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Long Y, Pan N, Yu Y, Zhang S, Qin K, Chen Y, Sweeney JA, DelBello MP, Gong Q. Shared and Distinct Neurobiological Bases of Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Comparative Meta-Analysis of Structural Abnormalities. J Am Acad Child Adolesc Psychiatry 2024; 63:586-604. [PMID: 38072245 DOI: 10.1016/j.jaac.2023.09.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/14/2023] [Accepted: 12/01/2023] [Indexed: 01/02/2024]
Abstract
OBJECTIVE Pediatric bipolar disorder (PBD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur and share dysfunctions in affective and cognitive domains. As the neural substrates underlying their overlapping and dissociable symptomatology have not been well delineated, a meta-analysis of whole-brain voxel-based morphometry studies in PBD and ADHD was conducted. METHOD A systematic literature search was performed in PubMed, Web of Science, and Embase. The seed-based d mapping toolbox was used to identify altered clusters of PBD or ADHD and obtain their conjunctive and comparative abnormalities. Suprathreshold patterns were subjected to large-scale network analysis to identify affected brain networks. RESULTS The search revealed 10 PBD studies (268 patients) and 32 ADHD studies (1,333 patients). Decreased gray matter volumes in the right insula and anterior cingulate cortex relative to typically developing individuals were conjunctive in PBD and ADHD. Reduced volumes in the right inferior frontal gyrus, left orbitofrontal cortex, and hippocampus were more substantial in PBD, while decreased volumes in the left precentral gyrus, left inferior frontal gyrus, and right superior frontal gyrus were more pronounced in ADHD. Neurodevelopmental effects modulated patterns of the left hippocampus in PBD and those of the left inferior frontal gyrus in ADHD. CONCLUSION These findings suggest that PBD and ADHD are characterized by both common and distinct patterns of gray matter volume alterations. Their overlapping abnormalities may represent a transdiagnostic problem of attention and emotion regulation shared by PBD and ADHD, whereas the disorder-differentiating substrates may contribute to the relative differences in cognitive and affective features that define the 2 disorders. PLAIN LANGUAGE SUMMARY Pediatric bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur, with overlapping changes in emotional and cognitive functioning. This meta-analysis summarizes findings from 10 articles on BD and 32 articles on ADHD to identify similarities and differences in brain structure between youth with BD and youth with ADHD. The authors found that both disorders share decreased gray matter volumes in the right insula and anterior cingulate cortex, which play important roles in emotion processing and attention, respectively. Youth with BD had decreased gray matter volume in the right inferior frontal gyrus, left orbitofrontal gyrus, and left hippocampus, while youth with ADHD had decreased volumes in the left precentral gyrus, left inferior frontal gyrus, and right superior frontal gyrus. STUDY PREREGISTRATION INFORMATION Structural Brain Abnormalities of Attention-Deficit/Hyperactivity Disorder and Bipolar Disorder in Children/Adolescents: An Overlapping Meta-analysis; https://osf.io; trg4m.
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Affiliation(s)
- Yajing Long
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Nanfang Pan
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; University of Cincinnati, Cincinnati, Ohio
| | - Yifan Yu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shufang Zhang
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Kun Qin
- University of Cincinnati, Cincinnati, Ohio; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ying Chen
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; University of Cincinnati, Cincinnati, Ohio
| | | | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Xiamen Hospital of Sichuan University, Xiamen, China.
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Long X, Li L, Wang X, Cao Y, Wu B, Roberts N, Gong Q, Kemp GJ, Jia Z. Gray matter alterations in adolescent major depressive disorder and adolescent bipolar disorder. J Affect Disord 2023; 325:550-563. [PMID: 36669567 DOI: 10.1016/j.jad.2023.01.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 12/24/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Gray matter volume (GMV) alterations in several emotion-related brain areas are implicated in mood disorders, but findings have been inconsistent in adolescents with major depressive disorder (MDD) or bipolar disorder (BD). METHODS We conducted a comprehensive meta-analysis of 35 region-of-interest (ROI) and 18 whole-brain voxel-based morphometry (VBM) MRI studies in adolescent MDD and adolescent BD, and indirectly compared the results in the two groups. The effects of age, sex, and other demographic and clinical scale scores were explored using meta-regression analysis. RESULTS In the ROI meta-analysis, right putamen volume was decreased in adolescents with MDD, while bilateral amygdala volume was decreased in adolescents with BD compared to healthy controls (HC). In the whole-brain VBM meta-analysis, GMV was increased in right middle frontal gyrus and decreased in left caudate in adolescents with MDD compared to HC, while in adolescents with BD, GMV was increased in left superior frontal gyrus and decreased in limbic regions compared with HC. MDD vs BD comparison revealed volume alteration in the prefrontal-limbic system. LIMITATION Different clinical features limit the comparability of the samples, and small sample size and insufficient clinical details precluded subgroup analysis or meta-regression analyses of these variables. CONCLUSIONS Distinct patterns of GMV alterations in adolescent MDD and adolescent BD could help to differentiate these two populations and provide potential diagnostic biomarkers.
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Affiliation(s)
- Xipeng Long
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China
| | - Lei Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China
| | - Xiuli Wang
- Department of Clinical Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu 610041, Sichuan, PR China
| | - Yuan Cao
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan, PR China
| | - Baolin Wu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China
| | - Neil Roberts
- The Queens Medical Research Institute (QMRI), School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China; Department of Radiology, West China Xiamen Hospital of Sichuan University, 699Jinyuan Xi Road, Jimei District, 361021 Xiamen, Fujian, PR China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Center (LiMRIC) and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Zhiyun Jia
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu 610041, Sichuan, PR China; Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, PR China.
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Gallucci J, Pomarol-Clotet E, Voineskos AN, Guerrero-Pedraza A, Alonso-Lana S, Vieta E, Salvador R, Hawco C. Longer illness duration is associated with greater individual variability in functional brain activity in Schizophrenia, but not bipolar disorder. Neuroimage Clin 2022; 36:103269. [PMID: 36451371 PMCID: PMC9723315 DOI: 10.1016/j.nicl.2022.103269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Individuals with schizophrenia exhibit greater inter-patient variability in functional brain activity during neurocognitive task performance. Some studies have shown associations of age and illness duration with brain function; however, the association of these variables with variability in brain function activity is not known. In order to better understand the progressive effects of age and illness duration across disorders, we examined the relationship with individual variability in brain activity. METHODS Neuroimaging and behavioural data were extracted from harmonized datasets collectively including 212 control participants, 107 individuals with bipolar disorder, and 232 individuals with schizophrenia (total n = 551). Functional activity in response to an N-back working memory task (2-back vs 1-back) was examined. Individual variability was quantified via the correlational distance of fMRI activity between participants; mean correlational distance of one participant in relation to all others was defined as a 'variability score'. RESULTS Greater individual variability was found in the schizophrenia group compared to the bipolar disorder and control groups (p = 1.52e-09). Individual variability was significantly associated with aging (p = 0.027), however, this relationship was not different across diagnostic groups. In contrast, in the schizophrenia sample only, a longer illness duration was associated with increased variability (p = 0.027). CONCLUSION An increase in variability was observed in the schizophrenia group related to illness duration, beyond the effects of normal aging, implying illness-related deterioration of cognitive networks. This has clinical implications for considering long-term trajectories in schizophrenia and progressive neural and cognitive decline which may be amiable to novel treatments.
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Affiliation(s)
- Julia Gallucci
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Catalonia, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Catalonia, Spain
| | - Aristotle N. Voineskos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Amalia Guerrero-Pedraza
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Catalonia, Spain,Benito Menni Complex Assistencial en Salut Mental, Barcelona, Catalonia, Spain
| | - Silvia Alonso-Lana
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Catalonia, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Catalonia, Spain,Research Centre and Memory Clinic, Fundació ACE Institut Català de Neurociències Aplicades – Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Catalonia, Spain,Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Catalonia, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Catalonia, Spain
| | - Colin Hawco
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Corresponding authors at: Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Spain.
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Long J, Qin K, Wu Y, Li L, Zhou J. Gray matter abnormalities and associated familial risk endophenotype in individuals with first-episode bipolar disorder: Evidence from whole-brain voxel-wise meta-analysis. Asian J Psychiatr 2022; 74:103179. [PMID: 35691059 DOI: 10.1016/j.ajp.2022.103179] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/16/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
Abstract
Gray matter abnormalities have been widely reported in individuals with and at familial risk for bipolar disorder (BD). However, inconsistent findings were reported, and whether shared abnormalities exist between at-risk individuals and patients which can represent an endophenotype remained unclear. This meta-analysis aimed at identifying robust patterns of gray matter changes in patients with first-episode BD (FEBD) and associated risk endophenotype of BD. A systematic literature search was performed to identify eligible voxel-based morphometry studies comparing FEBD patients and healthy controls. Findings of included studies were integrated using the Seed-based d Mapping toolbox. Common and distinct patterns of gray matter abnormalities between FEBD patients and unaffected at-risk individuals were explored. A total of 16 VBM studies comparing 411 FEBD patients and 521 controls were included. FEBD patients showed increased gray matter volume in the cerebellum, posterior cingulate cortex and striatum, and decreased gray matter volume in the medial superior frontal gyrus and gyrus rectus. No common abnormalities were identified between FEBD patients and unaffected at-risk individuals. More gray matter loss in the medial superior frontal gyrus and insula were found in FEBD patients relative to unaffected at-risk individuals. These findings revealed robust gray matter abnormalities in the cortico-striato-cerebellar and default mode network regions in FEBD, and implicated that gray matter deficits may not represent a familial risk endophenotype of BD.
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Affiliation(s)
- Jingyi Long
- Department of Radiology, Wuhan Mental Health Center, Wuhan 430012, Hubei, China; Department of Radiology, Wuhan Hospital for Psychotherapy, Wuhan 430012, Hubei, China
| | - Kun Qin
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati 45219, OH, USA
| | - Yong Wu
- Department of Depression, Wuhan Hospital for Psychotherapy, Wuhan 430012, Hubei, China
| | - Lu Li
- Department of Interventional Radiology, Wuhan Jinyintan Hospital, Wuhan 430023, Hubei, China.
| | - Juan Zhou
- Department of Ultrasonography, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu, China.
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Liu J, Wen F, Yan J, Yu L, Wang F, Wang D, Zhang J, Yan C, Chu J, Li Y, Li Y, Cui Y. Gray Matter Alterations in Pediatric Schizophrenia and Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis of Voxel-Based Morphometry Studies. Front Psychiatry 2022; 13:785547. [PMID: 35308883 PMCID: PMC8924120 DOI: 10.3389/fpsyt.2022.785547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/02/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study is comparing gray matter alterations in SCZ pediatric patients with those suffering from obsessive-compulsive disorder (OCD) based on a systematic review and an activation likelihood estimation (ALE) meta-analysis. METHODS A systematic literature search was performed in PubMed, Elsevier, and China National Knowledge Infrastructure (CNKI). A systematic review and an ALE meta-analysis were performed to quantitatively examine brain gray matter alterations. RESULTS Children and adolescents with schizophrenia had decreased gray matter volume (GMV) mainly in the prefrontal cortex (PFC), temporal cortex (such as the middle temporal gyrus and transverse temporal gyrus), and insula, while children and adolescents with OCD mainly had increased GMV in the PFC and the striatum (including the lentiform nucleus and caudate nucleus), and decreased GMV in the parietal cortex. CONCLUSIONS Our results suggest that gray matter abnormalities in the PFC may indicate homogeneity between the two diseases. In children and adolescents, structural alterations in schizophrenia mainly involve the fronto-temporal and cortico-insula circuits, whereas those in OCD mainly involve the prefrontal-parietal and the prefrontal-striatal circuits.
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Affiliation(s)
- Jingran Liu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Fang Wen
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Junjuan Yan
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Liping Yu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Fang Wang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Duo Wang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Jishui Zhang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Chunmei Yan
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Jiahui Chu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Yanlin Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Ying Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
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Cazes J, Dimick MK, Kennedy KG, Fiksenbaum L, Zai CC, Patel R, Islam AH, Tampakeras M, Freeman N, Kennedy JL, MacIntosh BJ, Goldstein BI. Structural neuroimaging phenotypes of a novel multi-gene risk score in youth bipolar disorder. J Affect Disord 2021; 289:135-143. [PMID: 33979723 DOI: 10.1016/j.jad.2021.04.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is among the most heritable psychiatric disorders, particularly in early-onset cases, owing to multiple genes of small effect. Here we examine a multi-gene risk score (MGRS), to address the gap in multi-gene research in early-onset BD. METHODS MGRS was derived from 34 genetic variants relevant to neuropsychiatric diseases and related systemic processes. Multiple MGRS were calculated across a spectrum of inclusion p-value thresholds, based on allelic associations with BD. Youth participants (123 BD, 103 healthy control [HC]) of European descent were included, of which 101 participants (58 BD, 43 HC) underwent MRI T1-weighted structural neuroimaging. Hierarchical regressions examined for main effects and MGRS-by-diagnosis interaction effects on 6 regions-of-interest (ROIs). Vertex-wise analysis also examined MGRS-by-diagnosis interactions. RESULTS MGRS based on allelic association p≤0.60 was most robust, explaining 6.8% of variance (t(226)=3.46, p=.001). There was an MGRS-by-diagnosis interaction effect on ventrolateral prefrontal cortex surface area (vlPFC; β=.21, p=.0007). Higher MGRS was associated with larger vlPFC surface area in BD vs. HC. There were 8 significant clusters in vertex-wise analyses, primarily in fronto-temporal regions, including vlPFC. LIMITATIONS Cross-sectional design, modest sample size. CONCLUSIONS There was a diagnosis-by-MGRS interaction effect on vlPFC surface area, a region involved in emotional processing, emotional regulation, and reward response. Vertex-wise analysis also identified several clusters overlapping this region. This preliminary study provides an example of an approach to imaging-genetics that is intermediate between candidate gene and genome-wide association studies, enriched for genetic variants with established relevance to neuropsychiatric diseases.
