systems predicted worse functional outcomes.

CONCLUSIONS

Brain-wide reductions of structural connectivity exist during the early stages of psychotic illness and cannot be attributed to antipsychotic medication. Moreover, baseline measures of structural connectivity can predict change in patient functional outcomes up to one year after engagement with treatment services.

Retinal Nerve Fiber Layer Thickness in Patients with Schizophrenia and Its Relation with Cognitive Impairment

Background

Schizophrenia is a chronic severe mental illness with heterogeneous clinical presentation, course, and outcome. Cognitive impairment is one of its core features. Retinal nerve fiber layer (RNFL) imaging using OCT (optical coherence tomography) could provide easy access for in vivo imaging of the retina, rendering it as a "window to the brain." Studies done on schizophrenia have shown RNFL thinning. This study attempts to look into the association between cognitive impairment, disease duration, and RNFL abnormality in patients with schizophrenia using OCT.

Methods

Patients diagnosed with schizophrenia meeting DSM 5 (Diagnostic and Statistical Manual of Mental Disorders) criteria and who were confirmed to be in remission for at least six months clinically and scoring less than three on PANSS-8 (positive and negative symptom scale-8) remission scale were included. They were administered the Montreal Cognitive Assessment Scale (MoCA) for cognitive assessment. RNFL measures were taken using spectral domain-OCT. Variables were compared using Pearson's correlation test, one-way ANOVA test, and independent t-test as appropriate.

Results

A total of 36 patients were studied. MoCA scores and RNFL thickness showed a positive correlation. Patients with schizophrenia had reduced average RNFL thickness and reduced RNFL thickness in superior, inferior, and temporal quadrants. Average RNFL thickness, Superior and inferior quadrant RNFL thickness showed a positive correlation with MoCA scores. No correlation was obtained between macular volume, macular thickness, duration of illness, and MoCA scores.

Conclusion

Patients with schizophrenia have reduced average RNFL thickness. Patients with low MoCA scores have RNFL thinning.

Eye Movement Characteristics for Predicting a Transition to Psychosis: Longitudinal Changes and Implications

BACKGROUND AND HYPOTHESIS

Substantive inquiry into the predictive power of eye movement (EM) features for clinical high-risk (CHR) conversion and their longitudinal trajectories is currently sparse. This study aimed to investigate the efficiency of machine learning predictive models relying on EM indices and examine the longitudinal alterations of these indices across the temporal continuum.

STUDY DESIGN

EM assessments (fixation stability, free-viewing, and smooth pursuit tasks) were performed on 140 CHR and 98 healthy control participants at baseline, followed by a 1-year longitudinal observational study. We adopted Cox regression analysis and constructed random forest prediction models. We also employed linear mixed-effects models (LMMs) to analyze longitudinal changes of indices while stratifying by group and time.

STUDY RESULTS

Of the 123 CHR participants who underwent a 1-year clinical follow-up, 25 progressed to full-blown psychosis, while 98 remained non-converters. Compared with the non-converters, the converters exhibited prolonged fixation durations, decreased saccade amplitudes during the free-viewing task; larger saccades, and reduced velocity gain during the smooth pursuit task. Furthermore, based on 4 baseline EM measures, a random forest model classified converters and non-converters with an accuracy of 0.776 (95% CI: 0.633, 0.882). Finally, LMMs demonstrated no significant longitudinal alterations in the aforementioned indices among converters after 1 year.

CONCLUSIONS

Aberrant EMs may precede psychosis onset and remain stable after 1 year, and applying eye-tracking technology combined with a modeling approach could potentially aid in predicting CHRs evolution into overt psychosis.

Chromatic fusion: Generative multimodal neuroimaging data fusion provides multi-informed insights into schizophrenia

This work proposes a novel generative multimodal approach to jointly analyze multimodal data while linking the multimodal information to colors. We apply our proposed framework, which disentangles multimodal data into private and shared sets of features from pairs of structural (sMRI), functional (sFNC and ICA), and diffusion MRI data (FA maps). With our approach, we find that heterogeneity in schizophrenia is potentially a function of modality pairs. Results show (1) schizophrenia is highly multimodal and includes changes in specific networks, (2) non-linear relationships with schizophrenia are observed when interpolating among shared latent dimensions, and (3) we observe a decrease in the modularity of functional connectivity and decreased visual-sensorimotor connectivity for schizophrenia patients for the FA-sFNC and sMRI-sFNC modality pairs, respectively. Additionally, our results generally indicate decreased fractional corpus callosum anisotropy, and decreased spatial ICA map and voxel-based morphometry strength in the superior frontal lobe as found in the FA-sFNC, sMRI-FA, and sMRI-ICA modality pair clusters. In sum, we introduce a powerful new multimodal neuroimaging framework designed to provide a rich and intuitive understanding of the data which we hope challenges the reader to think differently about how modalities interact.

Chromatic fusion: generative multimodal neuroimaging data fusion provides multi-informed insights into schizophrenia

This work proposes a novel generative multimodal approach to jointly analyze multimodal data while linking the multimodal information to colors. By linking colors to private and shared information from modalities, we introduce chromatic fusion, a framework that allows for intuitively interpreting multimodal data. We test our framework on structural, functional, and diffusion modality pairs. In this framework, we use a multimodal variational autoencoder to learn separate latent subspaces; a private space for each modality, and a shared space between both modalities. These subspaces are then used to cluster subjects, and colored based on their distance from the variational prior, to obtain meta-chromatic patterns (MCPs). Each subspace corresponds to a different color, red is the private space of the first modality, green is the shared space, and blue is the private space of the second modality. We further analyze the most schizophrenia-enriched MCPs for each modality pair and find that distinct schizophrenia subgroups are captured by schizophrenia-enriched MCPs for different modality pairs, emphasizing schizophrenia's heterogeneity. For the FA-sFNC, sMRI-ICA, and sMRI-ICA MCPs, we generally find decreased fractional corpus callosum anisotropy and decreased spatial ICA map and voxel-based morphometry strength in the superior frontal lobe for schizophrenia patients. To additionally highlight the importance of the shared space between modalities, we perform a robustness analysis of the latent dimensions in the shared space across folds. These robust latent dimensions are subsequently correlated with schizophrenia to reveal that for each modality pair, multiple shared latent dimensions strongly correlate with schizophrenia. In particular, for FA-sFNC and sMRI-sFNC shared latent dimensions, we respectively observe a reduction in the modularity of the functional connectivity and a decrease in visual-sensorimotor connectivity for schizophrenia patients. The reduction in modularity couples with increased fractional anisotropy in the left part of the cerebellum dorsally. The reduction in the visual-sensorimotor connectivity couples with a reduction in the voxel-based morphometry generally but increased dorsal cerebellum voxel-based morphometry. Since the modalities are trained jointly, we can also use the shared space to try and reconstruct one modality from the other. We show that cross-reconstruction is possible with our network and is generally much better than depending on the variational prior. In sum, we introduce a powerful new multimodal neuroimaging framework designed to provide a rich and intuitive understanding of the data that we hope challenges the reader to think differently about how modalities interact.

