Auditory Mismatch Negativity and P300a Elicited by the "Optimal" Multi-feature Paradigm in Early Schizophrenia

Examining the Complex Mismatch Negativity in Early Phase Psychosis Using the Dual Rule Paradigm

Using electroencephalography (EEG) to examine the simple mismatch negativity (MMN), a marker of auditory cortex function, has been of great interest in the exploration of biomarkers for psychotic illness. Despite many studies reporting MMN deficits in chronic schizophrenia, there are inconsistent reports of MMN reductions in the early phases of psychotic illness, suggesting the MMN elicited by traditional paradigms may not be a sensitive enough measure of vulnerability to be used as a biomarker. Recently, a more computationally complex measure of auditory cortex function (the complex mismatch negativity; cMMN) has been hypothesized to provide a more sensitive marker of illness vulnerability. The current study employed a novel dual rule paradigm, in which two pattern rules are established and violated, to examine the cMMN in 14 individuals with early phase psychosis (EPP, < 5 years illness) and 15 healthy controls (HC). Relationships between cMMN waveforms, symptom severity, and measures of functioning were explored. We found reductions of cMMN amplitudes at the site of maximal amplitude in EPP (p = .017) with large effect sizes (Hedges' g = 0.96). This study is an early step in the exploration of the cMMN as a biomarker for psychosis. Our results provide evidence that the dual rule cMMN paradigm shows promise as a method for cMMN elicitation that captures more subtle neurofunctional changes in the early stages of illness.

Duration mismatch negativity under varying deviant conditions in individuals with high schizotypal traits

Background

Although impaired auditory mismatch negativity (MMN) has consistently been found in individuals with schizophrenia, there are few and inconsistent reports on nonclinical individuals with schizotypy. To date, no studies have thoroughly assessed MMN with different degrees of deviant oddballs in nonclinical schizotypal samples. The aim of this study was to examine the extent of duration MMN (dMMN) amplitudes under two deviant duration conditions (large and small) in nonclinical participants with high schizotypal traits.

Methods

An extreme-group design was utilized, in which 63 participants from the schizotypy and control groups were selected from a pool of 1519 young adults using the Schizotypal Personality Questionnaire (SPQ). MMN was measured using passive duration oddball paradigms. Basic demographic information and musical backgrounds were assessed and matched, while depression and anxiety were evaluated and controlled for. The repeated measures analysis of covariance was utilized to evaluate differences in dMMN between groups. The Bonferroni correction was applied for multiple comparisons. Partial correlation and multiple linear regression analyses were conducted to investigate the association between dMMN amplitudes and SPQ scores.

Results

The amplitudes of dMMN at Cz were significantly increased under the large deviance condition in nonclinical schizotypal individuals (F = 4.36, p = .04). Large-deviance dMMN amplitudes at Fz were positively correlated with mild cognitive-perceptual symptoms in the control group (rp = .42, p = .03). However, as schizophrenia-like symptoms worsened and approached the clinical threshold for schizophrenia, small-deviance dMMN amplitudes at Cz showed negative associations with the cognitive-perceptual factor in the schizotypy group (rp = -.40, p = .04).

Conclusion

These results suggest the importance of considering the degree of deviation in duration when implementing the auditory oddball paradigm among nonclinical participants with schizotypal traits. In addition, our findings reveal a potential non-linear relationship between bottom-up auditory processing and the positive dimension of the schizophrenia spectrum.

Development of Biomarkers Potentially Sensitive to Early Psychosis Using Mismatch Negativity (MMN) to Complex Pattern Deviations