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Affiliation(s)
| | - Mikaela K Dimick
- University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kody G Kennedy
- University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lisa Fiksenbaum
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Clement C Zai
- Neurogenetics Section and Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Harvard T.H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, USA
| | - Ronak Patel
- University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alvi H Islam
- University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Maria Tampakeras
- Neurogenetics Section and Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Natalie Freeman
- Neurogenetics Section and Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - James L Kennedy
- University of Toronto, Toronto, ON, Canada; Neurogenetics Section and Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Benjamin I Goldstein
- University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Keramatian K, Chakrabarty T, Saraf G, Pinto JV, Yatham LN. Grey matter abnormalities in first-episode mania: A systematic review and meta-analysis of voxel-based morphometry studies. Bipolar Disord 2021; 23:228-240. [PMID: 32961005 DOI: 10.1111/bdi.12995] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES It has been proposed that different stages of bipolar disorder may be underpinned by distinct neurobiological substrates. However, structural neuroimaging studies in early stages of the illness are limited by small sample sizes yielding inconsistent findings. The purpose of this systematic review and meta-analysis, therefore, was to identify regional grey matter volume (GMV) changes that are consistently associated with first episode of mania (FEM). METHODS Following PRISMA guidelines, we conducted a systematic search of the literature to identify Voxel-Based Morphometry (VBM) studies in FEM patients compared with healthy individuals. We then conducted a voxel-wise meta-analysis using Seed-based d-Mapping technique. Finally, we performed univariate meta-regression analyses to explore the potential effects of moderator variables including age, gender, and percentage of lithium users on GMV alterations. RESULTS We identified 15 VBM studies and included 12 studies in the meta-analysis. Four studies found no regional differences in GM volumes while other 11 studies reported volume changes in frontal and temporal regions as well as anterior cingulate cortex (ACC), cerebellum and basal ganglia. The meta-analysis revealed a single cluster of GMV reduction in bilateral pregenual ACC in patients with FEM compared to healthy individuals (P < .001). The Egger's test showed no evidence of publication bias at peak voxel level (P = .447). Meta-regression analyses revealed no significant effects of moderators evaluated. CONCLUSIONS Structural brain changes are evident in the early stages of bipolar disorder. GMV reduction in bilateral pregenual ACC is the most consistent finding in VBM studies of FEM.
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Affiliation(s)
- Kamyar Keramatian
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Gayatri Saraf
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Jairo V Pinto
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Keramatian K, Su W, Saraf G, Chakrabarty T, Yatham LN. Preservation of Gray Matter Volume in Early Stage of Bipolar Disorder: A Case for Early Intervention: Préservation du volume de matière grise au stade précoce du trouble bipolaire: un cas pour intervention précoce. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:139-146. [PMID: 32419481 PMCID: PMC7918870 DOI: 10.1177/0706743720927827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE It has been proposed that different stages of the bipolar disorder might have distinct neurobiological changes. However, the evidence for this has not been consistent, as the studies in early stages of the illness are limited by small sample sizes. The purpose of this study was to investigate the gray matter volume changes in bipolar patients who recently recovered from their first episode of mania (FEM). METHODS Using a whole-brain voxel-based analysis, we compared the regional gray matter volumes of 61 bipolar patients who have recovered from their FEM in the past 3 months with 43 age- and gender-matched healthy participants. We also performed a series of subgroup analyses to determine the effects of hospitalization during the FEM, history of depressive episodes, and exposure to lithium. RESULTS No statistically significant difference was found between gray matter volumes of FEM patients and healthy participants, even at a more liberal threshold (P < 0.001, uncorrected for multiple comparisons). Voxel-based subgroup analyses did not reveal significant gray matter differences except for a trend toward decreased gray matter volume in left lateral occipital cortex (P < 0.001, uncorrected) in patients with a previous history of depression. CONCLUSION This study represents the largest structural neuroimaging investigation of FEM published to date. Early stage of bipolar disorder was not found to be associated with significant gray matter volume changes. Our findings suggest that there might be a window of opportunity for early intervention strategies to prevent or delay neuroprogression in bipolar disorder.
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Affiliation(s)
- Kamyar Keramatian
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Wayne Su
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Gayatri Saraf
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
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Increased Proinflammatory Cytokines, Executive Dysfunction, and Reduced Gray Matter Volumes In First-Episode Bipolar Disorder and Major Depressive Disorder. J Affect Disord 2020; 274:825-831. [PMID: 32664021 DOI: 10.1016/j.jad.2020.05.158] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/24/2020] [Accepted: 05/29/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUNDS The association between systemic inflammation, executive dysfunction, and gray matter (GM) volume difference in first-episode affective disorders, including bipolar and major depressive disorders, is unclear. METHODS Twenty-two patients with first-episode bipolar disorder, 22 age- and sex-matched patients with first-episode major depressive disorder, and 22 matched controls were enrolled in our study; all patients underwent comprehensive assessments, including clinical assessment, executive function examination (Wisconsin card sorting test [WCST]), proinflammatory cytokine receptors (soluble interleukin-6 receptor and tumor necrosis factor-α receptor 1 [TNFR1]), and brain magnetic resonance imaging. Voxel-based morphometry was performed to analyze the GM volume difference between bipolar and major depressive disorders. RESULTS Patients with bipolar disorder were more likely to exhibit higher levels of TNFR1 (P = .038), more number of deficits in WCST (P < .05), and smaller GM volume in the middle frontal cortex (uncorrected voxel level P < .001) compared with those with major depressive disorder and healthy controls. Positive associations were observed between the middle frontal cortex volume, executive function, and the TNFR1 level. DISCUSSION GM volume reduction in the middle frontal cortex, a greater level of systemic inflammation, and executive dysfunction were observed in first-episode affective disorders, especially bipolar disorder. A positive correlation between middle frontal cortex volume, executive function, and the TNFR1 level may indicate a divergent effect of brain and systemic inflammation functioning in the early phase (first episode) of affective disorder.
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Mana S, Paillère Martinot ML, Martinot JL. Brain imaging findings in children and adolescents with mental disorders: A cross-sectional review. Eur Psychiatry 2020; 25:345-54. [PMID: 20620025 DOI: 10.1016/j.eurpsy.2010.04.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 04/08/2010] [Accepted: 04/22/2010] [Indexed: 01/18/2023] Open
Abstract
AbstractBackgroundWhile brain imaging studies of juvenile patients has expanded in recent years to investigate the cerebral neurophysiologic correlates of psychiatric disorders, this research field remains scarce. The aim of the present review was to cluster the main mental disorders according to the differential brain location of the imaging findings recently reported in children and adolescents reports. A second objective was to describe the worldwide distribution and the main directions of the recent magnetic resonance imaging (MRI) and positron tomography (PET) studies in these patients.MethodsA survey of 423 MRI and PET articles published between 2005 and 2008 was performed. A principal component analysis (PCA), then an activation likelihood estimate (ALE) meta-analysis, were applied on brain regional information retrieved from articles in order to cluster the various disorders with respect to the cerebral structures where alterations were reported. Furthermore, descriptive analysis characterized the literature production.ResultsTwo hundred and seventy-four articles involving children and adolescent patients were analyzed. Both the PCA and ALE methods clustered, three groups of diagnosed psychiatric disorders, according to the brain structural and functional locations: one group of affective disorders characterized by abnormalities of the frontal-limbic regions; a group of mental disorders with “cognition deficits” mainly related to cortex abnormalities; and one psychomotor condition associated with abnormalities in the basal ganglia. The descriptive analysis indicates a focus on attention deficit hyperactivity disorders and autism spectrum disorders, a general steady rise in the number of annual reports, and lead of US research.ConclusionThis cross-sectional review of child and adolescent mental disorders based on neuroimaging findings suggests overlaps of brain locations that allow to cluster the diagnosed disorders into three sets with respectively marked affective, cognitive, and psychomotor phenomenology. Furthermore, the brain imaging research effort was unequally distributed across disorders, and did not reflect their prevalence.
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Affiliation(s)
- S Mana
- Service hospitalier central de médecine nucléaire et neurospin, INSERM-CEA, Research Unit 1000 Neuroimaging & psychiatry, University Paris Sud and University Paris Descartes, 4, place Gl.-Leclerc, 91401 Orsay, France.
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11
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Ioakeimidis V, Haenschel C, Yarrow K, Kyriakopoulos M, Dima D. A Meta-analysis of Structural and Functional Brain Abnormalities in Early-Onset Schizophrenia. ACTA ACUST UNITED AC 2020. [DOI: 10.1093/schizbullopen/sgaa016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abstract
Early-onset schizophrenia (EOS) patients demonstrate brain changes that are similar to severe cases of adult-onset schizophrenia. Neuroimaging research in EOS is limited due to the rarity of the disorder. The present meta-analysis aims to consolidate MRI and functional MRI findings in EOS. Seven voxel-based morphometry (VBM) and 8 functional MRI studies met the inclusion criteria, reporting whole-brain analyses of EOS vs healthy controls. Activation likelihood estimation (ALE) was conducted to identify aberrant anatomical or functional clusters across the included studies. Separate ALE analyses were performed, first for all task-dependent studies (Cognition ALE) and then only for working memory ones (WM ALE). The VBM ALE revealed no significant clusters for gray matter volume reductions in EOS. Significant hypoactivations peaking in the right anterior cingulate cortex (rACC) and the right temporoparietal junction (rTPJ) were detected in the Cognition ALE. In the WM ALE, consistent hypoactivations were found in the left precuneus (lPreC), the right inferior parietal lobule (rIPL) and the rTPJ. These hypoactivated areas show strong associations with language, memory, attention, spatial, and social cognition. The functional co-activated networks of each suprathreshold ALE cluster, identified using the BrainMap database, revealed a core co-activation network with similar topography to the salience network. Our results add support to posterior parietal, ACC and rTPJ dysfunction in EOS, areas implicated in the cognitive impairments characterizing EOS. The salience network lies at the core of these cognitive processes, co-activating with the hypoactivating regions, and thus highlighting the importance of salience dysfunction in EOS.
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Affiliation(s)
- Vasileios Ioakeimidis
- Department of Psychology, School of Arts and Social Sciences, City, University of London, London, UK
| | - Corinna Haenschel
- Department of Psychology, School of Arts and Social Sciences, City, University of London, London, UK
| | - Kielan Yarrow
- Department of Psychology, School of Arts and Social Sciences, City, University of London, London, UK
| | - Marinos Kyriakopoulos
- National and Specialist Acorn Lodge Inpatient Children Unit, South London & Maudsley NHS Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Danai Dima
- Department of Psychology, School of Arts and Social Sciences, City, University of London, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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12
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Lu X, Zhong Y, Ma Z, Wu Y, Fox PT, Zhang N, Wang C. Structural imaging biomarkers for bipolar disorder: Meta-analyses of whole-brain voxel-based morphometry studies. Depress Anxiety 2019; 36:353-364. [PMID: 30475436 DOI: 10.1002/da.22866] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/20/2018] [Accepted: 11/06/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a common and destructive psychiatric illness worldwide. Although it is known that BD is associated with morphological abnormalities of the brain, the regions implicated in BD remain unclear. Therefore, we aimed to update current knowledge on potential structural imaging biomarkers of BD. METHODS Studies published up to January 31, 2018, were identified by a comprehensive literature search of PubMed, EBSCO, and BrainMap voxel-based morphometry (VBM) database. Whole-brain VBM studies that examined gray matter (GM) abnormalities of group comparisons between BD and healthy controls (HC) and reported results as coordinates in a standard reference space were included. Different meta-analyses were performed by activation likelihood estimation (ALE) algorithm. RESULTS A total of 46 studies with 56 experiments, including 1720 subjects and 268 foci were included. Seven different meta-analyses were calculated separately across experiments reporting decreased or increased GM volume among BD, BDΙ, BD-adults, and BD-youths groups. Fifteen regions of significantly different GM volume between four groups and HC were identified. There were extensive GM deficits in the prefrontal and temporal cortex, and enlargements in the putamen, cingulate cortex, and precuneus. CONCLUSIONS The results revealed that the thinning of prefrontal cortex was a key region in the pathophysiology of BD. The enlargement of the cingulate cortex may be implicated in a compensatory mechanism. It underscored important differences between BD-adults and BD-youths and specific biomarkers of three subgroups.