Neuronal dysfunction in individuals at early stage of schizophrenia, A resting-state fMRI study

Schizophrenia has been associated with abnormal intrinsic brain activity, involving various cognitive impairments. Qualitatively similar abnormalities are seen in individuals at ultra-high risk (UHR) for psychosis. In this study, resting-state fMRI (rs-fMRI) data were collected from 44 drug-naïve first-episode schizophrenia (Dn-FES) patients, 48 UHR individuals, and 40 healthy controls (HCs). The fractional amplitude of low-frequency fluctuations (fALFF), regional homogeneity (ReHo), and functional connectivity (FC), were performed to evaluate resting brain function. A support vector machine (SVM) was applied for classification analysis. Compared to HCs, both clinical groups showed increased fALFF in the central executive network (CEN), decreased ReHo in the ventral visual pathway (VVP) and decreased FC in temporal-sensorimotor regions. Excellent performance was achieved by using fALFF value in distinguishing both FES (sensitivity=83.21%, specificity=80.58%, accuracy=81.37%, p=0.009) and UHR (sensitivity=75.88%, specificity=85.72%, accuracy=80.72%, p<0.001) from HC group. Moreover, the study highlighted the importance of frontal and temporal alteration in the pathogenesis of schizophrenia. However, no fMRI features were observed that could well distinguish Dn-FES from UHR group. To conclude, fALFF in the CEN may provide potential power for identifying individuals at the early stage of schizophrenia and the alteration in the frontal and temporal lobe may be important to these individuals.

Altered brain connectivity during visual stimulation in schizophrenia

Schizophrenia (SCZ) can be described as a functional dysconnectivity syndrome that affects brain connectivity and circuitry. However, little is known about how sensory stimulation modulates network parameters in schizophrenia, such as their small-worldness (SW) during visual processing. To address this question, we applied graph theory algorithms to multi-electrode EEG recordings obtained during visual stimulation with a checkerboard pattern-reversal stimulus. Twenty-six volunteers participated in the study, 13 diagnosed with schizophrenia (SCZ; mean age = 38.3 years; SD = 9.61 years) and 13 healthy controls (HC; mean age = 28.92 years; SD = 12.92 years). The visually evoked potential (VEP) showed a global amplitude decrease (p < 0.05) for SCZ patients as opposed to HC but no differences in latency (p > 0.05). As a signature of functional connectivity, graph measures were obtained from the Magnitude-Squared Coherence between signals from pairs of occipital electrodes, separately for the alpha (8-13 Hz) and low-gamma (36-55 Hz) bands. For the alpha band, there was a significant effect of the visual stimulus on all measures (p < 0.05) but no group interaction between SCZ and HZ (p > 0.05). For the low-gamma spectrum, both groups showed a decrease of Characteristic Path Length (L) during visual stimulation (p < 0.05), but, contrary to the HC group, only SCZ significantly lowered their small-world (SW) connectivity index during visual stimulation (SCZ p < 0.05; HC p > 0.05). This indicates dysconnectivity of the functional network in the low-gamma band of SCZ during stimulation, which might indirectly reflect an altered ability to react to new sensory input in patients. These results provide novel evidence about a possible electrophysiological signature of the global deficits revealed by the application of graph theory onto electroencephalography in schizophrenia.

Computational modeling of excitatory/inhibitory balance impairments in schizophrenia

Deficits in glutamatergic function are well established in schizophrenia (SZ) as reflected in "input" dysfunction across sensory systems. By contrast, less is known about contributions of the GABAergic system to impairments in excitatory/inhibitory balance. We investigated this issue by measuring contrast thresholds for orientation detection, orientation discriminability, and orientation-tilt-aftereffect curves in schizophrenia subjects and matched controls. These measures depend on the amplitude and width of underlying orientation tuning curves, which, in turn, depend on excitatory and inhibitory interactions. By simulating a well-established V1 orientation selectivity model and its link to perception, we demonstrate that reduced cortical excitation and inhibition are both necessary to explain our psychophysical data. Reductions in GABAergic feedback may represent a compensatory response to impaired glutamatergic input in SZ, or a separate pathophysiological event. We also found evidence for the widely accepted, but rarely tested, inverse relationship between orientation discriminability and tuning width.

Perceptual pathways to hallucinogenesis

Recent advances in computational psychiatry have provided unique insights into the neural and cognitive underpinnings of psychotic symptoms. In particular, a host of new data has demonstrated the utility of computational frameworks for understanding how hallucinations might arise from alterations in typical perceptual processing. Of particular promise are models based in Bayesian inference that link hallucinatory perceptual experiences to latent states that may drive them. In this piece, we move beyond these findings to ask: how and why do these latent states arise, and how might we take advantage of heterogeneity in that process to develop precision approaches to the treatment of hallucinations? We leverage specific models of Bayesian inference to discuss components that might lead to the development of hallucinations. Using the unifying power of our model, we attempt to place disparate findings in the study of psychotic symptoms within a common framework. Finally, we suggest directions for future elaboration of these models in the service of a more refined psychiatric nosology based on predictable, testable, and ultimately treatable information processing derangements.

Building Models of Functional Interactions Among Brain Domains that Encode Varying Information Complexity: A Schizophrenia Case Study

Revealing associations among various structural and functional patterns of the brain can yield highly informative results about the healthy and disordered brain. Studies using neuroimaging data have more recently begun to utilize the information within as well as across various functional and anatomical domains (i.e., groups of brain networks). However, most whole-brain approaches assume similar complexity of interactions throughout the brain. Here we investigate the hypothesis that interactions between brain networks capture varying amounts of complexity, and that we can better capture this information by varying the complexity of the model subspace structure based on available training data. To do this, we employ a Bayesian optimization-based framework known as the Tree Parzen Estimator (TPE) to identify, exploit and analyze patterns of variation in the information encoded by temporal information extracted from functional magnetic resonance imaging (fMRI) subdomains of the brain. Using a repeated cross-validation procedure on a schizophrenia classification task, we demonstrate evidence that interactions between specific functional subdomains are better characterized by more sophisticated model architectures compared to less complicated ones required by the others for optimally contributing towards classification and understanding the brain's functional interactions. We show that functional subdomains known to be involved in schizophrenia require more complex architectures to optimally unravel discriminatory information about the disorder. Our study points to the need for adaptive, hierarchical learning frameworks that cater differently to the features from different subdomains, not only for a better prediction but also for enabling the identification of features predicting the outcome of interest.

Visual Evoked Potential Abnormalities in Phelan-McDermid Syndrome

OBJECTIVE

The current study used visual evoked potentials (VEPs) to examine excitatory and inhibitory postsynaptic activity in children with Phelan-McDermid syndrome (PMS) and the association with genetic factors. PMS is caused by haploinsufficiency of SHANK3 on chromosome 22 and represents a common single-gene cause of autism spectrum disorder (ASD) and intellectual disability.

METHOD

Transient VEPs were obtained from 175 children, including 31 with PMS, 79 with idiopathic ASD, 45 typically developing controls, and 20 unaffected siblings of children with PMS. Stimuli included standard and short-duration contrast-reversing checkerboard conditions, and the reliability between these 2 conditions was assessed. Test-retest reliability and correlations with deletion size were explored in the group with PMS.

RESULTS

Children with PMS and, to a lesser extent, those with idiopathic ASD displayed significantly smaller amplitudes and decreased beta and gamma band activity relative to TD controls and PMS siblings. Across groups, high intraclass correlation coefficients were obtained between standard and short-duration conditions. In children with PMS, test-retest reliability was strong. Deletion size was significantly correlated with P₆₀-N₇₅ amplitude for both conditions.

CONCLUSION

Children with PMS displayed distinct transient VEP waveform abnormalities in both time and frequency domains that might reflect underlying glutamatergic deficits that were associated with deletion size. A similar response pattern was observed in a subset of children with idiopathic ASD. VEPs offer a noninvasive measure of excitatory and inhibitory neurotransmission that holds promise for stratification and surrogate endpoints in ongoing clinical trials in PMS and ASD.

