1
|
Dheerendra P, Grent-'t-Jong T, Gajwani R, Gross J, Gumley AI, Krishnadas R, Lawrie SM, Schwannauer M, Schultze-Lutter F, Uhlhaas PJ. Intact Mismatch Negativity Responses in Clinical High Risk for Psychosis and First-Episode Psychosis: Evidence From Source-Reconstructed Event-Related Fields and Time-Frequency Data. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:121-131. [PMID: 37778724 DOI: 10.1016/j.bpsc.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/26/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND This study examined whether mismatch negativity (MMN) responses are impaired in participants at clinical high risk for psychosis (CHR-P) and patients with first-episode psychosis (FEP) and whether MMN deficits predict clinical outcomes in CHR-Ps. METHODS Magnetoencephalography data were collected during a duration-deviant MMN paradigm for a group of 116 CHR-P participants, 33 FEP patients (15 antipsychotic-naïve), clinical high risk negative group (n = 38) with substance abuse and affective disorder, and 49 healthy control participants. Analysis of group differences of source-reconstructed event-related fields as well as time-frequency and intertrial phase coherence focused on the bilateral Heschl's gyri and bilateral superior temporal gyri. RESULTS Significant magnetic MMN responses were found across participants in the bilateral Heschl's gyri and bilateral superior temporal gyri. However, MMN amplitude as well as time-frequency and intertrial phase coherence responses were intact in CHR-P participants and FEP patients compared with healthy control participants. Furthermore, MMN deficits were not related to persistent attenuated psychotic symptoms or transitions to psychosis in CHR-P participants. CONCLUSIONS Our data suggest that magnetic MMN responses in magnetoencephalography data are not impaired in early-stage psychosis and may not predict clinical outcomes in CHR-P participants.
Collapse
Affiliation(s)
- Pradeep Dheerendra
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, United Kingdom
| | - Tineke Grent-'t-Jong
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, United Kingdom; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Ruchika Gajwani
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Joachim Gross
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Muenster, Germany
| | - Andrew I Gumley
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Rajeev Krishnadas
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, United Kingdom
| | - Stephen M Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthias Schwannauer
- Department of Clinical Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany; Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Peter J Uhlhaas
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, United Kingdom; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
| |
Collapse
|
2
|
Hamilton HK, Roach BJ, Bachman PM, Belger A, Carrión RE, Duncan E, Johannesen JK, Light GA, Niznikiewicz MA, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, McGlashan TH, Perkins DO, Tsuang MT, Walker EF, Woods SW, Cannon TD, Mathalon DH. Mismatch Negativity in Response to Auditory Deviance and Risk for Future Psychosis in Youth at Clinical High Risk for Psychosis. JAMA Psychiatry 2022; 79:780-789. [PMID: 35675082 PMCID: PMC9178501 DOI: 10.1001/jamapsychiatry.2022.1417] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Importance Although clinical criteria for identifying youth at risk for psychosis have been validated, they are not sufficiently accurate for predicting outcomes to inform major treatment decisions. The identification of biomarkers may improve outcome prediction among individuals at clinical high risk for psychosis (CHR-P). Objective To examine whether mismatch negativity (MMN) event-related potential amplitude, which is deficient in schizophrenia, is reduced in young people with the CHR-P syndrome and associated with outcomes, accounting for effects of antipsychotic medication use. Design, Setting, and Participants MMN data were collected as part of the multisite case-control North American Prodrome Longitudinal Study (NAPLS-2) from 8 university-based outpatient research programs. Baseline MMN data were collected from June 2009 through April 2013. Clinical outcomes were assessed throughout 24 months. Participants were individuals with the CHR-P syndrome and healthy controls with MMN data. Participants with the CHR-P syndrome who developed psychosis (ie, converters) were compared with those who did not develop psychosis (ie, nonconverters) who were followed up for 24 months. Analysis took place between December 2019 and December 2021. Main Outcomes and Measures Electroencephalography was recorded during a passive auditory oddball paradigm. MMN elicited by duration-, pitch-, and duration + pitch double-deviant tones was measured. Results The CHR-P group (n = 580; mean [SD] age, 19.24 [4.39] years) included 247 female individuals (42.6%) and the healthy control group (n = 241; mean age, 20.33 [4.74] years) included 114 female individuals (47.3%). In the CHR-P group, 450 (77.6%) were not taking antipsychotic medication at baseline. Baseline MMN amplitudes, irrespective of deviant type, were deficient in future CHR-P converters to psychosis (n = 77, unmedicated n = 54) compared with nonconverters (n = 238, unmedicated n = 190) in both the full sample (d = 0.27) and the unmedicated subsample (d = 0.33). In the full sample, baseline medication status interacted with group and deviant type indicating that double-deviant MMN, compared with single deviants, was reduced in unmedicated converters compared with nonconverters (d = 0.43). Further, within the unmedicated subsample, deficits in double-deviant MMN were most strongly associated with earlier conversion to psychosis (hazard ratio, 1.40 [95% CI, 1.03-1.90]; P = .03], which persisted over and above positive symptom severity. Conclusions and Relevance This study found that MMN amplitude deficits were sensitive to future psychosis conversion among individuals at risk of CHR-P, particularly those not taking antipsychotic medication at baseline, although associations were modest. While MMN shows limited promise as a biomarker of psychosis onset on its own, it may contribute novel risk information to multivariate prediction algorithms and serve as a translational neurophysiological target for novel treatment development in a subgroup of at-risk individuals.