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Affiliation(s)
- Xin Lu
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, Nanjing, Jiangsu, China
| | - Zijuan Ma
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yun Wu
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Peter T Fox
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,South Texas Veterans Healthcare System, University of Texas Health San Antonio, San Antonio, United States.,Research Imaging Institute, University of Texas Health San Antonio, San Antonio, United States
| | - Ning Zhang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chun Wang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
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13
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Castro-Fornieles J, Bargalló N, Calvo A, Arango C, Baeza I, Gonzalez-Pinto A, Parellada M, Graell M, Moreno C, Otero S, Janssen J, Rapado-Castro M, de la Serna E. Gray matter changes and cognitive predictors of 2-year follow-up abnormalities in early-onset first-episode psychosis. Eur Child Adolesc Psychiatry 2018; 27:113-126. [PMID: 28707138 DOI: 10.1007/s00787-017-1013-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 06/02/2017] [Indexed: 11/26/2022]
Abstract
This study aims to examine regional gray matter (GM) changes over a period of 2 years in patients diagnosed with early-onset first-episode psychosis (EO-FEP), and to identify baseline predictors of abnormalities at the follow-up. Fifty-nine patients with EO-FEP aged 11-17 years were assessed. Magnetic resonance imaging was carried out at admission and 2 years later. Changes over time were assessed with voxel-based morphometry. Fifty-nine patients (34 schizophrenia-SCZ, 15 bipolar disorder-BP, and 10 other psychotic disorders) and 70 healthy controls were assessed. At baseline no differences were found between the EO-FEP groups and control subjects. Over time, SCZ patients presented a larger GM decrease in the orbitofrontal cortex, anterior midline frontal cortex, cingulate, left caudate, and thalamus. BP patients also had a larger GM decrease in the right putamen, right orbitofrontal cortex, and anterior and midline region of the right superior frontal gyrus and left caudate, but with fewer areas showing significant differences than in the comparison between SCZ and controls. In the cross-sectional analysis, only SCZ patients showed differences with respect to controls in some GM areas. Significant baseline predictors of a 2-year reduction in GM were IQ and working memory. EO-FEP patients did not show differences in GM compared to controls at baseline. Both SCZ and BP patients showed a greater decrease in specific areas during the first 2 years. At follow-up, only SCZ patients differed significantly from controls in specific brain areas. The GM reduction was predicted by baseline cognitive variables.
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Affiliation(s)
- Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489, Neurosciences Institute, Hospital Clínic of Barcelona, IDIBAPS, CIBERSAM, Villarroel, 170, 08036, Barcelona, Spain.
- Department of Psychiatry and Psychobiology, University of Barcelona, Barcelona, Spain.
| | - Nuria Bargalló
- Image Diagnostic Center, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Anna Calvo
- Image Diagnostic Center, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, CIBERSAM, Universidad Complutense, Madrid, Spain
| | - Immaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489, Neurosciences Institute, Hospital Clínic of Barcelona, IDIBAPS, CIBERSAM, Villarroel, 170, 08036, Barcelona, Spain
| | - Ana Gonzalez-Pinto
- Department of Psychiatry, Hospital Santiago Apóstol, CIBERSAM, EHU/University of the Basque Country, Vitoria, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, CIBERSAM, Universidad Complutense, Madrid, Spain
| | - Montserrat Graell
- Department of Child and Adolescent Psychiatry and Psychology, CIBERSAM, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, CIBERSAM, Universidad Complutense, Madrid, Spain
| | - Soraya Otero
- Child and Adolescent Mental Health Unit, Department of Psychiatry and Psychology, CIBERSAM, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Joost Janssen
- Department of Child and Adolescent Psychiatry, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, CIBERSAM, Universidad Complutense, Madrid, Spain
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marta Rapado-Castro
- Department of Child and Adolescent Psychiatry, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, CIBERSAM, Universidad Complutense, Madrid, Spain
| | - Elena de la Serna
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489, Neurosciences Institute, Hospital Clínic of Barcelona, IDIBAPS, CIBERSAM, Villarroel, 170, 08036, Barcelona, Spain
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14
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Knöchel C, Schmied C, Linden DEJ, Stäblein M, Prvulovic D, de A de Carvalho L, Harrison O, Barros PO, Carvalho AF, Reif A, Alves GS, Oertel-Knöchel V. White matter abnormalities in the fornix are linked to cognitive performance in SZ but not in BD disorder: An exploratory analysis with DTI deterministic tractography. J Affect Disord 2016; 201:64-78. [PMID: 27177298 DOI: 10.1016/j.jad.2016.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 02/19/2016] [Accepted: 03/07/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND In psychosis, white matter (WM) microstructural changes have been detected previously; however, direct comparisons of findings between bipolar (BD) and schizophrenia (SZ) patients are scarce. In this study, we employed deterministic tractography to reconstruct WM tracts in BD and SZ patients. METHODS Diffusion tensor imaging (DTI) data was carried out with n=32 euthymic BD type I patients, n=26 SZ patients and 30 matched healthy controls. Deterministic tractography using multiple indices of diffusion (fractional anisotropy (FA), tract volume (Vol), tract length (Le) and number of tracts (NofT)) were obtained from the fornix, the cingulum, the anterior thalamic radiation, and the corpus callosum bilaterally. RESULTS We showed widespread WM microstructural changes in SZ, and changes in the corpus callosum, the left cingulum and the fornix in BD. Fornix fiber tracking scores were associated with cognitive performance in SZ, and with age and age at disease onset in the BD patient group. LIMITATIONS Although the influence of psychopharmacological drugs as biasing variables on morphological alterations has been discussed for SZ and BD, we did not observe a clear influence of drug exposure on our findings. CONCLUSIONS These results confirm the assumption that SZ patients have more severe WM changes than BD patients. The findings also suggest a major role of WM changes in the fornix as important fronto-limbic connections in the etiology of cognitive symptoms in SZ, but not in BD.
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Affiliation(s)
- Christian Knöchel
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany.
| | - Claudia Schmied
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - David E J Linden
- MRC Centre for Neuropsychiatric Genetics & Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, United Kingdom
| | - Michael Stäblein
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - David Prvulovic
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - Luiza de A de Carvalho
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Octavia Harrison
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany; Brain Imaging Center, Goethe Univ., Frankfurt/Main, Germany
| | - Paulo O Barros
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - André F Carvalho
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Andreas Reif
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - Gilberto S Alves
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Viola Oertel-Knöchel
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
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15
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Torres US, Duran FLS, Schaufelberger MS, Crippa JAS, Louzã MR, Sallet PC, Kanegusuku CYO, Elkis H, Gattaz WF, Bassitt DP, Zuardi AW, Hallak JEC, Leite CC, Castro CC, Santos AC, Murray RM, Busatto GF. Patterns of regional gray matter loss at different stages of schizophrenia: A multisite, cross-sectional VBM study in first-episode and chronic illness. NEUROIMAGE-CLINICAL 2016; 12:1-15. [PMID: 27354958 PMCID: PMC4910144 DOI: 10.1016/j.nicl.2016.06.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/27/2016] [Accepted: 06/02/2016] [Indexed: 12/17/2022]
Abstract
Background: Structural brain abnormalities in schizophrenia have been repeatedly demonstrated in magnetic resonance imaging (MRI) studies, but it remains unclear whether these are static or progressive in nature. While longitudinal MRI studies have been traditionally used to assess the issue of progression of brain abnormalities in schizophrenia, information from cross-sectional neuroimaging studies directly comparing first-episode and chronic schizophrenia patients to healthy controls may also be useful to further clarify this issue. With the recent interest in multisite mega-analyses combining structural MRI data from multiple centers aiming at increased statistical power, the present multisite voxel-based morphometry (VBM) study was carried out to examine patterns of brain structural changes according to the different stages of illness and to ascertain which (if any) of such structural abnormalities would be specifically correlated to potential clinical moderators, including cumulative exposure to antipsychotics, age of onset, illness duration and overall illness severity. Methods: We gathered a large sample of schizophrenia patients (161, being 99 chronic and 62 first-episode) and controls (151) from four previous morphometric MRI studies (1.5 T) carried out in the same geographical region of Brazil. Image processing and analyses were conducted using Statistical Parametric Mapping (SPM8) software with the diffeomorphic anatomical registration through exponentiated Lie algebra (DARTEL) algorithm. Group effects on regional gray matter (GM) volumes were investigated through whole-brain voxel-wise comparisons using General Linear Model Analysis of Co-variance (ANCOVA), always including total GM volume, scan protocol, age and gender as nuisance variables. Finally, correlation analyses were performed between the aforementioned clinical moderators and regional and global brain volumes. Results: First-episode schizophrenia subjects displayed subtle volumetric deficits relative to controls in a circumscribed brain regional network identified only in small volume-corrected (SVC) analyses (p < 0.05, FWE-corrected), including the insula, temporolimbic structures and striatum. Chronic schizophrenia patients, on the other hand, demonstrated an extensive pattern of regional GM volume decreases relative to controls, involving bilateral superior, inferior and orbital frontal cortices, right middle frontal cortex, bilateral anterior cingulate cortices, bilateral insulae and right superior and middle temporal cortices (p < 0.05, FWE-corrected over the whole brain). GM volumes in several of those brain regions were directly correlated with age of disease onset on SVC analyses for conjoined (first-episode and chronic) schizophrenia groups. There were also widespread foci of significant negative correlation between duration of illness and relative GM volumes, but such findings remained significant only for the right dorsolateral prefrontal cortex after accounting for the influence of age of disease onset. Finally, significant negative correlations were detected between life-time cumulative exposure to antipsychotics and total GM and white matter volumes in schizophrenia patients, but no significant relationship was found between indices of antipsychotic usage and relative GM volume in any specific brain region. Conclusion: The above data indicate that brain changes associated with the diagnosis of schizophrenia are more widespread in chronic schizophrenia compared to first-episode patients. Our findings also suggest that relative GM volume deficits may be greater in (presumably more severe) cases with earlier age of onset, as well as varying as a function of illness duration in specific frontal brain regions. Finally, our results highlight the potentially complex effects of the continued use of antipsychotic drugs on structural brain abnormalities in schizophrenia, as we found that cumulative doses of antipsychotics affected brain volumes globally rather than selectively on frontal-temporal regions. Structural brain changes are more widespread in chronic than first-episode schizophrenia. Regional GM deficits may be greater in cases with earlier age of onset. Illness duration seems to impact in some specific frontal structural brain changes. Antipsychotics seem to affect brain volumes globally rather than regionally.
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Affiliation(s)
- Ulysses S Torres
- Post-Graduation Program in Radiology, Institute of Radiology (INRAD), Faculty of Medicine, University of São Paulo, Brazil; Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil
| | - Fabio L S Duran
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil
| | - Maristela S Schaufelberger
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Department of Neuroscience and Behaviour, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - José A S Crippa
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Department of Neuroscience and Behaviour, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Mario R Louzã
- Department and Institute of Psychiatry, University of Sao Paulo Medical School, Brazil
| | - Paulo C Sallet
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Department and Institute of Psychiatry, University of Sao Paulo Medical School, Brazil
| | | | - Helio Elkis
- Department and Institute of Psychiatry, University of Sao Paulo Medical School, Brazil
| | - Wagner F Gattaz
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Department and Institute of Psychiatry, University of Sao Paulo Medical School, Brazil; Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil
| | - Débora P Bassitt
- Department and Institute of Psychiatry, University of Sao Paulo Medical School, Brazil
| | - Antonio W Zuardi
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Department of Neuroscience and Behaviour, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Jaime Eduardo C Hallak
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Department of Neuroscience and Behaviour, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Claudia C Leite
- Post-Graduation Program in Radiology, Institute of Radiology (INRAD), Faculty of Medicine, University of São Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil
| | - Claudio C Castro
- Post-Graduation Program in Radiology, Institute of Radiology (INRAD), Faculty of Medicine, University of São Paulo, Brazil; Department of Diagnostic Imaging, Heart Institute (InCor), Faculty of Medicine, University of São Paulo, Brazil
| | - Antonio Carlos Santos
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Department of Internal Medicine - Radiology Division, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - Geraldo F Busatto
- Post-Graduation Program in Radiology, Institute of Radiology (INRAD), Faculty of Medicine, University of São Paulo, Brazil; Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São Paulo, Brazil; Department and Institute of Psychiatry, University of Sao Paulo Medical School, Brazil
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Fraguas D, Díaz-Caneja CM, Pina-Camacho L, Janssen J, Arango C. Progressive brain changes in children and adolescents with early-onset psychosis: A meta-analysis of longitudinal MRI studies. Schizophr Res 2016; 173:132-139. [PMID: 25556081 DOI: 10.1016/j.schres.2014.12.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/11/2014] [Accepted: 12/15/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies on longitudinal brain volume changes in patients with early-onset psychosis (EOP) are particularly valuable for understanding the neurobiological basis of brain abnormalities associated with psychosis. However, findings have not been consistent across studies in this population. We aimed to conduct a meta-analysis on progressive brain volume changes in children and adolescents with EOP. METHODS A systematic literature search of magnetic resonance imaging (MRI) studies comparing longitudinal brain volume changes in children and adolescents with EOP and healthy controls was conducted. The annualized rates of relative change in brain volume by region of interest (ROI) were used as raw data for the meta-analysis. The effect of age, sex, duration of illness, and specific diagnosis on volume change was also evaluated. RESULTS Five original studies with 156 EOP patients (mean age at baseline MRI in the five studies ranged from 13.3 to 16.6years, 67.31% males) and 163 age- and sex-matched healthy controls, with a mean duration of follow-up of 2.46years (range 2.02-3.40), were included. Frontal gray matter (GM) was the only region in which significant differences in volume change over time were found between patients and controls (Hedges' g -0.435, 95% confidence interval (CI): -0.678 to -0.193, p<0.001). Younger age at baseline MRI was associated with greater loss of temporal GM volume over time in patients as compared with controls (p=0.005). Within patients, a diagnosis of schizophrenia was related to greater occipital GM volume loss over time (p=0.001). CONCLUSIONS Compared with healthy individuals, EOP patients show greater progressive frontal GM loss over the first few years after illness onset. Age at baseline MRI and diagnosis of schizophrenia appear to be significant moderators of particular specific brain volume changes.
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Affiliation(s)
- David Fraguas
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Covadonga M Díaz-Caneja
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Laura Pina-Camacho
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK
| | - Joost Janssen
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain; Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, The Netherlands
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain.