Infrequent stimulus deviations from repetitive sequences elicit mismatch negativity (MMN) even passively, making MMN practical for clinical applications. Auditory MMN is typically elicited by a change in one (or more) physical stimulus parameters (eg, pitch, duration). This lower-order simple MMN (sMMN) is impaired in long-term schizophrenia. However, sMMN contains activity from release from stimulus adaptation, clouding its face validity as purely deviance-related. More importantly, it is unreliably reduced in samples of first-episode psychosis, limiting its utility as a biomarker. Complex pattern-deviant MMN (cMMN) tasks, which elicit early and late responses, are based on higher-order abstractions and better isolate deviance detection. Their abstract nature may increase the sensitivity to processing deficits in early psychosis. However, both the early and late cMMNs are small, limiting separation between healthy and psychotic samples. In 29 healthy individuals, we tested a new dual-rule cMMN paradigm to assess additivity of deviance. Sounds alternated lateralization between left and right, and low and high pitches, creating a left-low, right-high alternating pattern. Deviants were a repeated left-low, violating lateralization and pitch patterns. Early and late cMMNs on the dual-rule task were significantly larger than those on the one-rule extra tone cMMN task (P < .05). Further, the dual-rule early cMMN was not significantly smaller than pitch or duration sMMNs (P > .48, .28, respectively). These results demonstrate additivity for cMMN pattern-violating rules. This increase in cMMN amplitude should increase group difference effect size, making it a prime candidate for a biomarker of disease presence at first psychotic episode, and perhaps even prior to the emergence of psychosis.

Mismatch Negativity and Theta Oscillations Evoked by Auditory Deviance in Early Schizophrenia

BACKGROUND

Amplitude reduction of mismatch negativity (MMN), an event-related potential component indexing NMDA receptor-dependent auditory echoic memory and predictive coding, is widely replicated in schizophrenia. Time-frequency analyses of single-trial electroencephalography epochs suggest that theta oscillation abnormalities underlie MMN deficits in schizophrenia. However, this has received less attention in early schizophrenia (ESZ).

METHODS

Patients with ESZ (n = 89), within 5 years of illness onset, and healthy control subjects (n = 105) completed an electroencephalography MMN paradigm (duration-deviant, pitch-deviant, duration + pitch double-deviant). Repeated measures analyses of variance assessed group differences in MMN, theta intertrial phase coherence (ITC), and theta total power from frontocentral electrodes, after normal age adjustment. Group differences were retested after covarying MMN and theta measures.

RESULTS

Relative to healthy control subjects, patients with ESZ showed auditory deviance deficits. Patients with ESZ had MMN deficits for duration-deviants (p = .041), pitch-deviants (ps = .007), and double-deviants (ps < .047). Patients with ESZ had reduced theta ITC for standards (ps < .040) and duration-deviants (ps < .030). Furthermore, patients with ESZ had reduced theta power across deviants at central electrodes (p = .013). MMN group deficits were not fully accounted for by theta ITC and power, and neither were theta ITC group deficits fully accounted for by MMN. Group differences in theta total power were no longer significant after covarying for MMN.

CONCLUSIONS

Patients with ESZ showed reduced MMN and theta total power for all deviant types. Theta ITC showed a relatively specific reduction for duration-deviants. Although MMN and theta ITC were correlated in ESZ, covarying for one did not fully account for deficits in the other, raising the possibility of their sensitivity to dissociable pathophysiological processes.

Correlation of motor-auditory cross-modal and auditory unimodal N1 and mismatch responses of schizophrenic patients and normal subjects: an MEG study

Introduction

It has been suggested that the positive symptoms of schizophrenic patients (hallucinations, delusions, and passivity experience) are caused by dysfunction of their internal and external sensory prediction errors. This is often discussed as related to dysfunction of the forward model that executes self-monitoring. Several reports have suggested that dysfunction of the forward model in schizophrenia causes misattributions of self-generated thoughts and actions to external sources. There is some evidence that the forward model can be measured using the electroencephalography (EEG) and magnetoencephalography (MEG) components such as N1 (m) and mismatch negativity (MMN) (m). The objective in this MEG study is to investigate differences in the N1m and MMNm-like activity generated in motor-auditory cross-modal tasks in normal control (NC) subjects and schizophrenic (SC) patients, and compared that activity with N1m and MMNm in the auditory unimodal task.

Methods

The N1m and MMNm/MMNm-like activity were recorded in 15 SC patients and 12 matched NC subjects. The N1m-attenuation effects and peak amplitude of MMNm/MMNm-like activity of the NC and SC groups were compared. Additionally, correlations between MEG measures (N1m suppression rate, MMNm, and MMNm-like activity) and clinical variables (Positive and Negative Syndrome Scale (PANSS) scores and antipsychotic drug (APD) dosages) in SC patients were investigated.