Altered Resting State Functional Connectivity and Its Correlation with Cognitive Functions at Ultra High Risk for Psychosis

The aim of this study is to identify robust resting state-functional connectivity (rs-FC) alterations and their correlations with the neuropsychological characteristics of Ultra-High Risk (UHR) for psychosis subjects compared to healthy controls (HCs). Twenty individuals with UHR and sixteen HCs underwent resting-state functional magnetic resonance imaging (rs-fMRI) and a cognitive battery evaluating attention, episodic memory and executive functions. Compared to HCs, UHR individuals showed working memory and set-shifting impairments. In functional connectivity (FC) analyses, the Default Mode Network (DMN) of the UHR subjects displayed increased FC with the visual areas and decreased FC with the Dorsal Attention Network (DAN). Additionally, the salience network (SN) of the UHR subjects displayed increased connectivity with wide posterior cortical areas in the temporal, parietal and occipital lobes, corresponding to posterior nodes of the SN itself, the Somato-Motor Network (SMN) and the DAN. The SN connectivity with the left SMN and DAN was positively correlated with the Trail Making Test - B scores of the UHR subjects. These findings show that the SN and DMN, which mostly show abnormal connectivity patterns in psychosis, are also affected in UHR subjects, while the SN plays a more central role with its hyperconnectivity to the DAN and SMN.

Early visual processing and adaptation as markers of disease, not vulnerability: EEG evidence from 22q11.2 deletion syndrome, a population at high risk for schizophrenia

We investigated visual processing and adaptation in 22q11.2 deletion syndrome (22q11.2DS), a condition characterized by an increased risk for schizophrenia. Visual processing differences have been described in schizophrenia but remain understudied early in the disease course. Electrophysiology was recorded during a visual adaptation task with different interstimulus intervals to investigate visual processing and adaptation in 22q11.2DS (with (22q+) and without (22q−) psychotic symptoms), compared to control and idiopathic schizophrenia groups. Analyses focused on early windows of visual processing. While increased amplitudes were observed in 22q11.2DS in an earlier time window (90–140 ms), decreased responses were seen later (165–205 ms) in schizophrenia and 22q+. 22q11.2DS, and particularly 22q−, presented increased adaptation effects. We argue that while amplitude and adaptation in the earlier time window may reflect specific neurogenetic aspects associated with a deletion in chromosome 22, amplitude in the later window may be a marker of the presence of psychosis and/or of its chronicity/severity.

Cytoarchitectonic Maps of the Human Metathalamus in 3D Space

The human metathalamus plays an important role in processing visual and auditory information. Understanding its layers and subdivisions is important to gain insights in its function as a subcortical relay station and involvement in various pathologies. Yet, detailed histological references of the microanatomy in 3D space are still missing. We therefore aim at providing cytoarchitectonic maps of the medial geniculate body (MGB) and its subdivisions in the BigBrain – a high-resolution 3D-reconstructed histological model of the human brain, as well as probabilistic cytoarchitectonic maps of the MGB and lateral geniculate body (LGB). Therefore, histological sections of ten postmortem brains were studied. Three MGB subdivisions (MGBv, MGBd, MGBm) were identified on every 5th BigBrain section, and a deep-learning based tool was applied to map them on every remaining section. The maps were 3D-reconstructed to show the shape and extent of the MGB and its subdivisions with cellular precision. The LGB and MGB were additionally identified in nine other postmortem brains. Probabilistic cytoarchitectonic maps in the MNI “Colin27” and MNI ICBM152 reference spaces were computed which reveal an overall low interindividual variability in topography and extent. The probabilistic maps were included into the Julich-Brain atlas, and are freely available. They can be linked to other 3D data of human brain organization and serve as an anatomical reference for diagnostic, prognostic and therapeutic neuroimaging studies of healthy brains and patients. Furthermore, the high-resolution MGB BigBrain maps provide a basis for data integration, brain modeling and simulation to bridge the larger scale involvement of thalamocortical and local subcortical circuits.

A Real-World Observation of Antipsychotic Effects on Brain Volumes and Intrinsic Brain Activity in Schizophrenia

Background

The confounding effects of antipsychotics that led to the inconsistencies of neuroimaging findings have long been the barriers to understanding the pathophysiology of schizophrenia (SZ). Although it is widely accepted that antipsychotics can alleviate psychotic symptoms during the early most acute phase, the longer-term effects of antipsychotics on the brain have been unclear. This study aims to look at the susceptibility of different imaging measures to longer-term medicated status through real-world observation.

Methods

We compared gray matter volume (GMV) with amplitude of low-frequency fluctuations (ALFFs) in 89 medicated-schizophrenia (med-SZ), 81 unmedicated-schizophrenia (unmed-SZ), and 235 healthy controls (HC), and the differences were explored for relationships between imaging modalities and clinical variables. We also analyzed age-related effects on GMV and ALFF values in the two patient groups (med-SZ and unmed-SZ).

Results

Med-SZ demonstrated less GMV in the prefrontal cortex, temporal lobe, cingulate gyri, and left insula than unmed-SZ and HC (p &lt; 0.05, family-wise error corrected). Additionally, GMV loss correlated with psychiatric symptom relief in all SZ. However, medicated status did not influence ALFF values: all SZ showed increased ALFF in the anterior cerebrum and decreased ALFF in posterior visual cortices compared with HC (p &lt; 0.05, family-wise error corrected). Age-related GMV effects were seen in all regions, which showed group-level differences except fusiform gyrus. No significant correlation was found between ALFF values and psychiatric symptoms.

Conclusion

GMV loss appeared to be pronounced to longer-term antipsychotics, whereby imbalanced alterations in regional low-frequency fluctuations persisted unaffected by antipsychotic treatment. Our findings may help to understand the disease course of SZ and potentially identify a reliable neuroimaging feature for diagnosis.

Cognitive function mediates the relationship between visual contrast sensitivity and functional outcome in schizophrenia

BACKGROUND

Individuals with schizophrenia exhibit deficits in visual contrast processing, though less is known about how these deficits impact neurocognition and functional outcomes. This study investigated effects of contrast sensitivity (CS) on cognition and capacity for independent living in schizophrenia.

METHODS

Participants were 58 patients with schizophrenia (n = 49) and schizoaffective disorder (n = 9). Patients completed a psychophysical paradigm to obtain CS with stimuli consisting of grating patterns of low (0.5 and 1 cycles/degree) and high spatial frequencies (4, 7, 21 cycles/degree). Patients completed the MATRICS Consensus Cognitive Battery and Wechsler Adult Intelligence Scales, Third Edition to assess cognition, and the problem-solving factor of the Independent Living Scales to assess functional capacity. We computed bivariate correlation coefficients for all pairs of variables and tested mediation models with CS to low (CS-LSF) and high spatial frequencies (CS-HSF) as predictors, cognitive measures as mediators, and capacity for independent living as an outcome.

RESULTS

Cognition mediated the relationship between CS and independent living with CS-LSF a stronger predictor than CS-HSF. Mediation effects were strongest for perceptual organization and memory-related domains. In an expanded moderated mediation model, CS-HSF was found to be a significant predictor of independent living through perceptual organization as a mediator and CS-LSF as a moderator of this relationship.

CONCLUSION

CS relates to functional capacity in schizophrenia through neurocognition. These relationships may inform novel visual remediation interventions.