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17
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Pina-Camacho L, Del Rey-Mejías Á, Janssen J, Bioque M, González-Pinto A, Arango C, Lobo A, Sarró S, Desco M, Sanjuan J, Lacalle-Aurioles M, Cuesta MJ, Saiz-Ruiz J, Bernardo M, Parellada M. Age at First Episode Modulates Diagnosis-Related Structural Brain Abnormalities in Psychosis. Schizophr Bull 2016; 42:344-57. [PMID: 26371339 PMCID: PMC4753597 DOI: 10.1093/schbul/sbv128] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Brain volume and thickness abnormalities have been reported in first-episode psychosis (FEP). However, it is unclear if and how they are modulated by brain developmental stage (and, therefore, by age at FEP as a proxy). This is a multicenter cross-sectional case-control brain magnetic resonance imaging (MRI) study. Patients with FEP (n = 196), 65.3% males, with a wide age at FEP span (12-35 y), and healthy controls (HC) (n = 157), matched for age, sex, and handedness, were scanned at 6 sites. Gray matter volume and thickness measurements were generated for several brain regions using FreeSurfer software. The nonlinear relationship between age at scan (a proxy for age at FEP in patients) and volume and thickness measurements was explored in patients with schizophrenia spectrum disorders (SSD), affective psychoses (AFP), and HC. Earlier SSD cases (ie, FEP before 15-20 y) showed significant volume and thickness deficits in frontal lobe, volume deficits in temporal lobe, and volume enlargements in ventricular system and basal ganglia. First-episode AFP patients had smaller cingulate cortex volume and thicker temporal cortex only at early age at FEP (before 18-20 y). The AFP group also had age-constant (12-35-y age span) volume enlargements in the frontal and parietal lobe. Our study suggests that age at first episode modulates the structural brain abnormalities found in FEP patients in a nonlinear and diagnosis-dependent manner. Future MRI studies should take these results into account when interpreting samples with different ages at onset and diagnosis.
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Affiliation(s)
| | - Ángel Del Rey-Mejías
- Ciber del Area de Salud Mental (CIBERSAM), Spain;,Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain;,Department of Methodology, School of Psychology, Universidad Complutense, Madrid, Spain
| | - Joost Janssen
- Ciber del Area de Salud Mental (CIBERSAM), Spain;,Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - Miquel Bioque
- Ciber del Area de Salud Mental (CIBERSAM), Spain;,Barcelona Clínic Schizophrenia Unit, Neurosciences Institute, Hospital Clínic, Barcelona, Spain
| | - Ana González-Pinto
- Ciber del Area de Salud Mental (CIBERSAM), Spain;,Department of Psychiatry, Hospital Universitario de Álava (Sede Santiago), EHU/University of the Basque Country, Vitoria, Spain
| | - Celso Arango
- Ciber del Area de Salud Mental (CIBERSAM), Spain;,Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - Antonio Lobo
- Ciber del Area de Salud Mental (CIBERSAM), Spain;,Department of Medicine and Psychiatry, Hospital Clínico, University of Zaragoza, IIS Aragón, Zaragoza, Spain
| | - Salvador Sarró
- Ciber del Area de Salud Mental (CIBERSAM), Spain;,FIDMAG Hermanas Hospitalarias,Barcelona, Spain
| | - Manuel Desco
- Ciber del Area de Salud Mental (CIBERSAM), Spain;,Department of Bioengineering and Aerospace Engineering, Universidad Carlos III de Madrid, Madrid, Spain;,Medicina y Cirugía Experimental, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain
| | - Julio Sanjuan
- Ciber del Area de Salud Mental (CIBERSAM), Spain;,Department of Psychiatry, Hospital Clinic, University of Valencia, INCLIVA, Valencia, Spain
| | - Maria Lacalle-Aurioles
- Department of Bioengineering and Aerospace Engineering, Universidad Carlos III de Madrid, Madrid, Spain;,Laboratory of Cerebrovascular Research, Montreal Neurological Institute, McGill University, Montréal, Quebec, Canada
| | - Manuel J. Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
| | - Jerónimo Saiz-Ruiz
- Ciber del Area de Salud Mental (CIBERSAM), Spain;,Department of Psychiatry, Hospital Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Miguel Bernardo
- Ciber del Area de Salud Mental (CIBERSAM), Spain;,Barcelona Clínic Schizophrenia Unit, Neurosciences Institute, Hospital Clínic, Barcelona, Spain;,Department of Psychiatry and Clinical Psychobiology, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Mara Parellada
- Ciber del Area de Salud Mental (CIBERSAM), Spain;,Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
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18
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Knöchel C, Stäblein M, Prvulovic D, Ghinea D, Wenzler S, Pantel J, Alves G, Linden DEJ, Harrison O, Carvalho A, Reif A, Oertel-Knöchel V. Shared and distinct gray matter abnormalities in schizophrenia, schizophrenia relatives and bipolar disorder in association with cognitive impairment. Schizophr Res 2016; 171:140-8. [PMID: 26833265 DOI: 10.1016/j.schres.2016.01.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/22/2015] [Accepted: 01/12/2016] [Indexed: 01/01/2023]
Abstract
Cognitive impairments have been linked to structural and functional alterations in frontal and subcortical brain regions, ultimately leading to fronto-thalamic connectivity disturbances. We hypothesized that such neuronal disruptions in frontal and subcortical structures may account for neuropsychological deficits in schizophrenia (SZ), schizophrenia relatives and bipolar disorder (BD). We acquired T1-weighted anatomical MRI sequences in 209 participants: 57 SZ patients, 47 first-degree relatives of SZ patients, 48 BD I patients and 57 healthy controls. We computed group comparisons of gray matter (GM) volume in frontal and basal ganglia regions-of-interest, followed by correlation analysis between psychomotor speed, executive functioning and learning and GM volumes in candidate regions. Several frontal GM volume reductions as well as GM increases in the thalamus and the putamen were exhibited in SZ patients as compared to controls. The same finding was observed - less pronounced - when comparing SZ relatives and controls. BD patients presented GM volume increases in the basal ganglia in comparison to controls. In SZ patients, increases in bilateral thalamus GM volume and decreases in left middle and superior frontal gyrus volume were significantly associated with worse cognitive performance. In summary, our results indicate distinct imbalances across frontal-subcortical circuits in BD, SZ relatives and SZ. The functional relevance of the findings were mainly limited to the SZ patients group: in this group, abnormalities were directly associated with cognitive performance. This result is in line with the finding that the volume alterations were strongest in SZ patients and followed by BD patients and SZ relatives.
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Affiliation(s)
- Christian Knöchel
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany.
| | - Michael Stäblein
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany
| | - David Prvulovic
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Denisa Ghinea
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Sofia Wenzler
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Johannes Pantel
- Institute of General Practice, Goethe University, Frankfurt, Germany
| | - Gilberto Alves
- Translational Psychiatry Research Group, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - David E J Linden
- MRC Centre for Neuropsychiatric Genetics & Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, United Kingdom
| | - Octavia Harrison
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Andre Carvalho
- Translational Psychiatry Research Group, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Andreas Reif
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Viola Oertel-Knöchel
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany
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19
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Zhang Y, Zheng J, Fan X, Guo X, Guo W, Yang G, Chen H, Zhao J, Lv L. Dysfunctional resting-state connectivities of brain regions with structural deficits in drug-naive first-episode schizophrenia adolescents. Schizophr Res 2015; 168:353-9. [PMID: 26281967 DOI: 10.1016/j.schres.2015.07.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 07/05/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Individuals with adolescent-onset schizophrenia (AOS) are a subgroup of patients who present clinical symptoms between 13 and 18years of age. Little is known about neurodevelopmental abnormalities in this patient population. The present study was to examine possible resting-state dysfunctional connectivity of brain regions with altered gray matter volume in AOS. METHODS Gray matter volume was investigated by voxel-based morphometry (VBM) analysis. Resting-state functional connectivity analysis was used to examine the correlations between regions with structural deficits and the remaining regions. RESULTS Thirty-seven first-episode schizophrenia adolescents and 30 healthy controls were enrolled. Compared to the controls, the patients showed significantly decreased gray matter volumes in the right superior temporal gyrus (STG) and middle temporal gyrus (MTG) (ps<0.05). With the right STG as seed, significantly reduced connectivities were found within the frontal-temporal networks in the patient group (ps<0.05). With the right MTG as seed, the patient group showed significantly reduced connectivities in the default-mode networks and visual networks (ps<0.05). Compared to significant correlations in the controls (p=0.02), the patients had no observed correlations between functional connectivity of the right STG and gray matter volume of this region. Significant positive correlations were found between functional connectivity of the right STG with the left middle frontal gyrus and the Positive and Negative Syndrome Scale total scores (p=0.048) after controlling the confounding variables. CONCLUSIONS These findings show dysfunctional resting-state connectivities of the right STG and MTG with decreased gray matter volume in adolescents with AOS, suggesting that neurodevelopmental abnormalities may be present in AOS.
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Affiliation(s)
- Yan Zhang
- Mental Health Institute, The Second Xiangya Hospital of Central South University, Key Laboratory for Mental Health of Hunan Province, Changsha, China; Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Junjie Zheng
- Key Laboratory for NeuroInformation of the Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoduo Fan
- UMass Memorial Medical Center, University of Massachusetts Medical School, MA, USA
| | - Xiaofeng Guo
- Mental Health Institute, The Second Xiangya Hospital of Central South University, Key Laboratory for Mental Health of Hunan Province, Changsha, China
| | - Wenbin Guo
- Mental Health Institute, The Second Xiangya Hospital of Central South University, Key Laboratory for Mental Health of Hunan Province, Changsha, China
| | - Ge Yang
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Huafu Chen
- Key Laboratory for NeuroInformation of the Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Jingping Zhao
- Mental Health Institute, The Second Xiangya Hospital of Central South University, Key Laboratory for Mental Health of Hunan Province, Changsha, China.
| | - Luxian Lv
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.
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20
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Palaniyappan L, Maayan N, Bergman H, Davenport C, Adams CE, Soares‐Weiser K. Voxel-based morphometry for separation of schizophrenia from other types of psychosis in first episode psychosis. Cochrane Database Syst Rev 2015; 2015:CD011021. [PMID: 26252640 PMCID: PMC7104330 DOI: 10.1002/14651858.cd011021.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Schizophrenia is a psychiatric disorder which involves distortions in thought and perception, blunted affect, and behavioural disturbances. The longer psychosis goes unnoticed and untreated, the more severe the repercussions for relapse and recovery. There is some evidence that early intervention services can help, and diagnostic techniques that could contribute to early intervention may offer clinical utility in these situations. The index test being evaluated in this review is the structural magnetic resonance imaging (MRI) analysis technique known as voxel-based morphometry (VBM) that estimates the distribution of grey matter tissue volume across several brain regions. This review is an exploratory examination of the diagnostic 'potential' of VBM for use as an additional tool in the clinical examination of patients with first episode psychosis to establish whether an individual will progress on to developing schizophrenia as opposed to other types of psychosis. OBJECTIVES To determine whether VBM applied to the brain can be used to differentiate schizophrenia from other types of psychosis in participants who have received a clinical diagnosis of first episode psychosis. SEARCH METHODS In December 2013, we updated a previous search (May 2012) of MEDLINE, EMBASE, and PsycInfo using OvidSP. SELECTION CRITERIA We included retrospective and prospective studies that consecutively or randomly selected adolescent and adult participants (< 45 years) with a first episode of psychosis; and that evaluated the diagnostic accuracy of VBM for differentiating schizophrenia from other psychoses compared with a clinical diagnosis made by a qualified mental health professional, with or without the use of standard operational criteria or symptom checklists. We excluded studies in children, and in adult participants with organic brain disorders or who were at high risk for schizophrenia, such as people with a genetic predisposition. DATA COLLECTION AND ANALYSIS Two review authors screened all references for inclusion. We assessed the quality of studies using the QUADAS-2 instrument. Due to a lack of data, we were not able to extract 2 x 2 data tables for each study nor undertake any meta-analysis. MAIN RESULTS We included four studies with a total of 275 participants with first episode psychosis. VBM was not used to diagnose schizophrenia in any of the studies, instead VBM was used to quantify the magnitude of differences in grey matter volume. Therefore, none of the included studies reported data that could be used in the analysis, and we summarised the findings narratively for each study. AUTHORS' CONCLUSIONS There is no evidence to currently support diagnosing schizophrenia (as opposed to other psychotic disorders) using the pattern of brain changes seen in VBM studies in patients with first episode psychosis. VBM has the potential to discriminate between diagnostic categories but the methods to do this reliably are currently in evolution. In addition, the lack of applicability of the use of VBM to clinical practice in the studies to date limits the usefulness of VBM as a diagnostic aid to differentiate schizophrenia from other types of psychotic presentations in people with first episode of psychosis.