Collapse
Affiliation(s)
- Holly K. Hamilton
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco
| | - Brian J. Roach
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Peter M. Bachman
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aysenil Belger
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill
| | - Ricardo E. Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Erica Duncan
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jason K. Johannesen
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut
| | - Gregory A. Light
- Department of Psychiatry, University of California, San Diego, La Jolla
- Veterans Affairs San Diego Healthcare System, La Jolla, California
| | - Margaret A. Niznikiewicz
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston
- Veterans Affairs Boston Healthcare System, Brockton, Massachusetts
| | - Jean Addington
- Hotchkiss Brain Institute Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles
- Department of Psychology, University of California, Los Angeles, Los Angeles
| | | | - Barbara A. Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York
| | - Thomas H. McGlashan
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut
| | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill
| | - Ming T. Tsuang
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Elaine F. Walker
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
- Department of Psychology, Emory University, Atlanta, Georgia
| | - Scott W. Woods
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut
| | - Tyrone D. Cannon
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut
- Department of Psychology, Yale University, School of Medicine, New Haven, Connecticut
| | - Daniel H. Mathalon
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco
| |
Collapse
|
3
|
Barros C, Silva CA, Pinheiro AP. Advanced EEG-based learning approaches to predict schizophrenia: Promises and pitfalls. Artif Intell Med 2021; 114:102039. [PMID: 33875158 DOI: 10.1016/j.artmed.2021.102039] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/11/2020] [Accepted: 02/16/2021] [Indexed: 01/10/2023]
Abstract
The complexity and heterogeneity of schizophrenia symptoms challenge an objective diagnosis, which is typically based on behavioral and clinical manifestations. Moreover, the boundaries of schizophrenia are not precisely demarcated from other nosologic categories, such as bipolar disorder. The early detection of schizophrenia can lead to a more effective treatment, improving patients' quality of life. Over the last decades, hundreds of studies aimed at specifying the neurobiological mechanisms that underpin clinical manifestations of schizophrenia, using techniques such as electroencephalography (EEG). Changes in event-related potentials of the EEG have been associated with sensory and cognitive deficits and proposed as biomarkers of schizophrenia. Besides contributing to a more effective diagnosis, biomarkers can be crucial to schizophrenia onset prediction and prognosis. However, any proposed biomarker requires substantial clinical research to prove its validity and cost-effectiveness. Fueled by developments in computational neuroscience, automatic classification of schizophrenia at different stages (prodromal, first episode, chronic) has been attempted, using brain imaging pattern recognition methods to capture differences in functional brain activity. Advanced learning techniques have been studied for this purpose, with promising results. This review provides an overview of recent machine learning-based methods for schizophrenia classification using EEG data, discussing their potentialities and limitations. This review is intended to serve as a starting point for future developments of effective EEG-based models that might predict the onset of schizophrenia, identify subjects at high-risk of psychosis conversion or differentiate schizophrenia from other disorders, promoting more effective early interventions.
