Longitudinal changes in neuroanatomy and neural activity in early schizophrenia

Development of network oscillations through adolescence in male and female rats

The primary aim of this research was to study the developmental trajectory of oscillatory synchronization in neural networks of normal healthy rats during adolescence, corresponding to the vulnerable age of schizophrenia prodrome in human. To monitor the development of oscillatory networks through adolescence we used a "pseudo-longitudinal" design. Recordings were performed in terminal experiments under urethane anesthesia, every day from PN32 to PN52 using rats-siblings from the same mother, to reduce individual innate differences between subjects. We found that hippocampal theta power decreased and delta power in prefrontal cortex increased through adolescence, indicating that the oscillations in the two different frequency bands follow distinct developmental trajectories to reach the characteristic oscillatory activity found in adults. Perhaps even more importantly, theta rhythm showed age-dependent stabilization toward late adolescence. Furthermore, sex differences was found in both networks, more prominent in the prefrontal cortex compared with hippocampus. Delta increase was stronger in females and theta stabilization was completed earlier in females, in postnatal days PN41-47, while in males it was only completed in late adolescence. Our finding of a protracted maturation of theta-generating networks in late adolescence is overall consistent with the findings of longitudinal studies in human adolescents, in which oscillatory networks demonstrated a similar pattern of maturation.

Diverse definitions of the early course of schizophrenia-a targeted literature review

Schizophrenia is a debilitating psychiatric disorder and patients experience significant comorbidity, especially cognitive and psychosocial deficits, already at the onset of disease. Previous research suggests that treatment during the earlier stages of disease reduces disease burden, and that a longer time of untreated psychosis has a negative impact on treatment outcomes. A targeted literature review was conducted to gain insight into the definitions currently used to describe patients with a recent diagnosis of schizophrenia in the early course of disease ('early' schizophrenia). A total of 483 relevant English-language publications of clinical guidelines and studies were identified for inclusion after searches of MEDLINE, MEDLINE In-Process, relevant clinical trial databases and Google for records published between January 2005 and October 2015. The extracted data revealed a wide variety of terminology and definitions used to describe patients with 'early' or 'recent-onset' schizophrenia, with no apparent consensus. The most commonly used criteria to define patients with early schizophrenia included experience of their first episode of schizophrenia or disease duration of less than 1, 2 or 5 years. These varied definitions likely result in substantial disparities of patient populations between studies and variable population heterogeneity. Better agreement on the definition of early schizophrenia could aid interpretation and comparison of studies in this patient population and consensus on definitions should allow for better identification and management of schizophrenia patients in the early course of their disease.

The parahippocampal gyrus as a neural marker of early remission in first-episode psychosis: a voxel-based morphometry study

INTRODUCTION

Outcome from psychotic disorders is heterogeneous with poor long-term clinical outcome associated with such markers as decreased internal capsule volume and increased ventricular volumes. No previous study has examined neuroimaging markers in relation to early remission.

METHODS

This neuroimaging study included 68 previously untreated first episode of psychosis (FEP) patients, of whom 28 achieved remission and 40 did not after six months of treatment, and 42 healthy controls. Using voxel-based morphometry (VBM), we set out to determine if specific neural correlates could be identified in FEP patients not achieving remission in a specialized early-intervention service.

RESULTS

Nonremitted patients had significant lower grey matter concentration (GMC) in the parahippocampal gyrus bilaterally compared to remitted patients. A classification model utilizing parahippocampal GMC correctly classified remission status 79% of the time and accounted for 56% of the variance. Moreover, GMC on the left (r=-0.35, p=0.004) and right (r=-0.47, p<0.0001) side correlated with social withdrawal while only the left side correlated with verbal memory (r=0.21, p=0.03).

CONCLUSIONS

Neural markers of early remission are present in first-episode patients. A better understanding of the neural etiology of psychosis and its relationship to outcome may encourage the search for new medications to help improve outcome in relation to the identified brain regions like the parahippocampal gyrus.

Molecular mechanisms underlying glutamatergic dysfunction in schizophrenia: therapeutic implications

Early models for the etiology of schizophrenia focused on dopamine neurotransmission because of the powerful anti-psychotic action of dopamine antagonists. Nevertheless, recent evidence increasingly supports a primarily glutamatergic dysfunction in this condition, where dopaminergic disbalance is a secondary effect. A current model for the pathophysiology of schizophrenia involves a dysfunctional mechanism by which the NMDA receptor (NMDAR) hypofunction leads to a dysregulation of GABA fast- spiking interneurons, consequently disinhibiting pyramidal glutamatergic output and disturbing the signal-to-noise ratio. This mechanism might explain better than other models some cognitive deficits observed in this disease, as well as the dopaminergic alterations and therapeutic effect of anti-psychotics. Although the modulation of glutamate activity has, in principle, great therapeutic potential, a side effect of NMDAR overactivation is neurotoxicity, which accelerates neuropathological alterations in this illness. We propose that metabotropic glutamate receptors can have a modulatory effect over the NMDAR and regulate excitotoxity mechanisms. Therefore, in our view metabotropic glutamate receptors constitute a highly promising target for future drug treatment in this disease.

Voxel-based morphometry in schizophrenia: implications for neurodevelopmental connectivity models, cognition and affect

Voxel-based morphometry (VBM) studies have provided valuable data on the nature and distribution of gray and white matter abnormalities in schizophrenia relative to the whole brain. Most VBM studies have focused on chronic patients, but there are accumulating studies of first-episode schizophrenia and other high-risk groups such as first-degree relatives. This review outlines the evidence from VBM studies of both chronic and first-episode/high-risk groups. The most consistent reduction revealed in chronic patients is in the superior temporal cortex, and in first-episode/high-risk individuals, in frontal brain regions. These findings are reviewed in relation to complementary evidence for neurodevelopmental deviation, and functional associations with both neuroimaging and behavioral measures of general and social cognition.

Dynamic organization of the emotional brain: responsivity, stability, and instability

Models of emotion processing have commonly been formulated as dichotomies such as approach versus avoidance. These models and associated research on evolutionary adaptation, awareness, motivational arousal, and cortical-subcortical brain systems are reviewed. A continuum model of emotional-significance processing is proposed to integrate current dichotomies and reflect the highly interconnected nature of brain systems. This model highlights a spectrum from "mismatches," signifying potential danger, to "matches," signifying safety and the expectation of reward. Subcortical-cortical interactions and autonomic arousal modulation support mismatch and match processing across a temporal continuum from milliseconds (in which processing is automatic and arguably nonconscious) to tenths of a second (in which responses are facilitated and contextual evaluation commences) to minutes and hours (when memory consolidation and neural plasticity occur). Variations at distinct points along this continuum, with contributions from constitutional and genetic factors, may contribute to individual differences in emotional stability and instability in neuropsychiatric disorders.