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Affiliation(s)
- Lena Palaniyappan
- The University of NottinghamDivison of Psychiatry, Institute of Mental HealthRoom 09, C FloorInnovation Park, Triumph RoadNottinghamUKNG7 2TU
| | - Nicola Maayan
- Enhance Reviews LtdCentral Office, Cobweb BuildingsThe Lane, LyfordWantageUKOX12 0EE
| | - Hanna Bergman
- Enhance Reviews LtdCentral Office, Cobweb BuildingsThe Lane, LyfordWantageUKOX12 0EE
| | - Clare Davenport
- University of BirminghamPublic Health, Epidemiology and BiostatisticsBirminghamUKB15 2TT
| | - Clive E Adams
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthInnovation Park, Triumph Road,NottinghamUKNG7 2TU
| | - Karla Soares‐Weiser
- Enhance Reviews LtdCentral Office, Cobweb BuildingsThe Lane, LyfordWantageUKOX12 0EE
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21
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Lachman A. New developments in diagnosis and treatment update: Schizophrenia/first episode psychosis in children and adolescents. J Child Adolesc Ment Health 2015; 26:109-24. [PMID: 25391710 DOI: 10.2989/17280583.2014.924416] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Childhood onset schizophrenia (COS) is diagnosed before the age of 13 years, and early onset schizophrenia (EOS) is diagnosed before the age of 18 years. EOS is considered extremely rare and its prevalence in comparison to the worldwide prevalence of schizophrenia (1%) has not adequately been studied. Patients who experience the first episode of psychosis need to be treated early and optimally to lessen the morbidity and improve the outcome of the illness. Treatment needs to be a combination of both pharmacological and non-pharmacological modalities. Pharmacological intervention is necessary for remission, improvement of positive symptoms and to aid with the efficacy of psychosocial interventions. There is a lack of efficacy and safety data of the use of antipsychotic medication in children, with most of the information available being extrapolations of adult data. An increased use of atypical antipsychotic drugs in the treatment of EOS has been accompanied by growing concern about the appropriate use and associated side effects in children and adolescents. This update highlights new developments, concepts and treatment trends in EOS.
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Affiliation(s)
- Anusha Lachman
- a Department of Psychiatry , Stellenbosch University , Tygerberg Campus, Parow , South Africa . Author's
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22
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Díaz-Caneja CM, Pina-Camacho L, Rodríguez-Quiroga A, Fraguas D, Parellada M, Arango C. Predictors of outcome in early-onset psychosis: a systematic review. NPJ SCHIZOPHRENIA 2015; 1:14005. [PMID: 27336027 PMCID: PMC4849440 DOI: 10.1038/npjschz.2014.5] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 01/31/2023]
Abstract
Given the global burden of psychotic disorders, the identification of patients with early-onset psychosis (EOP; that is, onset before the age of 18) at higher risk of adverse outcome should be a priority. A systematic search of Pubmed, Embase, and PsycInfo (1980 through August 2014) was performed to identify longitudinal observational studies assessing correlates and/or predictors of clinical, functional, cognitive, and biological outcomes in EOP. Seventy-five studies were included in the review. Using multivariate models, the most replicated predictors of worse clinical, functional, cognitive, and biological outcomes in EOP were premorbid difficulties and symptom severity (especially of negative symptoms) at baseline. Longer duration of untreated psychosis (DUP) predicted worse clinical, functional, and cognitive outcomes. Higher risk of attempting suicide was predicted by greater severity of psychotic illness and of depressive symptoms at the first episode of psychosis. Age at onset and sex were not found to be relevant predictors of outcome in most multivariate models, whereas studies using bivariate analyses yielded inconsistent results. Lower intelligence quotient at baseline predicted lower insight at follow-up, worse functional outcomes, and a diagnostic outcome of schizophrenia. Biological predictors of outcome in EOP have been little studied and have not been replicated. Lower levels of antioxidants at baseline predicted greater brain volume changes and worse cognitive functioning at follow-up, whereas neuroimaging markers such as regional cortical thickness and gray matter volume at baseline predicted remission and better insight at follow-up, respectively. EOP patients with poorer premorbid adjustment and prominent negative symptoms at initial presentation are at risk of poor outcome. They should therefore be the target of careful monitoring and more intensive interventions to address whether the disease course can be modified in this especially severely affected group. Early intervention strategies to reduce DUP may also improve outcome in EOP.
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Affiliation(s)
- Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - Laura Pina-Camacho
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK
| | - Alberto Rodríguez-Quiroga
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - David Fraguas
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
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23
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Ansell BRE, Dwyer DB, Wood SJ, Bora E, Brewer WJ, Proffitt TM, Velakoulis D, McGorry PD, Pantelis C. Divergent effects of first-generation and second-generation antipsychotics on cortical thickness in first-episode psychosis. Psychol Med 2015; 45:515-527. [PMID: 25077698 PMCID: PMC4413868 DOI: 10.1017/s0033291714001652] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 03/19/2014] [Accepted: 06/16/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Whether there are differential effects of first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) on the brain is currently debated. Although some studies report that FGAs reduce grey matter more than SGAs, others do not, and research to date is limited by a focus on schizophrenia spectrum disorders. To address this limitation, this study investigated the effects of medication in patients being treated for first-episode schizophrenia or affective psychoses. METHOD Cortical thickness was compared between 52 first-episode psychosis patients separated into diagnostic (i.e. schizophrenia or affective psychosis) and medication (i.e. FGA and SGA) subgroups. Patients in each group were also compared to age- and sex-matched healthy controls (n = 28). A whole-brain cortical thickness interaction analysis of medication and diagnosis was then performed. Correlations between cortical thickness with antipsychotic dose and psychotic symptoms were examined. RESULTS The effects of medication and diagnosis did not interact, suggesting independent effects. Compared with controls, diagnostic differences were found in frontal, parietal and temporal regions. Decreased thickness in FGA-treated versus SGA-treated groups was found in a large frontoparietal region (p < 0.001, corrected). Comparisons with healthy controls revealed decreased cortical thickness in the FGA group whereas the SGA group showed increases in addition to decreases. In FGA-treated patients cortical thinning was associated with higher negative symptoms whereas increased cortical thickness in the SGA-treated group was associated with lower positive symptoms. CONCLUSIONS Our results suggest that FGA and SGA treatments have divergent effects on cortical thickness during the first episode of psychosis that are independent from changes due to illness.
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Affiliation(s)
- B. R. E. Ansell
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - D. B. Dwyer
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - S. J. Wood
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
- School of Psychology, University of Birmingham, UK
| | - E. Bora
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - W. J. Brewer
- Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria, Australia
| | - T. M. Proffitt
- Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria, Australia
| | - D. Velakoulis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - P. D. McGorry
- Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria, Australia
| | - C. Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
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24
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Rizzutti S, Schuch V, Augusto BM, Coimbra CC, Pereira JPC, Bueno OFA. Neuropsychological Profiles Correlated with Clinical and Behavioral Impairments in a Sample of Brazilian Children with Attention-Deficit Hyperactivity Disorder. Front Psychiatry 2015; 6:163. [PMID: 26635638 PMCID: PMC4661035 DOI: 10.3389/fpsyt.2015.00163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/29/2015] [Indexed: 01/10/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder that implies several-step process, and there is no single test to diagnose both ADHD and associated comorbidities, such as oppositional-defiant disorder (ODD), anxiety disorder, depression, and certain types of learning disabilities. The purpose of the present study was to examine correlations between behavioral and clinical symptoms by administering an extensive neuropsychological battery to a sample of children and adolescents from a developing country. The sample was divided into three groups: non-ADHD, ADHD-non-comorbid, and ADHD + comorbidity. A full neuropsychological battery and clinical assessment found that 105 children met DSM-5 criteria, of whom 46.6% had the predominantly inattentive presentation, 37.3% had combined presentation, and 16% were predominantly hyperactive/impulsive presentation. The internal correlation between neuropsychological tests did not reach statistical significance in the comparison between ADHD and non-ADHD cases (p < 0.17). Clinical ADHD cases, including both + comorbidity and non-comorbid groups, performed substantially worse on continuous performance test (CPT), working memory. Comparing ADHD-non-comorbid and ADHD + comorbidity groups, the latter did significantly worse on inhibitory control, time processing, and the level of perseveration response on CPT indexes, as well as on working memory performance and child behavior checklist (CBCL) tests particularly the CBCL-deficient emotional self-regulation test in the ADHD + comorbidity group. Children diagnosed as ODD or with conduct disorder showed close correlations between clinical CBCL profiles and externalized symptoms. Our findings suggest that ADHD + comorbidity and ADHD non-comorbid cases may be differentiated by a number of neuropsychological measures, such as processing speed, inhibitory control, and working memory, that may reflect different levels of involvement of the hot and cool executive domains, which are more impaired in cases of severe symptomatic-externalized behavior and emotional regulation problems. Therefore, profiles based on clinical and behavioral findings can help clinicians select better strategies for detecting neuropsychological impairment in Brazilian children with ADHD.
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Affiliation(s)
- Sueli Rizzutti
- Psychobiology Department, Universidade Federal de São Paulo , São Paulo , Brazil
| | - Viviane Schuch
- Psychobiology Department, Universidade Federal de São Paulo , São Paulo , Brazil
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25
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Serafini G, Pompili M, Borgwardt S, Houenou J, Geoffroy PA, Jardri R, Girardi P, Amore M. Brain changes in early-onset bipolar and unipolar depressive disorders: a systematic review in children and adolescents. Eur Child Adolesc Psychiatry 2014; 23:1023-41. [PMID: 25212880 DOI: 10.1007/s00787-014-0614-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 08/29/2014] [Indexed: 01/09/2023]
Abstract
Pediatric bipolar disorder (BD) and unipolar disorder (UD) share common symptomatic and functional impairments. Various brain imaging techniques have been used to investigate the integrity of brain white matter (WM) and gray matter (GM) in these disorders. Despite promising preliminary findings, it is still unclear whether these alterations may be considered as common trait markers or may be used to distinguish BD from UD. A systematic literature search of studies between 1980 and September 2013 which reported WM/GM changes in pediatric and adolescent BD/UD, as detected by diffusion tensor imaging and voxel-based analysis was conducted. Of the 34 articles judged as eligible, 17 fulfilled our inclusion criteria and were finally retained in this review. More abnormalities have been documented in the brains of children and adolescents with BD than UD. Reductions in the volume of basal ganglia and the hippocampus appeared more specific for pediatric UD, whereas reduced corpus callosum volume and increased rates of deep WM hyperintensities were more specific for pediatric BD. Seminal papers failed to address the possibility that the differences between unipolar and bipolar samples might be related to illness severity, medication status, comorbidity or diagnosis. UD and BD present both shared and distinctive impairments in the WM and GM compartments. More WM abnormalities have been reported in children and adolescents with bipolar disease than in those with unipolar disease, maybe as a result of a low number of DTI studies in pediatric UD. Future longitudinal studies should investigate whether neurodevelopmental changes are diagnosis-specific.
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Affiliation(s)
- Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, IRCCS San Martino, Largo Rosanna Benzi 10, 16100, Genoa, Italy,
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Janssen J, Alemán-Gómez Y, Schnack H, Balaban E, Pina-Camacho L, Alfaro-Almagro F, Castro-Fornieles J, Otero S, Baeza I, Moreno D, Bargalló N, Parellada M, Arango C, Desco M. Cortical morphology of adolescents with bipolar disorder and with schizophrenia. Schizophr Res 2014; 158:91-9. [PMID: 25085384 DOI: 10.1016/j.schres.2014.06.040] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 05/12/2014] [Accepted: 06/24/2014] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Recent evidence points to overlapping decreases in cortical thickness and gyrification in the frontal lobe of patients with adult-onset schizophrenia and bipolar disorder with psychotic symptoms, but it is not clear if these findings generalize to patients with a disease onset during adolescence and what may be the mechanisms underlying a decrease in gyrification. METHOD This study analyzed cortical morphology using surface-based morphometry in 92 subjects (age range 11-18 years, 52 healthy controls and 40 adolescents with early-onset first-episode psychosis diagnosed with schizophrenia (n=20) or bipolar disorder with psychotic symptoms (n=20) based on a two year clinical follow up). Average lobar cortical thickness, surface area, gyrification index (GI) and sulcal width were compared between groups, and the relationship between the GI and sulcal width was assessed in the patient group. RESULTS Both patients groups showed decreased cortical thickness and increased sulcal width in the frontal cortex when compared to healthy controls. The schizophrenia subgroup also had increased sulcal width in all other lobes. In the frontal cortex of the combined patient group sulcal width was negatively correlated (r=-0.58, p<0.001) with the GI. CONCLUSIONS In adolescents with schizophrenia and bipolar disorder with psychotic symptoms there is cortical thinning, decreased GI and increased sulcal width of the frontal cortex present at the time of the first psychotic episode. Decreased frontal GI is associated with the widening of the frontal sulci which may reduce sulcal surface area. These results suggest that abnormal growth (or more pronounced shrinkage during adolescence) of the frontal cortex represents a shared endophenotype for psychosis.