Results

It was found that (i) there was no significant difference in N1m-attenuation for the NC and SC groups, and that (ii) MMNm in the unimodal task in the SC group was significantly smaller than that in the NC group. Further, the MMNm-like activity in the cross-modal task was smaller than that of the MMNm in the unimodal task in the NC group, but there was no significant difference in the SC group. The PANSS positive symptoms and general psychopathology score were moderately negatively correlated with the amplitudes of the MMNm-like activity, and the APD dosage was moderately negatively correlated with the N1m suppression rate. However, none of these correlations reached statistical significance.

Discussion

The findings suggest that schizophrenic patients perform altered predictive processes differently from healthy subjects in latencies reflecting MMNm, depending on whether they are under forward model generation or not. This may support the hypothesis that schizophrenic patients tend to misattribute their inner experience to external agents, thus leading to the characteristic schizophrenia symptoms.

Reduced duration mismatch negativity elicited by the multi-feature 'optimal' paradigm in early-phase psychosis

BACKGROUND

MMN and P3a are EEG-derived event related potentials that are thought to be prospective biomarkers for schizophrenia and, potentially, early-phase psychosis (EPP).

METHODS

EPP (n = 12) and healthy control (n = 35) participants listened to a multi-feature optimal paradigm with five deviant types (gap, duration, location, intensity, and frequency).

RESULTS

There was a significant amplitude difference between the EPP and HC group with duration MMN (p =.02). No significant amplitude differences between groups were found for the P3a waveform. There were several correlations for the EPP group with the BNSS, SOFAS, and PANSS-general questionnaires. Length of illness was not associated with MMN or P3a.

CONCLUSIONS

The optimal paradigm is suitable for eliciting multiple deviant types within a short amount of time in both clinical and healthy populations. This study confirms duration MMN deficits within an EPP group and that MMN is related to functional outcomes and positive and negative symptomology.

Application of Machine Learning to Diagnostics of Schizophrenia Patients Based on Event-Related Potentials

Schizophrenia is a major psychiatric disorder that significantly reduces the quality of life. Early treatment is extremely important in order to mitigate the long-term negative effects. In this paper, a machine learning based diagnostics of schizophrenia was designed. Classification models were applied to the event-related potentials (ERPs) of patients and healthy subjects performing the visual cued Go/NoGo task. The sample consisted of 200 adult individuals ranging in age from 18 to 50 years. In order to apply the machine learning models, various features were extracted from the ERPs. The process of feature extraction was parametrized through a special procedure and the parameters of this procedure were selected through a grid-search technique along with the model hyperparameters. Feature extraction was followed by sequential feature selection transformation in order to prevent overfitting and reduce the computational complexity. Various models were trained on the resulting feature set. The best model was support vector machines with a sensitivity and specificity of 91% and 90.8%, respectively.

Auditory acuity and musical ability in young adults with high schizotypal traits

BACKGROUND

Despite auditory cognition dysfunction being consistently found in people with schizophrenia, the evidence from non-clinical individuals with schizotypy is rare and inconsistent. No studies thus far have comprehensively assessed the association among auditory perception, musical cognition, and schizotypy in non-clinical samples.

AIM

We aimed to explore abnormalities in auditory skills, from basic perception to musical ability, among individuals with schizotypal traits.

METHOD

An extreme-group design was adopted. Sixty-six participants from the schizotypy and control groups were screened from 1093 young adults using the Schizotypal Personality Questionnaire (SPQ). Auditory acuity was assessed using four auditory discrimination threshold tests, and musical ability was evaluated through the Montreal Battery of Evaluation of Amusia (MBEA). Basic demographic information and musical backgrounds were assessed and matched, and depression, anxiety, and digit-span index were evaluated and controlled.

RESULTS

Elevated sensitivity in auditory perception and improved musical talent were found in young adults with high schizotypal traits. Auditory acuity and musical ability were positively correlated with schizotypy and its factors among participants across groups. A regression analysis in the control group showed that cognitive perceptual scores of SPQ positively predicted auditory temporal sensitivity. The mediation analysis revealed an indirect effect of pure tone duration discrimination between musical rhythmic ability and positive factor of schizotypy.

DISCUSSION

Elevated sensitivity in auditory temporal perception and improved musical talent in young adults with high schizotypy may contribute to explaining the variation of auditory process in the development of schizophrenia-spectrum disorders. It can also help elucidate the association between psychopathology and creativity in auditory modality.

