Insights and treatment options for psychiatric disorders guided by functional MRI

Converging effects of diverse treatment modalities on frontal cortex in schizophrenia: A review of longitudinal functional magnetic resonance imaging studies

OBJECTIVES

A variety of treatment options exist for schizophrenia, but the effects of these treatments on brain function are not clearly understood. To facilitate the development of more effective treatment strategies, it is important to identify how brain function in schizophrenia patients is affected by the diverse therapeutic approaches that are currently available. The aim of the present article is to systematically review the evidence for functional brain changes associated with different treatment modalities for schizophrenia.

METHODS

We searched PubMed for longitudinal functional MRI (fMRI) studies reporting on the effects of antipsychotic medications (APM), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), cognitive remediation therapy (CRT) and cognitive behavioral therapy for psychosis (CBTp) on brain function in schizophrenia.

RESULTS

Thirty six studies fulfilled the inclusion criteria. Functional alterations were observed in diverse brain regions. Across intervention modalities, changes in fMRI parameters were reported most commonly in frontal brain regions including prefrontal cortex, anterior cingulate and inferior frontal cortex.

CONCLUSIONS

We conclude that current treatments for schizophrenia commonly induce functional brain alterations in frontal brain regions. However, interpretability is limited by inconsistency in task and region of interest selection, and failures to replicate. Further task independent fMRI studies examining treatment effects with whole brain analysis are needed to deepen our insights.

Functional magnetic resonance imaging studies in bipolar disorder

Abnormalities in brain activation using functional magnetic resonance imaging (fMRI) during cognitive and emotional tasks have been identified in bipolar disorder patients, in frontal, subcortical and limbic regions. Several studies also indicate that mood state may be differentiated by lateralization of brain activation in fronto-limbic regions. The interpretation of fMRI studies in bipolar disorder is limited by the choice of regions of interest, medication effects, comorbidity, and task performance. These studies suggest that there is a complex alteration in regions important for neural networks underlying cognition and emotional processing in bipolar disorder. However, measuring changes in specific brain regions does not identify how these neural networks are affected. New analytical techniques of fMRI data are needed in order to resolve some of these issues and identify how changes in neural networks relate to cognitive and emotional processing in bipolar disorder.

Paracingulate sulcus morphology and fMRI activation detection in schizophrenia patients

OBJECTIVE

Altered anterior cingulate cortex activity has been consistently detected by functional imaging in schizophrenia patients. In the present study, we hypothesized that the detection of such local hypoactivity varies when the subjects' local gyrification is monitored. Using a group-statistical approach, we investigated whether the presence or absence of a paracingulate sulcus (PCS) does influence the detection of the activation patterns in the cognitive division of the anterior cingulate cortex (ACcd).

METHOD

fMRI data were acquired using an event-related paradigm during a task involving both priming and interference between stimuli. In the fMRI dataset collected from 13 schizophrenia patients and 16 healthy subjects, subgroups were defined according to the presence or absence of a PCS. Regional activations during interference between stimuli were examined in the ACcd of each hemisphere, using for each region of interest both voxel-based random-effects and non-parametric analyses.

RESULTS

ACcd activation was left-sided in healthy subjects with a PCS, and right-sided in healthy subjects devoid of a PCS. ACcd activations were detected bilaterally in schizophrenia patients with a PCS, whereas left ACcd was deactivated in patients without a PCS. Subgroup comparisons revealed no difference between healthy subjects with a PCS and patients with a PCS, whereas in the subgroups devoid of PCS, the patients exhibited a bilateral ACcd hypoactivation relative to healthy subjects.

CONCLUSIONS

PCS presence or absence influences the detection of ACcd activations in group-analysis of schizophrenia patients.

Head motion analysis during cognitive fMRI examination: application in patients with schizophrenia

OBJECTIVES

Functional MRI (fMRI) has become an important imaging modality for analyzing the neural mechanisms underlying schizophrenia. Earlier studies indicate that patients with schizophrenia tend to generate involuntary and unnecessary head motion during visual tasks. Since head motion can deteriorate the quality of fMRI data, an investigation was needed to examine the type and extent of head motion from patients with schizophrenia undergoing fMRI.

METHODS

Patients with schizophrenia and demographically-matched healthy comparison subjects underwent fMRI examination involving visual working memory tasks. We obtained head movement parameters (three translational and three rotational) through mathematical realignment of the volumetric image data, and transformed these parameters into head displacement indices to quantify the subject's head motion in space.

RESULTS

We found no group difference in displacement indices between the two groups. Group comparison of movement parameters indicated that the patient group showed reduced head motion along the superior-inferior direction when compared to healthy individuals.

CONCLUSION

These results suggest that cognitive fMRI examination in patients with schizophrenia can be successfully conducted without the deteriorative effects of head motion.

Review of longitudinal functional neuroimaging studies of drug treatments in patients with schizophrenia

We systematically reviewed twenty-one functional neuroimaging studies that used longitudinal designs to investigate the effects of medication treatments on brain functioning among patients with schizophrenia. The studies reviewed were comprised of functional magnetic resonance imaging and positron emission tomography research using a baseline and at least one follow-up. The present review summarizes the different effects of medication and disease status on brain function, with attention to functional normalization, specific drug effects, and comparisons of typical versus atypical antipsychotics. Particular emphasis is given to methodological limitations in the existing literature, including lack of reliability data, clinical heterogeneity among studies, and inadequate study designs and statistics. Suggestions are made for improving future longitudinal neuroimaging studies of treatment effects in schizophrenia.