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Affiliation(s)
- Joost Janssen
- Instituto de Investigación Sanitaria Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr. Esquerdo, 46, 28007 Madrid, Spain; Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain; Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Yasser Alemán-Gómez
- Instituto de Investigación Sanitaria Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr. Esquerdo, 46, 28007 Madrid, Spain; Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Avda. de la Universidad, 30, 28911 Leganés, Madrid, Spain
| | - Hugo Schnack
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Evan Balaban
- Behavioral Neurosciences Program, McGill University, N8-15 Stewart Biological Sciences Building, 1205 Docteur Penfield Avenue, Montreal QC H3A 1B1, Canada
| | - Laura Pina-Camacho
- Instituto de Investigación Sanitaria Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr. Esquerdo, 46, 28007 Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, 16 de Crespigny Park, London SE5 8AF, UK
| | - Fidel Alfaro-Almagro
- Instituto de Investigación Sanitaria Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain
| | - Josefina Castro-Fornieles
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr. Esquerdo, 46, 28007 Madrid, Spain; Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic of Neurosciences, Hospital Clínic Universitari of Barcelona, Villarroel, 170, Barcelona 08036, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Casanovas, 143, Barcelona 08036, Spain
| | - Soraya Otero
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr. Esquerdo, 46, 28007 Madrid, Spain; Child and Adolescent Mental Health Unit, Department of Psychiatry and Psychology, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla nº 25, 39008 Santander, Spain
| | - Inmaculada Baeza
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr. Esquerdo, 46, 28007 Madrid, Spain; Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic of Neurosciences, Hospital Clínic Universitari of Barcelona, Villarroel, 170, Barcelona 08036, Spain
| | - Dolores Moreno
- Instituto de Investigación Sanitaria Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr. Esquerdo, 46, 28007 Madrid, Spain; Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain
| | - Nuria Bargalló
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr. Esquerdo, 46, 28007 Madrid, Spain; Magnetic Resonance Image Core Facility, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain; Image Diagnostic Center, Hospital Clínic, Barcelona, Spain
| | - Mara Parellada
- Instituto de Investigación Sanitaria Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr. Esquerdo, 46, 28007 Madrid, Spain; Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain
| | - Celso Arango
- Instituto de Investigación Sanitaria Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr. Esquerdo, 46, 28007 Madrid, Spain; Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain
| | - Manuel Desco
- Instituto de Investigación Sanitaria Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Dr. Esquerdo, 46, 28007 Madrid, Spain; Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Avda. de la Universidad, 30, 28911 Leganés, Madrid, Spain
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McCarthy MJ, Liang S, Spadoni AD, Kelsoe JR, Simmons AN. Whole brain expression of bipolar disorder associated genes: structural and genetic analyses. PLoS One 2014; 9:e100204. [PMID: 24941232 PMCID: PMC4062532 DOI: 10.1371/journal.pone.0100204] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/22/2014] [Indexed: 11/19/2022] Open
Abstract
Studies of bipolar disorder (BD) suggest a genetic basis of the illness that alters brain function and morphology. In recent years, a number of genetic variants associated with BD have been identified. However, little is known about the associated genes, or brain circuits that rely upon their function. Using an anatomically comprehensive survey of the human transcriptome (The Allen Brain Atlas), we mapped the expression of 58 genes with suspected involvement in BD based upon their relationship to SNPs identified in genome wide association studies (GWAS). We then conducted a meta-analysis of structural MRI studies to identify brain regions that are abnormal in BD. Of 58 BD associated genes, 22 had anatomically distinct expression patterns that could be categorized into one of three clusters (C1–C3). Brain regions with the highest and lowest expression of these genes did not overlap strongly with anatomical sites identified as abnormal by structural MRI except in the parahippocampal gyrus, the inferior/superior temporal gyrus and the cerebellar vermis, regions where overlap was significant. Using the 22 genes in C1–C3 as reference points, additional genes with correlated expression patterns were identified and organized into sets based on similarity. Further analysis revealed that five of these gene sets were significantly associated with BD, suggesting that anatomical expression profile is correlated with genetic susceptibility to BD, particularly for genes in C2. Our data suggest that expression profiles of BD-associated genes do not explain the majority of structural abnormalities observed in BD, but may be useful in identifying new candidate genes. Our results highlight the complex neuroanatomical basis of BD, and reinforce illness models that emphasize impaired brain connectivity.
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Affiliation(s)
- Michael J. McCarthy
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
- * E-mail:
| | - Sherri Liang
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Andrea D. Spadoni
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - John R. Kelsoe
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Alan N. Simmons
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
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Valeiras B, Rosato Siri MV, Codagnone M, Reinés A, Pasquini JM. Gender influence on schizophrenia-relevant abnormalities in a cuprizone demyelination model. Glia 2014; 62:1629-44. [PMID: 24890315 DOI: 10.1002/glia.22704] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 05/08/2014] [Accepted: 05/19/2014] [Indexed: 11/08/2022]
Abstract
The aim of this study was to determine whether early demyelination can impact behavior in young adulthood. For this purpose, albino Wistar rats of either sex were exposed to cuprizone (CPZ) in two different intoxication protocols: one group was intoxicated before weaning (CPZ-BW), from postnatal day 7 (P7) to P21, through maternal milk, whereas the other group was intoxicated after weaning (CPZ-AW), from P21 to P35. After treatment, rats were returned to a normal diet until P90 when behavioral studies were performed. Both treatments produced marked demyelination in the corpus callosum and retraction of cortical myelin fibers. The subsequent normal diet allowed for effective remyelination at P90. Interestingly, CPZ-AW correlated with significant behavioral and neurochemical changes in a gender-dependent manner. CPZ-AW treatment altered both the number of social activities and the latency to the first social interaction in males, while also highly compromising recognition-related activities. In addition, only P90 males treated AW showed a hyperdopaminergic striatum, confirmed by an increase in tyrosine hydroxylase expression and in dopamine levels. Our results suggest that the timing of demyelination significantly influences the development of altered behavior, particularly in adult males.
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Affiliation(s)
- Brenda Valeiras
- Department of Biological Chemistry, IQUIFIB, School of Pharmacy and Biochemistry, University of Buenos Aires, CONICET, Buenos Aires, Argentina
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Arango C, Fraguas D, Parellada M. Differential neurodevelopmental trajectories in patients with early-onset bipolar and schizophrenia disorders. Schizophr Bull 2014; 40 Suppl 2:S138-46. [PMID: 24371326 PMCID: PMC3934406 DOI: 10.1093/schbul/sbt198] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Schizophrenia and bipolar disorders share not only clinical features but also some risk factors such as genetic markers and childhood adversity, while other risk factors such as urbanicity and obstetric complications seem to be specific to schizophrenia. An intriguing question is whether the well-established abnormal neurodevelopment present in many children and adolescents who eventually develop schizophrenia is also present in bipolar patients. The literature on adult bipolar patients is controversial. We report data on a subgroup of patients with pediatric-onset psychotic bipolar disorder who seem to share some developmental trajectories with patients with early-onset schizophrenia. These early-onset psychotic bipolar patients have low intelligence quotient, more neurological signs, reduced frontal gray matter at the time of their first psychotic episode, and greater brain changes than healthy controls in a pattern similar to early-onset schizophrenia cases. However, patients with early-onset schizophrenia seem to have more social impairment, developmental abnormalities (eg, language problems), and lower academic achievement in childhood than early-onset bipolar patients. We suggest that some of these abnormal developmental trajectories are more related to the phenotypic features (eg, early-onset psychotic symptoms) of these 2 syndromes than to categorically defined Diagnostic and Statistical Manual of Mental Disorders disorders.
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Affiliation(s)
- Celso Arango
- *To whom correspondence should be addressed; Hospital General Universitario Gregorio Marañón, Ibiza 43, 28009 Madrid, Spain; tel: 34-914265006; fax: 34-91426004, e-mail:
| | - David Fraguas
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
| | - Mara Parellada
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
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Narvaez JC, Zeni CP, Coelho RP, Wagner F, Pheula GF, Ketzer CR, Trentini CM, Tramontina S, Rohde LA. Does comorbid bipolar disorder increase neuropsychological impairment in children and adolescents with ADHD? BRAZILIAN JOURNAL OF PSYCHIATRY 2014; 36:53-9. [DOI: 10.1590/1516-4446-2013-1085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 07/07/2013] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Luis A. Rohde
- UFRGS, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents
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31
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Argyelan M, Ikuta T, DeRosse P, Braga RJ, Burdick KE, John M, Kingsley PB, Malhotra AK, Szeszko PR. Resting-state fMRI connectivity impairment in schizophrenia and bipolar disorder. Schizophr Bull 2014; 40:100-10. [PMID: 23851068 PMCID: PMC3885301 DOI: 10.1093/schbul/sbt092] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Schizophrenia and bipolar disorder share aspects of phenomenology and neurobiology and thus may represent a continuum of disease. Few studies have compared connectivity across the brain in these disorders or investigated their functional correlates. METHODS We used resting-state functional magnetic resonance imaging to evaluate global and regional connectivity in 32 healthy controls, 19 patients with bipolar disorder, and 18 schizophrenia patients. Patients also received comprehensive neuropsychological and clinical assessments. We computed correlation matrices among 266 regions of interest within the brain, with the primary dependent measure being overall global connectivity strength of each region with every other region. RESULTS Patients with schizophrenia had significantly lower global connectivity compared with healthy controls, whereas patients with bipolar disorder had global connectivity intermediate to and significantly different from those of patients with schizophrenia and healthy controls. Post hoc analyses revealed that compared with healthy controls, both patient groups had significantly lower connectivity in the paracingulate gyrus and right thalamus. Patients with schizophrenia also had significantly lower connectivity in the temporal occipital fusiform cortex, left caudate nucleus, and left thalamus compared with healthy controls. There were no significant differences among the patient groups in any of these regions. Lower global connectivity among all patients was associated with worse neuropsychological and clinical functioning, but these effects were not specific to any patient group. CONCLUSIONS These findings are consistent with the hypothesis that schizophrenia and bipolar disorder may represent a continuum of global disconnectivity in the brain but that regional functional specificity may not be evident.
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Affiliation(s)
- Miklos Argyelan
- *To whom correspondence should be addressed; Psychiatry Research, Zucker Hillside Hospital, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY 11004, US; tel: 718-470-4486, fax: 718-343-1659, e-mail:
| | - Toshikazu Ikuta
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY; ,Psychiatry Research, Zucker Hillside Hospital, North Shore–LIJ Health System, Glen Oaks, NY;
| | - Pamela DeRosse
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY; ,Psychiatry Research, Zucker Hillside Hospital, North Shore–LIJ Health System, Glen Oaks, NY;
| | - Raphael J. Braga
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY; ,Psychiatry Research, Zucker Hillside Hospital, North Shore–LIJ Health System, Glen Oaks, NY;
| | | | - Majnu John
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY; ,Psychiatry Research, Zucker Hillside Hospital, North Shore–LIJ Health System, Glen Oaks, NY;
| | - Peter B. Kingsley
- Department of Radiology, North Shore University Hospital, Manhasset, NY;
| | - Anil K. Malhotra
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY; ,Psychiatry Research, Zucker Hillside Hospital, North Shore–LIJ Health System, Glen Oaks, NY; ,Departments of Psychiatry and Molecular Medicine, Hofstra North Shore–LIJ School of Medicine, Hempstead, NY
| | - Philip R. Szeszko
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY; ,Psychiatry Research, Zucker Hillside Hospital, North Shore–LIJ Health System, Glen Oaks, NY; ,Departments of Psychiatry and Molecular Medicine, Hofstra North Shore–LIJ School of Medicine, Hempstead, NY
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Anderson D, Ardekani BA, Burdick KE, Robinson DG, John M, Malhotra AK, Szeszko PR. Overlapping and distinct gray and white matter abnormalities in schizophrenia and bipolar I disorder. Bipolar Disord 2013; 15:680-93. [PMID: 23796123 PMCID: PMC3762889 DOI: 10.1111/bdi.12096] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 01/13/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Schizophrenia and bipolar disorder may share common neurobiological mechanisms, but few studies have directly compared gray and white matter structure in these disorders. We used diffusion-weighted magnetic resonance imaging and a region of interest based analysis to identify overlapping and distinct gray and white matter abnormalities in 35 patients with schizophrenia and 20 patients with bipolar I disorder in comparison to 56 healthy volunteers. METHODS We examined fractional anisotropy within the white matter and mean diffusivity within the gray matter in 42 regions of interest defined on a probabilistic atlas following non-linear registration of the images to atlas space. RESULTS Patients with schizophrenia had significantly lower fractional anisotropy in temporal (superior temporal and parahippocampal) and occipital (superior and middle occipital) white matter compared to patients with bipolar disorder and healthy volunteers. By contrast, both patient groups demonstrated significantly higher mean diffusivity in frontal (inferior frontal and lateral orbitofrontal) and temporal (superior temporal and parahippocampal) gray matter compared to healthy volunteers, but did not differ from each other. CONCLUSIONS Our study implicates overlapping gray matter frontal and temporal lobe structural alterations in the neurobiology of schizophrenia and bipolar I disorder, but suggests that temporal and occipital lobe white matter deficits may be an additional risk factor for schizophrenia. Our findings may have relevance for future diagnostic classification systems and the identification of susceptibility genes for these disorders.
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Affiliation(s)
- Dana Anderson
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY,The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY
| | - Babak A. Ardekani
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY
| | - Katherine E. Burdick
- Departments of Psychiatry and Neuroscience, Mount Sinai School of Medicine, NY, NY
| | - Delbert G. Robinson
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY,The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Hofstra North Shore – LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - Majnu John
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY,The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY
| | - Anil K. Malhotra
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY,The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Hofstra North Shore – LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - Philip R. Szeszko
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY,The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Hofstra North Shore – LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA
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McClellan J, Stock S. Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry 2013; 52:976-90. [PMID: 23972700 DOI: 10.1016/j.jaac.2013.02.008] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 02/21/2013] [Indexed: 01/16/2023]
Abstract
This Practice Parameter reviews the literature on the assessment and treatment of children and adolescents with schizophrenia. Early-onset schizophrenia is diagnosed using the same criteria as in adults and appears to be continuous with the adult form of the disorder. Clinical standards suggest that effective treatment includes antipsychotic medications combined with psychoeducational, psychotherapeutic, and educational interventions. Since this Practice Parameter was last published in 2001, several controlled trials of atypical antipsychotic agents for early-onset schizophrenia have been conducted. However, studies suggest that many youth with early-onset schizophrenia do not respond adequately to available agents and are vulnerable to adverse events, particularly metabolic side effects. Further research is needed to develop more effective and safer treatments.