Atypically larger variability of resource allocation accounts for visual working memory deficits in schizophrenia

Working memory (WM) deficits have been widely documented in schizophrenia (SZ), and almost all existing studies attributed the deficits to decreased capacity as compared to healthy control (HC) subjects. Recent developments in WM research suggest that other components, such as precision, also mediate behavioral performance. It remains unclear how different WM components jointly contribute to deficits in schizophrenia. We measured the performance of 60 SZ (31 females) and 61 HC (29 females) in a classical delay-estimation visual working memory (VWM) task and evaluated several influential computational models proposed in basic science of VWM to disentangle the effect of various memory components. We show that the model assuming variable precision (VP) across items and trials is the best model to explain the performance of both groups. According to the VP model, SZ exhibited abnormally larger variability of allocating memory resources rather than resources or capacity per se. Finally, individual differences in the resource allocation variability predicted variation of symptom severity in SZ, highlighting its functional relevance to schizophrenic pathology. This finding was further verified using distinct visual features and subject cohorts. These results provide an alternative view instead of the widely accepted decreased-capacity theory and highlight the key role of elevated resource allocation variability in generating atypical VWM behavior in schizophrenia. Our findings also shed new light on the utility of Bayesian observer models to characterize mechanisms of mental deficits in clinical neuroscience.

Working memory is a core cognitive function related to a broad range of cognitive domains such as problem-solving, attention, executive control, and IQ. Although working memory deficits have been well-documented in schizophrenia, the underlying mechanisms remain unclear. Conventional working memory theories attribute working memory deficits in schizophrenia to their reduced memory capacity, overlooking the potential roles of other memory components, such as precision. In this study, we take the approach of computational psychiatry and use computational modeling to uncover the major determinants of working memory deficits. We assess working memory performance of a large cohort of participants (60 schizophrenia patients and 61 demographic matched healthy controls) and evaluate multiple mainstream computational models of visual working memory. The variable precision model turns out to be the best model for both groups. We further find that the poorer performance of schizophrenia patients arises from heterogeneous distribution of memory resources when encoding items in memory. This resource allocation variability can also predict symptom severity in schizophrenia. Our study highlights the use of computational models in psychiatric researches.

A systematic review of the neural correlates of multisensory integration in schizophrenia

Multisensory integration (MSI), in which sensory signals from different modalities are unified, is necessary for our comprehensive perception of and effective adaptation to the objects and events around us. However, individuals with schizophrenia suffer from impairments in MSI, which could explain typical symptoms like hallucination and reality distortion. Because the neural correlates of aberrant MSI in schizophrenia help us understand the physiognomy of this psychiatric disorder, we performed a systematic review of the current research on this subject. The literature search concerned investigated MSI in diagnosed schizophrenia patients compared to healthy controls using brain imaging. Seventeen of 317 identified studies were finally included. To assess risk of bias, the Newcastle-Ottawa quality assessment was used, and the review was written according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The results indicated that multisensory processes in schizophrenia are associated with aberrant, mainly reduced, neural activity in several brain regions, as measured by event-related potentials, oscillations, activity and connectivity. The conclusion is that a fronto-temporal region, comprising the frontal inferior gyrus, middle temporal gyrus and superior temporal gyrus/sulcus, along with the fusiform gyrus and dorsal visual stream in the occipital-parietal lobe are possible key regions of deficient MSI in schizophrenia.

Modular-level alterations of single-subject gray matter networks in schizophrenia

Schizophrenia is often regarded as a psychiatric disorder caused by disrupted connections in the brain. Evidence suggests that the gray matter of schizophrenia patients is damaged in a modular pattern. Recently, abnormal topological organization was observed in the gray matter networks of patients with schizophrenia. However, the modular-level alteration of gray matter networks in schizophrenia remains unclear. In this study, single-subject gray matter networks were constructed for a total of 217 subjects (116 patients with schizophrenia and 101 controls). We analyzed the topological characteristics of the brain network and the strengths of connections between and within modules. Compared with the outcomes in the control group, the global efficiency and participation coefficient values of the single-subject gray matter networks in schizophrenic patients were significantly reduced. The nodal participation coefficient of the regions involving the frontoparietal attention network, default mode network and subcortical network were significantly decreased in subjects with schizophrenia. The intermodule connections between the frontoparietal attention network and visual network and between the default mode network and subcortical network, in the frontoparietal attention network were significantly reduced in the patient group. In the frontoparietal attention network, the intramodule nodal connection strength of the left orbital inferior frontal gyrus and right inferior parietal gyrus was significantly decreased in schizophrenia patients. Reduced intermodule nodal connection strength between the frontoparietal attention network and visual network was associated with the severity of schizophrenia symptoms. These findings suggest that abnormal intramodule and intermodule connections in the structural brain network may a biomarker of schizophrenia symptoms.

Hypothesis of subcortical visual pathway impairment in schizophrenia

Schizophrenia is a severe mental disease involving both neurological and psychiatric abnormalities. Previous studies mainly focus on damage to high-order cognitive dysfunction, which is related to high-level cortical regions such as the prefrontal and temporal lobes. Recent research reveals that impairment of low-level sensory processing occurs in the early stage of schizophrenia, which may be due to impairment of the subcortical magnocellular visual pathway. Moreover, the structure and function of some important nuclei in a subcortical visual pathway are reported to be abnormal in patients with schizophrenia. Inspired by the above evidence, we propose a hypothesis that impairment of the Superior Colliculus-Pulvinar-Amygdala subcortical visual pathway may be involved in the pathological mechanisms of early stages of schizophrenia. And we propose a possible method to detect dysfunction of this subcortical pathway through examining topological processing, which may help early diagnosis of schizophrenia.

Neural mechanisms of psychosis vulnerability and perceptual abnormalities in the ALS-FTD spectrum

OBJECTIVE

The aims of this study were to (i) explore psychotic experiences across the entire amyotrophic lateral sclerosis-frontotemporal dementia (ALS-FTD) spectrum from a clinical and genetic perspective, (ii) determine the rate of abnormal perceptual experiences across the five sensory modalities and (iii) explore the neurobiological factors that lead to psychosis vulnerability in ALS-FTD.

METHODS

In a prospective case-controlled study design, 100 participants were enrolled including ALS (n = 37, 24% satisfied criteria for ALS-Plus), ALS-FTD (n = 11), bvFTD (n = 27) and healthy controls (n = 25). Psychotic experiences, perceptual abnormalities and psychosocial factors were determined by means of the clinical interview and carer and patient reports. Voxel-based morphometry analyses determined atrophy patterns in patients experiencing psychosis-like experiences and other perceptual abnormalities.

RESULTS

The rates of psychotic experiences and abnormalities of perception in each sensory modality were high across the entire ALS-FTD continuum. The rate was highest in those with C9orf72 expansions. Rates were also high in patients with pure ALS including psychosis measured by carer-based reports (18%) and self-report measures of psychotic-like experiences (21%). In an ENTER regression model, social anxiety and ACE-III scores were the best predictors of psychosis proneness, accounting for 44% of the score variance. Psychosis-like experiences and perceptual abnormalities were associated with a predominantly frontal and temporal pattern of atrophy that extended to the cerebellum and centred on the anterior thalamus.

INTERPRETATION

The model for psychosis proneness in ALS-FTD likely includes complex interactions between cognitive, social and neurobiological factors that determine vulnerability to psychosis and that may have relevance for individualised patient management.