Impairment of novelty-related theta oscillations and P3a in never medicated first-episode psychosis patients

We explored the neurophysiological activity underlying auditory novelty detection in antipsychotic-naive patients with a first episode of psychosis (FEP). Fifteen patients with a non-affective FEP and 13 healthy controls underwent an active involuntary attention task along with an EEG acquisition. Time-frequency representations of power, phase locking, and fronto-parietal connectivity were calculated. The P3a event-related potential was extracted as well. Compared to controls, the FEP group showed reduced theta phase-locking and fronto-parietal connectivity evoked by deviant stimuli. Also, the P3a amplitude was significantly reduced. Moreover, reduced theta connectivity was associated with more severe negative symptoms within the FEP group. Reduced activity (phase-locking and connectivity) of novelty-related theta oscillations, along with P3a reduction, may represent a failure to synchronize large-scale neural populations closely related to fronto-parietal attentional networks, and might be explored as a potential biomarker of disease severity in patients with emerging psychosis, given its association with negative symptoms.

Deficits in Pre-attentive Processing of Spatial Location and Negative Symptoms in Subjects at Clinical High Risk for Schizophrenia

Deficits in mismatch negativity (MMN) generation are among the best-established biomarkers for cognitive dysfunction in schizophrenia and predict conversion to schizophrenia (Sz) among individuals at symptomatic clinical high risk (CHR). Impairments in MMN index dysfunction at both subcortical and cortical components of the early auditory system. To date, the large majority of studies have been conducted using deviants that differ from preceding standards in either tonal frequency (pitch) or duration. By contrast, MMN to sound location deviation has been studied to only a limited degree in Sz and has not previously been examined in CHR populations. Here, we evaluated location MMN across Sz and CHR using an optimized, multi-deviant pattern that included a location-deviant, as defined using interaural time delay (ITD) stimuli along with pitch, duration, frequency modulation (FM) and intensity deviants in a sample of 42 Sz, 33 CHR and 28 healthy control (HC) subjects. In addition, we obtained resting state functional connectivity (rsfMRI) on CHR subjects. Sz showed impaired MMN performance across all deviant types, along with strong correlation between MMN deficits and impaired neurocognitive function. In this sample of largely non-converting CHR subjects, no deficits were observed in either pitch or duration MMN. By contrast, CHR subjects showed significant impairments in location MMN generation particularly over right hemisphere and significant correlation between impaired location MMN and negative symptoms including deterioration of role function. In addition, significant correlations were observed between location MMN and rsfMRI involving brainstem circuits. In general, location detection using ITD stimuli depends upon precise processing within midbrain regions and provides a rapid and robust reorientation of attention. Present findings reinforce the utility of MMN as a pre-attentive index of auditory cognitive dysfunction in Sz and suggest that location MMN may index brain circuits distinct from those indexed by other deviant types.

The Neuronal Basis of Predictive Coding Along the Auditory Pathway: From the Subcortical Roots to Cortical Deviance Detection

In this review, we attempt to integrate the empirical evidence regarding stimulus-specific adaptation (SSA) and mismatch negativity (MMN) under a predictive coding perspective (also known as Bayesian or hierarchical-inference model). We propose a renewed methodology for SSA study, which enables a further decomposition of deviance detection into repetition suppression and prediction error, thanks to the use of two controls previously introduced in MMN research: the many-standards and the cascade sequences. Focusing on data obtained with cellular recordings, we explain how deviance detection and prediction error are generated throughout hierarchical levels of processing, following two vectors of increasing computational complexity and abstraction along the auditory neuraxis: from subcortical toward cortical stations and from lemniscal toward nonlemniscal divisions. Then, we delve into the particular characteristics and contributions of subcortical and cortical structures to this generative mechanism of hierarchical inference, analyzing what is known about the role of neuromodulation and local microcircuitry in the emergence of mismatch signals. Finally, we describe how SSA and MMN are occurring at similar time frame and cortical locations, and both are affected by the manipulation of N-methyl- D-aspartate receptors. We conclude that there is enough empirical evidence to consider SSA and MMN, respectively, as the microscopic and macroscopic manifestations of the same physiological mechanism of deviance detection in the auditory cortex. Hence, the development of a common theoretical framework for SSA and MMN is all the more recommendable for future studies. In this regard, we suggest a shared nomenclature based on the predictive coding interpretation of deviance detection.