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Abstract
This study sought to examine whole brain and regional gray matter (GM) phenotypes across the schizophrenia (SZ)-bipolar disorder psychosis dimension using voxel-based morphometry (VBM 8.0 with DARTEL segmentation/normalization) and semi-automated regional parcellation, FreeSurfer (FS 4.3.1/64 bit). 3T T1 MPRAGE images were acquired from 19 volunteers with schizophrenia (SZ), 16 with schizoaffective disorder (SAD), 17 with psychotic bipolar I disorder (BD-P) and 10 healthy controls (HC). Contrasted with HC, SZ showed extensive cortical GM reductions, most pronounced in fronto-temporal regions; SAD had GM reductions overlapping with SZ, albeit less extensive; and BD-P demonstrated no GM differences from HC. Within the psychosis dimension, BD-P showed larger volumes in fronto-temporal and other cortical/subcortical regions compared with SZ, whereas SAD showed intermediate GM volumes. The two volumetric methodologies, VBM and FS, revealed highly overlapping results for cortical GM, but partially divergent results for subcortical volumes (basal ganglia, amygdala). Overall, these findings suggest that individuals across the psychosis dimension show both overlapping and unique GM phenotypes: decreased GM, predominantly in fronto-temporal regions, is characteristic of SZ but not of psychotic BD-P, whereas SAD display GM deficits overlapping with SZ, albeit less extensive.
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35
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Tang J, Liao Y, Zhou B, Tan C, Liu W, Wang D, Liu T, Hao W, Tan L, Chen X. Decrease in temporal gyrus gray matter volume in first-episode, early onset schizophrenia: an MRI study. PLoS One 2012; 7:e40247. [PMID: 22802957 PMCID: PMC3388989 DOI: 10.1371/journal.pone.0040247] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 06/03/2012] [Indexed: 11/18/2022] Open
Abstract
Background Loss of gray matter has been previously found in early-onset schizophrenic patients. However, there are no consistent findings between studies due to different methods used to measure grey matter volume/density and influences of confounding factors. Methods The volume of gray matter (GM) was measured in 29 first episode early-onset schizophrenia (EOS) and 34 well-matched healthy controls by using voxel-based morphometry (VBM). Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). The correlations between the GM volume and PANSS scores, age of psychosis onset, duration of psychosis, and chlorpromazine (CPZ) equivalent value were investigated. Results Relative to healthy subjects, the patients with first episode EOS showed significantly lower GM volume in the left middle and superior temporal gyrus. The loss of GM volume negatively correlated with PANSS-positive symptoms (p = 0.002), but not with PANSS-negative symptoms, PANSS-general psychopathology, and PANSS-total score. No significant correlation was found between GM volume and age of psychosis onset, duration of psychosis, and CPZ equivalent value. Conclusion Patients with first episode EOS have evidence of reduced GM in the left middle and superior temporal gyrus. Structural abnormalities in the left middle and superior temporal gyrus may contribute to the pathophysiology of schizophrenia.
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Affiliation(s)
- Jinsong Tang
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
| | - Yanhui Liao
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
| | - Bing Zhou
- Department of Radiology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
| | - Changliang Tan
- Department of Radiology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
| | - Weiqing Liu
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
| | - Dong Wang
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
| | - Tieqiao Liu
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
| | - Wei Hao
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
| | - Liwen Tan
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
| | - Xiaogang Chen
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
- * E-mail:
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36
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Fraguas D, Gonzalez-Pinto A, Micó JA, Reig S, Parellada M, Martínez-Cengotitabengoa M, Castro-Fornieles J, Rapado-Castro M, Baeza I, Janssen J, Desco M, Leza JC, Arango C. Decreased glutathione levels predict loss of brain volume in children and adolescents with first-episode psychosis in a two-year longitudinal study. Schizophr Res 2012; 137:58-65. [PMID: 22365149 DOI: 10.1016/j.schres.2012.01.040] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 01/28/2012] [Accepted: 01/29/2012] [Indexed: 02/07/2023]
Abstract
Progressive loss of cortical gray matter (GM), as measured by magnetic resonance imaging, has been described early in the course of first-episode psychosis. This study aims to assess the relationship between oxidative balance and progression of cortical GM changes in a multicenter sample of first-episode early-onset psychosis (EOP) patients from baseline to two-year follow-up. A total of 48 patients (13 females, mean age 15.9±1.5 years) and 56 age- and gender-matched healthy controls (19 females, 15.3±1.5 years) were assessed. Magnetic resonance imaging (MRI) scans performed both at the time of the first psychotic episode and 2 years later were used for volumetric measurements of left and right gray matter regions (frontal, parietal, and temporal lobes) and total sulcal cerebrospinal fluid (CSF). Total glutathione (GSH) blood levels were determined at baseline. In patients, after controlling for possible confounding variables, lower baseline GSH levels were significantly associated with greater volume decrease in left frontal (B=0.034, 95% confidence interval (CI): 0.011 to 0.056, r=0.620, p=0.006), parietal (B=0.039, 95% CI: 0.020 to 0.059, r=0.739, p=0.001), temporal (B=0.026, 95% CI: 0.016 to 0.036, r=0.779, p<0.001), and total (B=0.022, 95% CI: 0.014 to 0.031, r=0.803, p<0.001) gray matter, and with greater increase in total CSF (B=-0.560, 95% CI: -0.270 to -0.850, r=-0.722, p=0.001). Controls did not show significant associations between brain volume changes and GSH levels. GSH deficit during the first psychotic episode was related to greater loss of cortical GM two years later in patients with first-episode EOP, suggesting that oxidative damage may contribute to the progressive loss of cortical GM found in patients with first-episode psychosis.
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Affiliation(s)
- David Fraguas
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
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Selvaraj S, Arnone D, Job D, Stanfield A, Farrow TF, Nugent AC, Scherk H, Gruber O, Chen X, Sachdev PS, Dickstein DP, Malhi GS, Ha TH, Ha K, Phillips ML, McIntosh AM. Grey matter differences in bipolar disorder: a meta-analysis of voxel-based morphometry studies. Bipolar Disord 2012; 14:135-45. [PMID: 22420589 DOI: 10.1111/j.1399-5618.2012.01000.x] [Citation(s) in RCA: 219] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Several neuroimaging studies have reported structural brain differences in bipolar disorder using automated methods. While these studies have several advantages over those using region of interest techniques, no study has yet estimated a summary effect size or tested for between-study heterogeneity. We sought to address this issue using meta-analytic techniques applied for the first time in bipolar disorder at the level of the individual voxel. METHODS A systematic review identified 16 voxel-based morphometry (VBM) studies comparing individuals with bipolar disorder with unaffected controls, of which eight were included in the meta-analysis. In order to take account of heterogeneity, summary effect sizes were computed using a random-effects model with appropriate correction for multiple testing. RESULTS Compared with controls, subjects with bipolar disorder had reduced grey matter in a single cluster encompassing the right ventral prefrontal cortex, insula, temporal cortex, and claustrum. Study heterogeneity was widespread throughout the brain; though the significant cluster of grey matter reduction remained once these extraneous voxels had been removed. We found no evidence of publication bias (Eggers p = 0.63). CONCLUSIONS Bipolar disorder is consistently associated with reductions in right prefrontal and temporal lobe grey matter. Reductions elsewhere may be obscured by clinical and methodological heterogeneity.
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Affiliation(s)
- Sudhakar Selvaraj
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.
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Bora E, Fornito A, Yücel M, Pantelis C. The effects of gender on grey matter abnormalities in major psychoses: a comparative voxelwise meta-analysis of schizophrenia and bipolar disorder. Psychol Med 2012; 42:295-307. [PMID: 21835091 DOI: 10.1017/s0033291711001450] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Recent evidence from genetic and familial studies revitalized the debate concerning the validity of the distinction between schizophrenia and bipolar disorder. Comparing brain imaging findings is an important avenue to examine similarities and differences and, therefore, the validity of the distinction between these conditions. However, in contrast to bipolar disorder, most patient samples in studies of schizophrenia are predominantly male. This a limiting factor for comparing schizophrenia and bipolar disorder since male gender is associated with more severe neurodevelopmental abnormalities, negative symptoms and cognitive deficits in schizophrenia. METHOD We used a coordinate-based meta-analysis technique to compare grey matter (GM) abnormalities in male-dominated schizophrenia, gender-balanced schizophrenia and bipolar disorder samples based on published voxel-based morphometry (VBM) studies. In total, 72 English-language, peer reviewed articles published prior to January 2011 were included. All reports used VBM for comparing schizophrenia or bipolar disorder with controls and reported whole-brain analyses in standard stereotactic space. RESULTS GM reductions were more extensive in male-dominated schizophrenia compared to gender-balanced bipolar disorder and schizophrenia. In gender-balanced samples, GM reductions were less severe. Compared to controls, GM reductions were restricted to dorsal anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex in schizophrenia and ACC and bilateral fronto-insular cortex in bipolar disorder. CONCLUSIONS When gender is controlled, GM abnormalities in bipolar disorder and schizophrenia are mostly restricted to regions that have a role in emotional and cognitive aspects of salience respectively. Dorsomedial and dorsolateral prefrontal cortex were the only regions that showed greater GM reductions in schizophrenia compared to bipolar disorder.
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Affiliation(s)
- E Bora
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, VIC, Australia
| | - A Fornito
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, VIC, Australia
| | - M Yücel
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, VIC, Australia
| | - C Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, VIC, Australia
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Nemati F, Kolb B. Recovery from medial prefrontal cortex injury during adolescence: implications for age-dependent plasticity. Behav Brain Res 2012; 229:168-75. [PMID: 22261018 DOI: 10.1016/j.bbr.2012.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 12/22/2011] [Accepted: 01/02/2012] [Indexed: 10/14/2022]
Abstract
Focal cortical injuries generate various behavioral deficits associated with different morphological changes. The age and the area of the injury determine the nature and extent of recovery represented by the level of performance in various behavioral tasks. Previously, we have shown that motor cortex injury in early (but not late) adolescence leads to behavioral deficits that do not recover spontaneously with time. Considering the fact that the pace of brain maturation differs in different brain areas, we undertook to examine the pattern of spontaneous recovery following medial prefrontal cortex (mPFC) lesion in early or late adolescence. A battery of motor tasks (postural asymmetry, skilled reaching, sunflower seed manipulation, forepaw inhibition in swimming) was used to investigate the pattern of behavioral recovery following mPFC lesions. Golgi-Cox analysis was used to examine dendritic reorganization of the relevant brain areas. The results indicated that rats perform poorly when receiving mPFC injuries in late adolescence in contrast to when they receive the lesion in early adolescence. Almost opposite pattern of recovery following motor cortex and medial prefrontal injuries in early and late adolescence will be discussed as an age-area dependent model for prognosis of brain injury during adolescence.
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Affiliation(s)
- Farshad Nemati
- Department of Neuroscience, University of Lethbridge, 4401 University Drive Lethbridge, Alberta T1K 3M4, Canada.
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Janssen J, Alemán-Gómez Y, Reig S, Schnack HG, Parellada M, Graell M, Moreno C, Moreno D, Mateos-Pérez JM, Udias JM, Arango C, Desco M. Regional specificity of thalamic volume deficits in male adolescents with early-onset psychosis. Br J Psychiatry 2012; 200:30-6. [PMID: 22116979 DOI: 10.1192/bjp.bp.111.093732] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Thalamic volume deficits are associated with psychosis but it is unclear whether the volume reduction is uniformly distributed or whether it is more severe in particular thalamic regions. AIMS To quantify whole and regional thalamic volume in males with early-onset psychosis and healthy male controls. METHOD Brain scans were obtained for 80 adolescents: 46 individuals with early-onset psychosis with a duration of positive symptoms less than 6 months and 34 healthy controls. All participants were younger than 19 years. Total thalamic volumes were assessed using FreeSurfer and FSL-FIRST, group comparisons of regional thalamic volumes were studied with a surface-based approach. RESULTS Total thalamic volume was smaller in participants with early-onset psychosis relative to controls. Regional thalamic volume reduction was most significant in the right anterior mediodorsal area and pulvinar. CONCLUSIONS In males with minimally treated early-onset psychosis, thalamic volume deficits may be most pronounced in the anterior mediodorsal and posterior pulvinar regions, adding strength to findings from post-mortem studies in adults with psychosis.
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Affiliation(s)
- Joost Janssen
- Unidad de Medicina y Cirugía Experimental, Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón and Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
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de Castro-Manglano P, Mechelli A, Soutullo C, Landecho I, Gimenez-Amaya JM, Ortuño F, McGuire P. Structural brain abnormalities in first-episode psychosis: differences between affective psychoses and schizophrenia and relationship to clinical outcome. Bipolar Disord 2011; 13:545-55. [PMID: 22017223 DOI: 10.1111/j.1399-5618.2011.00953.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Several studies have described volumetric brain abnormalities in first-episode psychosis. The extent to which these differ in patients with schizophrenia and affective psychoses, or are related to subsequent clinical outcome, is unclear. We examined volumetric magnetic resonance imaging (MRI) abnormalities in young patients with a first episode of psychosis, and compared these volumetric abnormalities in patients with schizophrenia versus affective psychosis. We then assessed whether baseline MRI abnormalities in the entire sample predicted subsequent clinical outcome. METHODS A total of 28 adolescent patients with first-episode psychosis and 20 age-matched healthy volunteers were scanned using a 1.5 T scanner. MRI data were processed and analysed using voxel-based morphometry (VBM). We assessed clinical outcome three years after the initial scan. RESULTS Patients had smaller grey matter (GM) volumes than controls in frontal, insular, parietal, and cerebellar cortex. Patients with an affective psychosis had greater GM volume in the right posterior cingulate than both controls and patients with schizophrenia, but less GM volume in the left cerebellum and insula. In the sample as a whole, smaller right hippocampus GM volume was associated with poor clinical outcome at three-year follow-up. CONCLUSIONS Volumetric brain abnormalities are evident in young adults presenting with a first episode of both affective psychoses and schizophrenia, but there are also significant differences between these two patient groups. Clinical outcome after the first episode may be related to the severity of volumetric abnormalities at presentation.