Contrast Sensitivity on 1/f Noise Is More Greatly Impacted by Older Age for the Fovea Than Parafovea

SIGNIFICANCE

Contrast sensitivity changes across the visual field with age and is often measured clinically with various forms of perimetry on plain backgrounds. In daily life, the visual scene is more complicated, and therefore, the standard clinical measures of contrast sensitivity may not predict a patient's visual experience in more natural environments.

PURPOSE

This study aims to determine whether contrast thresholds in older adults are different from younger adults when measured on a 1/f noise background (a nonuniform background whose spatial frequency content is similar to those present in the natural vision environments).

METHODS

Twenty younger (age range, 20 to 35 years) and 20 older adults (age range, 61 to 79 years) with normal ocular health were recruited. Contrast thresholds were measured for a Gabor patch of 6 cycles per degree (sine wave grating masked by a Gaussian envelope of standard deviation 0.17°) presented on 1/f noise background (root-mean-square contrast, 0.05 and 0.20) that subtended 15° diameter of the central visual field. The stimulus was presented at four eccentricities (0°, 2°, 4°, and 6°) along the 45° meridian in the noise background, and nine contrast levels were tested at each eccentricity. The proportion of correct responses for detecting the target at each eccentricity was obtained, and psychometric functions were fit to estimate the contrast threshold.

RESULTS

Older adults demonstrate increased contrast thresholds compared with younger adults. There was an eccentricity-dependent interaction with age, with the difference between groups being highest in the fovea compared with other eccentricities. Performance was similar for the two noise backgrounds tested.

CONCLUSIONS

Our results revealed a strong eccentricity dependence in performance between older and younger adults, highlighting age-related differences in the contrast detection mechanisms between fovea and parafovea for stimuli presented on nonuniform backgrounds.

Body-environment integration: Temporal processing of tactile and auditory inputs along the schizophrenia continuum

According to the dimensional approach to psychosis, there is a continuum from low schizotypy to schizophrenia patients. The temporal aspect of sensory processing seems to be compromised across such continuum, as suggested by different studies separately investigating unisensory or multisensory domains. Most of these studies have so far focused primarily on the temporal processing of visual and auditory stimuli, either in schizotypy or schizophrenia, while leaving the tactile domain and the integration of touch with other senses mostly unexplored. Given the relevance of body-related perceptual abnormalities for psychosis proneness, we aimed at filling this gap in the literature across two studies. We asked participants with increasing levels of schizotypy (study 1) and schizophrenia patients (study 2) to perform three simultaneity judgement tasks: a unimodal tactile task, a unimodal auditory task and a bimodal audio-tactile task. Each task allowed estimating a simultaneity range (SR), as a proxy of the individual tolerance to asynchronies in the tactile, auditory and audio-tactile domains, respectively. Results showed larger SRs as the level of schizotypy increases. Specifically, the linear effect of schizotypy levels on the audio-tactile task was stronger than on the auditory task, which in turn was greater than the effect on the tactile task (study 1). Differently, schizophrenia patients showed larger SRs than controls in all the three tasks (study 2). The current study is the first empirical investigation across the continuum from low schizotypy to schizophrenia of the tolerance to asynchronies in the processing of external (auditory) and body-related (tactile) inputs.

Hallucinations on demand: the utility of experimentally induced phenomena in hallucination research

Despite the desire to delve deeper into hallucinations of all types, methodological obstacles have frustrated development of more rigorous quantitative experimental techniques, thereby hampering research progress. Here, we discuss these obstacles and, with reference to visual phenomena, argue that experimentally induced phenomena (e.g. hallucinations induced by flickering light and classical conditioning) can bring hallucinations within reach of more objective behavioural and neural measurement. Expanding the scope of hallucination research raises questions about which phenomena qualify as hallucinations, and how to identify phenomena suitable for use as laboratory models of hallucination. Due to the ambiguity inherent in current hallucination definitions, we suggest that the utility of phenomena for use as laboratory hallucination models should be represented on a continuous spectrum, where suitability varies with the degree to which external sensory information constrains conscious experience. We suggest that existing strategies that group pathological hallucinations into meaningful subtypes based on hallucination characteristics (including phenomenology, disorder and neural activity) can guide extrapolation from hallucination models to other hallucinatory phenomena. Using a spectrum of phenomena to guide scientific hallucination research should help unite the historically separate fields of psychophysics, cognitive neuroscience and clinical research to better understand and treat hallucinations, and inform models of consciousness. This article is part of the theme issue 'Offline perception: voluntary and spontaneous perceptual experiences without matching external stimulation'.

Heightened perception of illusory motion is associated with symptom severity in schizophrenia patients

Abnormal perceptual processing in schizophrenia may contribute to the development of positive symptoms such as hallucinations. Experimental findings suggest that such abnormalities result from impaired processing of local signals into complex cortical representations. Because complex processing is needed to generate the perception of illusory motion from local signals, deteriorated perception of illusory motion would be expected in schizophrenia. However, findings are mixed, and the relationship between complex motion processing and symptoms is unclear. Illusions with multiple flow components (e.g. rotation/expansion) are known to strongly engage specialized complex processing mechanisms that may be abnormal in schizophrenia, but have not yet been investigated. We used a recently constructed paradigm based on the Pinna-Brelstaff illusion to manipulate complex-flow illusory perception in a quantitative manner and probe associations with dimensional symptoms. In 102 patients and 90 controls, perceived speed and perceptual variability for the PBF were measured across a range of parameters. Meanwhile, eye movement was recorded and gaze parameters were analysed to examine effects on illusory perception. Our results showed that patients experienced faster illusory rotation than controls, while they made fewer eye fixations. This heightened illusory perception was significantly correlated with positive and general, but not negative, symptom scores. Our results indicate that unusual processing of complex-flow motion in patients may be specifically related to dimensional symptoms, which could provide a promising strategy for parsing heterogeneity in the schizophrenia syndrome. This further highlights the role of motion perception abnormalities in the pathophysiology of schizophrenia, thus encouraging future investigation into visual remediation therapeutics.

Multimodal Neuroimaging Study of Visual Plasticity in Schizophrenia

Schizophrenia is a severe mental illness with visual learning and memory deficits, and reduced long term potentiation (LTP) may underlie these impairments. Recent human fMRI and EEG studies have assessed visual plasticity that was induced with high frequency visual stimulation, which is thought to mimic an LTP-like phenomenon. This study investigated the differences in visual plasticity in participants with schizophrenia and healthy controls. An fMRI visual plasticity paradigm was implemented, and proton magnetic resonance spectroscopy data were acquired to determine whether baseline resting levels of glutamatergic and GABA metabolites were related to visual plasticity response. Adults with schizophrenia did not demonstrate visual plasticity after family-wise error correction; whereas, the healthy control group did. There was a significant regional difference in visual plasticity in the left visual cortical area V2 when assessing group differences, and baseline GABA levels were associated with this specific ROI in the SZ group only. Overall, this study suggests that visual plasticity is altered in schizophrenia and related to basal GABA levels.