Collapse
Affiliation(s)
- Carla Barros
- Center for Research in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Carlos A Silva
- Center for Microelectromechanical Systems (CMEMS), School of Engineering, University of Minho, Guimarães, Portugal
| | - Ana P Pinheiro
- Center for Research in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal; CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal.
| |
Collapse
|
4
|
Hamilton HK, Boos AK, Mathalon DH. Electroencephalography and Event-Related Potential Biomarkers in Individuals at Clinical High Risk for Psychosis. Biol Psychiatry 2020; 88:294-303. [PMID: 32507388 PMCID: PMC8300573 DOI: 10.1016/j.biopsych.2020.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 01/17/2023]
Abstract
Clinical outcomes vary among youths at clinical high risk for psychosis (CHR-P), with approximately 20% progressing to full-blown psychosis over 2 to 3 years and 30% achieving remission. Recent research efforts have focused on identifying biomarkers that precede psychosis onset and enhance the accuracy of clinical outcome prediction in CHR-P individuals, with the ultimate goal of developing staged treatment approaches based on the individual's level of risk. Identifying such biomarkers may also facilitate progress toward understanding pathogenic mechanisms underlying psychosis onset, which may support the development of mechanistically informed early interventions for psychosis. In recent years, electroencephalography-based event-related potential measures with established sensitivity to schizophrenia have gained traction in the study of CHR-P and its clinical outcomes. In this review, we describe the evidence for event-related potential abnormalities in CHR-P and discuss how they inform our understanding of information processing deficits as vulnerability markers for emerging psychosis and as indicators of future outcomes. Among the measures studied, P300 and mismatch negativity are notable because deficits predict conversion to psychosis and/or CHR-P remission. However, the accuracy with which these and other measures predict outcomes in CHR-P has been obscured in the prior literature by the tendency to only report group-level differences, underscoring the need for inclusion of individual predictive accuracy metrics in future studies. Nevertheless, both P300 and mismatch negativity show promise as electrophysiological markers of risk for psychosis, as target engagement measures for clinical trials, and as potential translational bridges between human studies and animal models focused on novel drug development for early psychosis.
Collapse
Affiliation(s)
- Holly K Hamilton
- San Francisco Veterans Affairs Health Care System, San Francisco, California; Department of Psychiatry, University of California, San Francisco, California
| | - Alison K Boos
- San Francisco Veterans Affairs Health Care System, San Francisco, California; Northern California Institute for Research and Education, San Francisco, California
| | - Daniel H Mathalon
- San Francisco Veterans Affairs Health Care System, San Francisco, California; Department of Psychiatry, University of California, San Francisco, California.
| |
Collapse
|
7
|
Savill M, D'Ambrosio J, Cannon TD, Loewy RL. Psychosis risk screening in different populations using the Prodromal Questionnaire: A systematic review. Early Interv Psychiatry 2018; 12:3-14. [PMID: 28782283 PMCID: PMC5812357 DOI: 10.1111/eip.12446] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/18/2017] [Accepted: 03/18/2017] [Indexed: 01/31/2023]
Abstract
AIM Diagnosing individuals at ultra high risk (UHR) for psychosis can improve early access to treatment, and a two-stage model utilizing self-report screening followed by a clinical interview can be accurate and efficient. However, it is currently unclear which screening cut-offs to adopt with different populations. METHODS A systematic review of diagnostic accuracy studies evaluating the Prodromal Questionnaire (PQ) as a preliminary screener for UHR and psychosis was conducted to examine screening effectiveness in different contexts. MedLine, PsycInfo, SCOPUS and ProQuest Dissertations and Abstracts databases were electronically searched, along with a review screen and citation search of key papers. Findings were summarized in a narrative synthesis. RESULTS In total, 14 diagnostic accuracy studies and 45 studies using the PQ as a screening tool for UHR and psychosis were included. In all settings, the 3 different versions of the PQ were all found to accurately identify UHR and full psychosis. Higher cut-off points were required in non-help-seeking samples, relative to general help-seeking populations, which in turn were higher than those needed in samples highly enriched with UHR participants. CONCLUSION The findings support the use of the PQ as a preliminary screening tool for UHR in different settings; however, higher thresholds in lower UHR-prevalence populations are necessary to minimize false positives. Including the distress criteria, rather than just number of symptoms, may improve screening effectiveness. Different thresholds may be appropriate in different contexts depending on the importance of sensitivity vs specificity. Protocol registration: CRD42016033004.
Collapse
Affiliation(s)
- Mark Savill
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Jennifer D'Ambrosio
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Tyrone D Cannon
- Departments of Psychology and Psychiatry, Yale University, New Haven, Connecticut
| | - Rachel L Loewy
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| |
Collapse
|