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Affiliation(s)
- Pilar de Castro-Manglano
- Section of Neurobiology of Psychosis, NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Instituteof Psychiatry, Kings College London, London, UK.
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Molina V, Galindo G, Cortés B, de Herrera AGS, Ledo A, Sanz J, Montes C, Hernández-Tamames JA. Different gray matter patterns in chronic schizophrenia and chronic bipolar disorder patients identified using voxel-based morphometry. Eur Arch Psychiatry Clin Neurosci 2011; 261:313-22. [PMID: 21188405 DOI: 10.1007/s00406-010-0183-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
Abstract
Gray matter (GM) volume deficits have been described in patients with schizophrenia (Sz) and bipolar disorder (BD), but to date, few studies have directly compared GM volumes between these syndromes with methods allowing for whole-brain comparisons. We have used structural magnetic resonance imaging (MRI) and voxel-based morphometry (VBM) to compare GM volumes between 38 Sz and 19 BD chronic patients. We also included 24 healthy controls. The results revealed a widespread cortical (dorsolateral and medial prefrontal and precentral) and cerebellar deficit as well as GM deficits in putamen and thalamus in Sz when compared to BD patients. Besides, a subcortical GM deficit was shown by Sz and BD groups when compared to the healthy controls, although a putaminal reduction was only evident in the Sz patients. In this comparison, the BD patients showed a limited cortical and subcortical GM deficit. These results support a partly different pattern of GM deficits associated to chronic Sz and chronic BD, with some degree of overlapping.
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Affiliation(s)
- Vicente Molina
- Department of Psychiatry, Hospital Universitario de Salamanca, Paseo de San Vicente, Spain.
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43
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James A, Hough M, James S, Burge L, Winmill L, Nijhawan S, Matthews PM, Zarei M. Structural brain and neuropsychometric changes associated with pediatric bipolar disorder with psychosis. Bipolar Disord 2011; 13:16-27. [PMID: 21320249 DOI: 10.1111/j.1399-5618.2011.00891.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To identify neuropsychological and structural brain changes using a combination of high-resolution structural and diffusion tensor imaging in pediatric bipolar disorder (PBD) with psychosis (presence of delusions and or hallucinations). METHODS We recruited 15 patients and 20 euthymic age- and gender-matched healthy controls. All subjects underwent high-resolution structural and diffusion tensor imaging. Voxel-based morphometry (VBM), tract-based spatial statistics (TBSS), and probabilistic tractography were used to analyse magnetic resonance imaging data. RESULTS The PBD subjects had normal overall intelligence with specific impairments in working memory, executive function, language function, and verbal memory. Reduced gray matter (GM) density was found in the left orbitofrontal cortex, left pars triangularis, right premotor cortex, occipital cortex, right occipital fusiform gyrus, and right crus of the cerebellum. TBSS analysis showed reduced fractional anisotropy (FA) in the anterior corpus callosum. Probabilistic tractography from this cluster showed that this region of the corpus callosum is connected with the prefrontal cortices, including those regions whose density is decreased in PBD. In addition, FA change was correlated with verbal memory and working memory, while more widespread reductions in GM density correlated with working memory, executive function, language function, and verbal memory. CONCLUSIONS The findings suggest widespread cortical changes as well as specific involvement of interhemispheric prefrontal tracts in PBD, which may reflect delayed myelination in these tracts.
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Affiliation(s)
- Anthony James
- Highfield Family and Adolescent Unit, Warneford Hospital Oxford Centre for Functional MRI of the Brain (FMRIB), John Radcliffe Hospital, Oxford GSK Clinical Imaging Centre, Imperial College London, London, UK.
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Chan RCK, Di X, McAlonan GM, Gong QY. Brain anatomical abnormalities in high-risk individuals, first-episode, and chronic schizophrenia: an activation likelihood estimation meta-analysis of illness progression. Schizophr Bull 2011; 37:177-88. [PMID: 19633214 PMCID: PMC3004195 DOI: 10.1093/schbul/sbp073] [Citation(s) in RCA: 240] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The present study reviewed voxel-based morphometry (VBM) studies on high-risk individuals with schizophrenia, patients experiencing their first-episode schizophrenia (FES), and those with chronic schizophrenia. We predicted that gray matter abnormalities would show progressive changes, with most extensive abnormalities in the chronic group relative to FES and least in the high-risk group. METHOD Forty-one VBM studies were reviewed. Eight high-risk studies, 14 FES studies, and 19 chronic studies were analyzed using anatomical likelihood estimation meta-analysis. RESULTS Less gray matter in the high-risk group relative to controls was observed in anterior cingulate regions, left amygdala, and right insula. Lower gray matter volumes in FES compared with controls were also found in the anterior cingulate and right insula but not the amygdala. Lower gray matter volumes in the chronic group were most extensive, incorporating similar regions to those found in FES and high-risk groups but extending to superior temporal gyri, thalamus, posterior cingulate, and parahippocampal gryus. Subtraction analysis revealed less frontotemporal, striatal, and cerebellar gray matter in FES than the high-risk group; the high-risk group had less gray matter in left subcallosal gyrus, left amygdala, and left inferior frontal gyrus compared with FES. Subtraction analysis confirmed lower gray matter volumes through ventral-dorsal anterior cingulate, right insula, left amygdala and thalamus in chronic schizophrenia relative to FES. CONCLUSIONS Frontotemporal brain structural abnormalities are evident in nonpsychotic individuals at high risk of developing schizophrenia. The present meta-analysis indicates that these gray matter abnormalities become more extensive through first-episode and chronic illness. Thus, schizophrenia appears to be a progressive cortico-striato-thalamic loop disorder.
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Affiliation(s)
- Raymond C. K. Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory,Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 4A Datun Road, Beijing 100101, China,Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China,To whom correspondence should be addressed;
| | - Xin Di
- Department of Psychology, Sun Yat-Sen University, Guangzhou, China
| | - Grainne M. McAlonan
- Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region, China,State key laboratory for Brain and Cognitive Sciences, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Qi-yong Gong
- Huaxi MR Research Centre, Department of Radiology, West China Hospital / West China School of Medicine, Sichuan University, Chengdu, China
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Leung M, Cheung C, Yu K, Yip B, Sham P, Li Q, Chua S, McAlonan G. Gray matter in first-episode schizophrenia before and after antipsychotic drug treatment. Anatomical likelihood estimation meta-analyses with sample size weighting. Schizophr Bull 2011; 37:199-211. [PMID: 19759093 PMCID: PMC3004197 DOI: 10.1093/schbul/sbp099] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cerebral morphological abnormalities in schizophrenia may be modulated by treatment, chronicity, and duration of illness. Comparing brain imaging studies of individuals with first-episode schizophrenia and neuroleptic naive (NN-FES) with that of their neuroleptic-treated counterparts (NT-FES) can help to dissect out the effect of these potential confounders. METHODS We used the anatomical likelihood estimation method to compare voxel-based morphometric studies of NN-FES (n = 162 patients) and NT-FES (n = 336 patients) studies. The analysis included a sample size weighting step based on the Liptak-Stouffer method to reflect the greater power of larger studies. RESULTS Patient samples were matched for age, gender, and duration of illness. An extensive network of gray matter deficits in frontal, temporal, insular, striatal, posterior cingulate, and cerebellar regions was detected in the NN-FES samples as compared with healthy controls. Major deficits were detected in the frontal, superior temporal, insular, and parahippocampal regions for the NT-FES group compared with the NN-FES group. In addition, the NT-FES group showed minor deficits in the caudate, cingulate, and inferior temporal regions compared with the NN-FES group. There were no regions with gray matter volumetric excess in the NT-FES group. CONCLUSION Frontal, striato-limbic, and temporal morphological abnormalities are present in the early stage of schizophrenia and are unrelated to the effects of neuroleptic treatment, chronicity, and duration of illness. There may be dynamic effects of treatment on striato-limbic and temporal, but not frontal, regional gray matter volumes of the brain.
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Affiliation(s)
- Meikei Leung
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Charlton Cheung
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kevin Yu
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Benjamin Yip
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Pak Sham
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong,Centre for Reproduction, Development and Growth, The University of Hong Kong
| | - Qi Li
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong,Centre for Reproduction, Development and Growth, The University of Hong Kong
| | - Siew Chua
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong,Centre for Reproduction, Development and Growth, The University of Hong Kong
| | - Grainne McAlonan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong,Centre for Reproduction, Development and Growth, The University of Hong Kong,To whom correspondence should be addressed; tel: +852-28199564, fax: +852-28551345, e-mail:
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Yu K, Cheung C, Leung M, Li Q, Chua S, McAlonan G. Are Bipolar Disorder and Schizophrenia Neuroanatomically Distinct? An Anatomical Likelihood Meta-analysis. Front Hum Neurosci 2010; 4:189. [PMID: 21103008 PMCID: PMC2987512 DOI: 10.3389/fnhum.2010.00189] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 09/22/2010] [Indexed: 11/13/2022] Open
Abstract
Objective: There is renewed debate on whether modern diagnostic classification should adopt a dichotomous or dimensional approach to schizophrenia and bipolar disorder. This study synthesizes data from voxel-based studies of schizophrenia and bipolar disorder to estimate the extent to which these conditions have a common neuroanatomical phenotype. Methods: A post-hoc meta-analytic estimation of the extent to which bipolar disorder, schizophrenia, or both conditions contribute to brain gray matter differences compared to controls was achieved using a novel application of the conventional anatomical likelihood estimation (ALE) method. 19 schizophrenia studies (651 patients and 693 controls) were matched as closely as possible to 19 bipolar studies (540 patients and 745 controls). Result: Substantial overlaps in the regions affected by schizophrenia and bipolar disorder included regions in prefrontal cortex, thalamus, left caudate, left medial temporal lobe, and right insula. Bipolar disorder and schizophrenia jointly contributed to clusters in the right hemisphere, but schizophrenia was almost exclusively associated with additional gray matter deficits (left insula and amygdala) in the left hemisphere. Limitation: The current meta-analytic method has a number of constraints. Importantly, only studies identifying differences between controls and patient groups could be included in this analysis. Conclusion: Bipolar disorder shares many of the same brain regions as schizophrenia. However, relative to neurotypical controls, lower gray matter volume in schizophrenia is more extensive and includes the amygdala. This fresh application of ALE accommodates multiple studies in a relatively unbiased comparison. Common biological mechanisms may explain the neuroanatomical overlap between these major disorders, but explaining why brain differences are more extensive in schizophrenia remains challenging.
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Affiliation(s)
- Kevin Yu
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong Pokfulam, Hong Kong
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47
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van der Schot AC, Vonk R, Brouwer RM, van Baal GCM, Brans RGH, van Haren NEM, Schnack HG, Boomsma DI, Nolen WA, Pol HEH, Kahn RS. Genetic and environmental influences on focal brain density in bipolar disorder. Brain 2010; 133:3080-92. [DOI: 10.1093/brain/awq236] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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48
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Should clinicians engaged in delivering evidence-based child and adolescent mental healthcare be excited about findings from empirical research? Curr Opin Psychiatry 2010; 23:299-303. [PMID: 20495457 DOI: 10.1097/yco.0b013e32833b519b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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El-Sayed M, Steen RG, Poe MD, Bethea TC, Gerig G, Lieberman J, Sikich L. Brain volumes in psychotic youth with schizophrenia and mood disorders. J Psychiatry Neurosci 2010; 35:229-36. [PMID: 20569649 PMCID: PMC2895153 DOI: 10.1503/jpn.090051] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND We sought to test the hypothesis that deficits in grey matter volume are characteristic of psychotic youth with early-onset schizophrenia-spectrum disorders (EOSS) but not of psychotic youth with early-onset mood disorders (EOMD). METHODS We used magnetic resonance imaging to examine brain volume in 24 psychotic youth (13 male, 11 female) with EOSS (n = 12) or EOMD (n = 12) and 17 healthy controls (10 male, 7 female). We measured the volume of grey and white matter using an automated segmentation program. RESULTS After adjustment for age and intracranial volume, whole brain volume was lower in the EOSS patients than in the healthy controls (p = 0.001) and EOMD patients (p = 0.002). The EOSS patients had a deficit in grey matter volume (p = 0.005), especially in the frontal (p = 0.003) and parietal (p = 0.006) lobes, with no significant differences in white matter volume. LIMITATIONS The main limitations of our study were its small sample size and the inclusion of patients with depression and mania in the affective group. CONCLUSION Adolescents with EOSS have grey matter deficits compared with healthy controls and psychotic adolescents with EOMD. Our results suggest that grey matter deficits are not generally associated with psychosis but may be specifically associated with schizophrenia. Larger studies with consistent methods are needed to reconcile the contradictory findings among imaging studies involving psychotic youth.
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Affiliation(s)
| | | | | | | | | | | | - Linmarie Sikich
- Correspondence to: Dr. L. Sikich, Department of Psychiatry, University of North Carolina, Chapel Hill NC 27599-7160; fax 919 966-9646;
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50
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Henze R, Brunner R, Thiemann U, Parzer P, Richterich A, Essig M, Resch F, Stieltjes B. Gray Matter Alterations in First-Admission Adolescents with Schizophrenia. J Neuroimaging 2010; 21:241-6. [DOI: 10.1111/j.1552-6569.2010.00504.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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