A critical review of the cognitive and perceptual factors influencing attentional scaling and visual processing

An important mechanism used to selectively process relevant information in the environment is spatial attention. One fundamental way in which spatial attention is deployed is attentional scaling - the process of focusing attentional resources either narrowly or broadly across the visual field. Although early empirical work suggested that narrowing attention improves all aspects of visual processing, recent studies have demonstrated that narrowing attention can also have no effect or even a detrimental impact when it comes to vision that is thought to be mediated via the magnocellular pathway of the visual system. Here, for the first time, we synthesize empirical evidence measuring the behavioral effects of attentional scaling on tasks gauging the contribution of the major neural pathways of the visual system, with the purpose of determining the potential factors driving these contradictory empirical findings. This analysis revealed that attentional scaling could be best understood by considering the unique methodologies used in the research literature to date. The implications of this analysis for theoretical frameworks of attentional scaling are discussed, and methodological improvements for future research are proposed.

Abnormal visual representations associated with confusion of perceived facial expression in schizophrenia with social anxiety disorder

Deficits in social functioning are especially severe amongst schizophrenia individuals with the prevalent comorbidity of social anxiety disorder (SZ&SAD). Yet, the mechanisms underlying the recognition of facial expression of emotions-a hallmark of social cognition-are practically unexplored in SZ&SAD. Here, we aim to reveal the visual representations SZ&SAD (n = 16) and controls (n = 14) rely on for facial expression recognition. We ran a total of 30,000 trials of a facial expression categorization task with Bubbles, a data-driven technique. Results showed that SZ&SAD's ability to categorize facial expression was impared compared to controls. More severe negative symptoms (flat affect, apathy, reduced social drive) was associated with more impaired emotion recognition ability, and with more biases in attributing neutral affect to faces. Higher social anxiety symptoms, on the other hand, was found to enhance the reaction speed to neutral and angry faces. Most importantly, Bubbles showed that these abnormalities could be explained by inefficient visual representations of emotions: compared to controls, SZ&SAD subjects relied less on fine facial cues (high spatial frequencies) and more on coarse facial cues (low spatial frequencies). SZ&SAD participants also never relied on the eye regions (only on the mouth) to categorize facial expressions. We discuss how possible interactions between early (low sensitivity to coarse information) and late stages of the visual system (overreliance on these coarse features) might disrupt SZ&SAD's recognition of facial expressions. Our findings offer perceptual mechanisms through which comorbid SZ&SAD impairs crucial aspects of social cognition, as well as functional psychopathology.

The MIR137 VNTR rs58335419 Is Associated With Cognitive Impairment in Schizophrenia and Altered Cortical Morphology

Genome-wide association studies (GWAS) of schizophrenia have strongly implicated a risk locus in close proximity to the gene for miR-137. While there are candidate single-nucleotide polymorphisms (SNPs) with functional implications for the microRNA's expression encompassed by the common haplotype tagged by rs1625579, there are likely to be others, such as the variable number tandem repeat (VNTR) variant rs58335419, that have no proxy on the SNP genotyping platforms used in GWAS to date. Using whole-genome sequencing data from schizophrenia patients (n = 299) and healthy controls (n = 131), we observed that the MIR137 4-repeats VNTR (VNTR4) variant was enriched in a cognitive deficit subtype of schizophrenia and associated with altered brain morphology, including thicker left inferior temporal gyrus and deeper right postcentral sulcus. These findings suggest that the MIR137 VNTR4 may impact neuroanatomical development that may, in turn, influence the expression of more severe cognitive symptoms in patients with schizophrenia.

Early Visual Processing Is Associated With Social Cognitive Performance in Recent-Onset Schizophrenia

BACKGROUND

Early-stage visual processing deficits are evident in chronic schizophrenia. Consistent with a cascade model of information processing, whereby early perceptual processes have downstream effects on higher-order cognition, impaired visual processing is associated with deficits in social cognition in this clinical population. However, the nature of this relationship in the early phase of illness is unknown. Here, we present data from a study of early visual processing and social cognitive performance in recent-onset schizophrenia (ROSz).

METHOD

Thirty-two people with ROSz and 20 healthy controls (HC) completed a visual backward masking task using stimuli of real world objects (Object Masking) to assess early-stage (i.e., 0-125 ms post-stimulus onset) visual processing. Subjects also completed two tasks of social cognition, one assessing relatively low-level processes of emotion identification (Emotion Biological Motion, EmoBio), and another assessing more complex, higher-order theory of mind abilities (The Awareness of Social Inference Test, TASIT). Group differences were tested with repeated measures ANOVAs and t-tests. Bivariate correlations and linear regressions tested the strength of associations between early-stage visual processing and social cognitive performance in ROSz.

RESULTS

For Object Masking, the mask interfered with object identification over a longer interval for ROSz than for HC [F (3.19, 159.35) = 8.51, p < 0.001]. ROSz were less accurate on the EmoBio task [t (50) = -3.36, p = 0.001] and on the TASIT compared to HC [F (1, 50) = 38.37, p < 0.001]. For the TASIT ROSz were disproportionately impaired on items assessing sarcasm detection [F (1, 50) = 4.30, p = 0.04]. In ROSz, better Object Masking performance was associated with better social cognitive performance [r EmoBio = 0.45, p < 0.01; r TASIT = 0.41, p < 0.02]. Regression analyses did not provide significant support for low-level social cognition mediating the relationship between visual processing and high-level social cognition.

CONCLUSION

Early-stage visual processing, low-level social cognition, and high-level social cognition were all significantly impaired in ROSz. Early-stage visual processing was associated with performance on the social cognitive tasks in ROSz, consistent with a cascade model of information processing. However, significant cascading effects within social cognition were not supported. These data suggest that interventions directed at early visual processing may yield downstream effects on social cognitive processes.

Atypical response inhibition and error processing in 22q11.2 Deletion Syndrome and schizophrenia: Towards neuromarkers of disease progression and risk

22q11.2 deletion syndrome (also known as DiGeorge syndrome or velo-cardio-facial syndrome) is characterized by increased vulnerability to neuropsychiatric symptoms, with approximately 30% of individuals with the deletion going on to develop schizophrenia. Clinically, deficits in executive function have been noted in this population, but the underlying neural processes are not well understood. Using a Go/No-Go response inhibition task in conjunction with high-density electrophysiological recordings (EEG), we sought to investigate the behavioral and neural dynamics of inhibition of a prepotent response (a critical component of executive function) in individuals with 22q11.2DS with and without psychotic symptoms, when compared to individuals with idiopathic schizophrenia and age-matched neurotypical controls. Twenty-eight participants diagnosed with 22q11.2DS (14-35 years old; 14 with at least one psychotic symptom), 15 individuals diagnosed with schizophrenia (18-63 years old) and two neurotypical control groups (one age-matched to the 22q11.2DS sample, the other age-matched to the schizophrenia sample) participated in this study. Analyses focused on the N2 and P3 no-go responses and error-related negativity (Ne) and positivity (Pe). Atypical inhibitory processing was shown behaviorally and by significantly reduced P3, Ne, and Pe responses in 22q11.2DS and schizophrenia. Interestingly, whereas P3 was only reduced in the presence of psychotic symptoms, Ne and Pe were equally reduced in schizophrenia and 22q11.2DS, regardless of the presence of symptoms. We argue that while P3 may be a marker of disease severity, Ne and Pe might be candidate markers of risk.

Atypical spatial frequency dependence of visual metacognition among schizophrenia patients

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Visual metacognition of controls was dependent on spatial frequency.

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Visual metacognition of schizophrenia patients was independent of spatial frequency.

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Patients and controls differently rely on the dorsolateral prefrontal cortex.

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Sensory inputs may reach metacognitive circuits in an atypical manner among patients.

Although altered early stages of visual processing have been reported among schizophrenia patients, how such atypical visual processing may affect higher-level cognition remains largely unknown. Here we tested the hypothesis that metacognitive performance may be atypically modulated by spatial frequency (SF) of visual stimuli among individuals with schizophrenia, given their altered magnocellular function. To study the effect of SF on metacognitive performance, we asked patients and controls to perform a visual detection task on gratings with different SFs and report confidence, and analyzed the data using the signal detection theoretic measure meta-d′. Control subjects showed better metacognitive performance after yes- (stimulus presence) than after no- (stimulus absence) responses (‘yes-response advantage’) for high SF (HSF) stimuli but not for low SF (LSF) stimuli. The patients, to the contrary, showed a ‘yes-response advantage’ not only for HSF but also for LSF stimuli, indicating atypical SF dependency of metacognition. An fMRI experiment using the same task revealed that the dorsolateral prefrontal cortex (DLPFC), known to be crucial for metacognition, shows activity mirroring the behavioral results: decoding accuracy of perceptual confidence in DLPFC was significantly higher for HSF than for LSF stimuli in controls, whereas this decoding accuracy was independent of SF in patients. Additionally, the functional connectivity of DLPFC with parietal and visual areas was modulated by SF and response type (yes/no) in a different manner between controls and patients. While individuals without schizophrenia may flexibly adapt metacognitive computations across SF ranges, patients may employ a different mechanism that is independent of SF. Because visual stimuli of low SF have been linked to predictive top-down processing, this may reflect atypical functioning in these processes in schizophrenia.

Visual Cortical Alterations and their Association with Negative Symptoms in Antipsychotic-Naïve First Episode Psychosis

Visual perceptual and processing deficits are common in schizophrenia and possibly point towards visual pathway alterations. However, no studies have examined visual cortical morphology in first-episode psychosis (FEP). In an antipsychotic-naïve FEP population, we investigated primary visual (V1), association area (V2), and motion perception (V5/MT) morphology compared to controls. We found reductions in the V1 and V2 areas, greater MT area and lower MT thickness in the FEP-schizophrenia group when compared to controls. Also, lower MT thickness was associated with worse negative symptoms. Our results shed light on this poorly studied area of visual cortex morphology in FEP.

Retinal ganglion cells dysfunctions in schizophrenia patients with or without visual hallucinations

The electroretinogram has revealed photoreceptor, bipolar cell, and, in one prior study, retinal ganglion cell (RGC) dysfunction in schizophrenia. The structural abnormalities of the RGC are well documented in schizophrenia and such abnormalities have been associated with visual hallucinations (VH) in neurological disorders. The goals of this study were: 1) to examine the functional responses of photoreceptors and RGC in schizophrenia patients in comparison with healthy controls; and 2) to compare the extent of retinal dysfunction in schizophrenia patients with or without VH. We recorded the flash electroretinogram in scotopic and photopic conditions, and the pattern electroretinogram, in schizophrenia patients (n = 29) and healthy controls (n = 29). Schizophrenia patients were divided in two groups: schizophrenia patients with VH (VH group, n = 12) and schizophrenia patients with auditory hallucinations or no hallucinations (AHNH group, n = 17). Our results replicate previous findings regarding photoreceptor dysfunction in schizophrenia. PERG results showed a significant increase of the P50 implicit time in schizophrenia patients compared with controls (t(55) = 2.1, p < .05, d = 0.55) and a significant increase of the N95 implicit time in schizophrenia patients compared with controls (t(55) = 4.2; p < .001, d = 0.66). We found an increased rod b-wave implicit time (dark-adapted 0.01 ERG) in the VH group compared to the AHNH group and to the control group, which was associated with lifetime VH score. Our results demonstrate a slowing of RGC signaling in schizophrenia patients, which could affect the quality of visual information reaching the visual cortex. The implications of the data for understanding VH in schizophrenia are discussed.

Retinal single-layer analysis with optical coherence tomography (OCT) in schizophrenia spectrum disorder

BACKGROUND

Volume reductions in brain structures of patients with schizophrenia spectrum disorder (SSD) have repeatedly been found in voxel-based morphometry MRI studies. Hence, an underlying neurodegenerative etiological component of SSD is currently being discussed. In recent years, the imaging method of optical coherence tomography (OCT) has shown its potential in evaluating structural changes in the retina in patients with confirmed neurodegenerative disorders, providing a window into the brain.

METHODS

Twenty-six patients with schizophrenia or schizoaffective disorder and 23 age- and sex-matched healthy controls were examined with the Heidelberg Spectralis OCT system to derive a single-layer analysis of both retinas. The segmentation of retinal layers was manually corrected to minimize artifacts and software imprecisions.

RESULTS

Compared to the control group, SSD patients showed reduced thickness and volume measurements for nearly all retinal layers, and these differences reached significance for macular volume, macular thickness, retinal nerve fiber layer (RNFL) and inner nucleiform layer (INL). Furthermore, a significant correlation between the duration of illness and the total volume of the RNFL was found.

CONCLUSION

Our OCT measurements demonstrate reduced single retinal layer thickness in patients with SSD. In the context of the MRI volume changes, our results provide further evidence that structural changes seen in the brain of patients are also observable in the retina, potentially allowing further insights into the different components of the nervous system that are altered in this highly etiologically complex disorder.

An investigation of retinal layer thicknesses in unaffected first-degree relatives of schizophrenia patients

INTRODUCTION

A large number of studies using different neuroimaging methods showed various structural changes both in patients and their unaffected first-degree relatives (FDRs) over the past years. Optical coherence tomography (OCT) is a relatively new, non-invasive imaging method used to obtain high-resolution cross-sectional images of the retina. A growing body of evidence reports thinning of retinal layers in patients with schizophrenia which is considered as a proxy for CNS alterations. We hypothesized that retinal layer changes would be observed in FDRs, in parallel with those seen in patients, as a potential endophenotype candidate.

METHODS

Thirty-eight schizophrenia patients, 38 FDRs of schizophrenia and 38 age and gender-matched healthy subjects with no family history (HCs) were recruited to this study. OCT measurements were performed and peripapillary retinal nerve fibre layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL) and macular thicknesses were measured.

RESULTS

The groups did not differ on RNFL, macular or GCL thickness. However, IPL thickness was significantly lower in both patients and FDRs than HCs (p = .025 and p = .041, respectively). The difference between groups remained significant after controlling for confounders such as age, gender, smoking status, comorbid medical diseases and BMI (p = .016 patients vs HCs and p = .014 FDRs vs HCs).

CONCLUSION

Our findings suggest that IPL thinning may hold promise as a useful endophenotype for genetic and early detection studies. The evaluation of this area could provide an important avenue for elucidating some of the neurodevelopmental aberrations in the disorder.

Retinal correlates of psychiatric disorders

Diagnosis and monitoring of psychiatric disorders rely heavily on subjective self-reports of clinical symptoms, which are complicated by the varying consistency of accounts reported by patients with an impaired mental state. Hence, more objective and quantifiable measures have been sought to provide clinicians with more robust methods to evaluate symptomology and track progression of disease in response to treatments. Owing to the shared origins of the retina and the brain, it has been suggested that changes in the retina may correlate with structural and functional changes in the brain. Vast improvements in retinal imaging, namely optical coherence tomography (OCT) and electrodiagnostic technology, have made it possible to investigate the eye at a microscopic level, allowing for the investigation of potential biomarkers in vivo. This review provides a summary of retinal biomarkers associated with schizophrenia, bipolar disorder and major depression, demonstrating how retinal biomarkers may be used to complement existing methods and provide structural markers of pathophysiological mechanisms that underpin brain dysfunction in psychiatric disorders.

Examining motion speed processing in schizophrenia using the flash lag illusion

Research on visual perception in schizophrenia suggests a deficit in motion processing. Specifically, difficulties with discriminating motion speed are commonly reported. However, speed discrimination tasks typically require participants to make judgments about the difference between two stimuli in a two-interval forced choice (2IFC) task. Such tasks not only tap into speed processing mechanisms, but also rely on higher executive functioning including working memory and attention which has been shown to be compromised in schizophrenia. We used the Flash Lag illusion to examine speed processing in patients with schizophrenia. Based on previous research showing a strong dependence between motion speed and the illusion magnitude, we expected a deficit in speed processing to alter this relationship. A motion processing deficit in patients would also predict overall reductions in perceived lag. We found the magnitude and speed dependence of the Flash Lag illusion to be similar in patients and controls. Together, the findings suggest no general abnormality in motion speed processing in schizophrenia.

Deficits in Auditory and Visual Sensory Discrimination Reflect a Genetic Liability for Psychosis and Predict Disruptions in Global Cognitive Functioning

Sensory discrimination thresholds (i.e., the briefest stimulus that can be accurately perceived) can be measured using tablet-based auditory and visual sweep paradigms. These basic sensory functions have been found to be diminished in patients with psychosis. However, the extent to which worse sensory discrimination characterizes genetic liability for psychosis, and whether it is related to clinical symptomatology and community functioning remains unknown. In the current study we compared patients with psychosis (PSY; N=76), their first-degree biological relatives (REL; N=44), and groups of healthy controls (CON; N=13 auditory and visual/N=275 auditory/N=267 visual) on measures of auditory and visual sensory discrimination, and examined relationships with a battery of symptom, cognitive, and functioning measures. Sound sweep thresholds differed among the PSY, REL, and CON groups, driven by higher thresholds in the PSY compared to CON group, with the REL group showing intermediate thresholds. Visual thresholds also differed among the three groups, driven by higher thresholds in the REL versus CON group, and no significant differences between the REL and PSY groups. Across groups and among patients, higher thresholds (poorer discrimination) for both sound and visual sweeps strongly correlated with lower global cognitive scores. We conclude that low-level auditory and visual sensory discrimination deficits in psychosis may reflect genetic liability for psychotic illness. Critically, these deficits relate to global cognitive disruptions that are a hallmark of psychotic illnesses such as schizophrenia.

Is Attentional Filtering Impaired in Schizophrenia?

Recent evidence suggests that schizophrenia involves hyperfocusing, an unusually narrow but intense focusing of processing resources. This appears to contradict the classic idea that schizophrenia involves an impairment in the ability to focus on relevant information and filter irrelevant information. Here, we review one set of studies suggesting that attentional filtering is impaired in people with schizophrenia and another set of studies suggesting that attentional filtering is unimpaired or even enhanced in these individuals. Considerable evidence supports both conclusions, and we propose 3 potential ways of reconciling the conflicting evidence. First, impaired attentional filtering may occur primarily during periods of active psychosis, with hyperfocusing being a part of the broad pattern of cognitive impairment that persists independent of the level of positive symptoms. Second, schizophrenia may involve hyperfocusing in the visual modality and impaired attentional filtering in the auditory modality. Third, attention may be directed toward irrelevant inputs as a result of impaired executive control, and hyperfocusing on those inputs may be functionally equivalent to a failure of attentional filtering. Given the widespread clinical observations and first-person reports of impaired attentional filtering in schizophrenia, it will be important for future research to test these possibilities.

Evidence for intact stimulus-specific neural adaptation for visual objects in schizophrenia and bipolar disorder: An ERP study

People with schizophrenia (SZ) or bipolar disorder (BD) experience dysfunction in visual processing. Dysfunctional neural tuning, in which neurons and neuronal populations are selectively activated by specific features of visual stimuli, may contribute to these deficits. Few studies have examined this possibility and there are inconsistent findings of tuning deficits in the literature. We utilized an event-related potential (ERP) paradigm to examine neural adaptation for visual objects, a measure of neural tuning whereby neurons respond less strongly to the repeated presentation of the same stimulus. Seventy-seven SZ, 53 BD, and 49 healthy comparison participants (HC) were examined. In three separate conditions, pictures of objects were presented repeatedly: the same object (SS), different objects from the same category (e.g., two different vases; SD), or different objects from different categories (e.g., a barrel and a clock, DD). Mass-univariate cluster-based permutation analyses identified electrodes and time-windows in which there were significant differences between the SS vs. DD and the SD vs. DD conditions. Mean ERP amplitudes were extracted from these clusters and analyzed for group differences. Results revealed a significant condition difference over parieto-occipital electrodes for the SS-DD comparison between 109–164 ms and for the SD-DD comparison between 78–203 ms, with larger amplitudes in the DD compared to either SS or SD condition. However, there were no significant differences in the pattern of results between groups. Thus, while we found neural adaptation effects using this ERP paradigm, we did not find evidence of group differences. Our results suggest that people with SZ or BD may not exhibit deficits in neural tuning for processing of visual objects using this EEG task with rapidly presented stimuli. However, the results are inconsistent with other studies using different methodologies (e.g., fMRI, behavioral tasks) that have found tuning deficits in people with schizophrenia.

Occipital Alpha Connectivity During Resting-State Electroencephalography in Patients With Ultra-High Risk for Psychosis and Schizophrenia

Schizophrenia patients always show cognitive impairment, which is proved to be related to hypo-connectivity or hyper-connectivity. Further, individuals with an ultra-high risk for psychosis also show abnormal functional connectivity-related cognitive impairment, especially in the alpha rhythm. Thus, the identification of functional networks is essential to our understanding of the disorder. We investigated the resting-state functional connectivity of the alpha rhythm measured by electroencephalography (EEG) to reveal the relation between functional network and clinical symptoms. The participants included 28 patients with first-episode schizophrenia (FES), 28 individuals with ultra-high risk for psychosis (UHR), and 28 healthy controls (HC). After the professional clinical symptoms evaluation, all the participants were instructed to keep eyes closed for 3-min resting-state EEG recording. The 3-min EEG data were segmented into artefact-free epochs (the length was 3 s), and the functional connectivity of the alpha phase was estimated using the phase lag index (PLI), which measures the phase differences of EEG signals. The FES and UHR groups displayed increased resting-state PLI connectivity compared with the HC group [F(2,74) = 10.804, p < 0.001]. Significant increases in the global efficiency, the local efficiency, and the path length were found in the FES and UHR groups compared with those of the HC group. FES and UHR showed an increased degree of connectivity compared with HC. The degree of the left occipital lobe area was higher in the UHR group than in the FES group. The hypothesis of disconnection is confirmed. Furthermore, differences between the UHR and FES group were found, which is valuable for producing clinical significance before the onset of schizophrenia.

A possible key role of vision in the development of schizophrenia

Based on a brief overview of the various aspects of schizophrenia reported by numerous studies, here we hypothesize that schizophrenia may originate (and in part be performed) from visual areas. In other words, it seems that a normal visual system or at least an evanescent visual perception may be an essential prerequisite for the development of schizophrenia as well as of various types of hallucinations. Our study focuses on auditory and visual hallucinations, as they are the most prominent features of schizophrenic hallucinations (and also the most studied types of hallucinations). Here, we evaluate the possible key role of the visual system in the development of schizophrenia.