1
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Sabbah SG, Northoff G. Global neural self-disturbance in schizophrenia: A systematic fMRI review. Schizophr Res 2024; 269:163-173. [PMID: 38820980 DOI: 10.1016/j.schres.2024.05.015] [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: 11/29/2023] [Revised: 04/04/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
There is a general consensus that schizophrenia (SZ) is characterized by major changes in the sense of self. Phenomenological studies suggest that these changes in the sense of self stem from a basic disturbance, hence the term 'basic self-disturbance'. While imaging studies demonstrate changes in various regions during self-focused tasks, the exact neural correlates of such basic self-disturbances remain unclear. If the self-disturbance is indeed basic and thereby underlies all other symptoms, one would expect it to be related to more global rather than local changes in the brain. Testing this hypothesis, we conducted a systematic review of fMRI studies on self in SZ. Our main findings are 1. Abnormal activity related to the self can be observed in a variety of different regions ranging from higher-order transmodal to lower-order unimodal regions, 2. These findings hold true across different tasks including self-reflection, self-referentiality, and self-agency, and 3. The global neural abnormalities related to the self in SZ correspond to all layers of the self, predominantly the mental and exteroceptive self. Such global neural disturbance of self converges well with the basic self-disturbance as described in phenomenology.
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Affiliation(s)
- Sami George Sabbah
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada; The Royal's Institute of Mental Health Research & University of Ottawa, Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, 145 Carling Avenue, Rm. 6435, Ottawa, ON, K1Z 7K4, Canada
| | - Georg Northoff
- The Royal's Institute of Mental Health Research & University of Ottawa, Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, 145 Carling Avenue, Rm. 6435, Ottawa, ON, K1Z 7K4, Canada
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2
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Otte ML, Schmitgen MM, Wolf ND, Kubera KM, Calhoun VD, Fritze S, Geiger LS, Tost H, Seidl UW, Meyer-Lindenberg A, Hirjak D, Wolf RC. Structure/function interrelationships and illness insight in patients with schizophrenia: a multimodal MRI data fusion study. Eur Arch Psychiatry Clin Neurosci 2023; 273:1703-1713. [PMID: 36806586 PMCID: PMC10713778 DOI: 10.1007/s00406-023-01566-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/23/2023] [Indexed: 02/23/2023]
Abstract
Illness insight in schizophrenia (SZ) has an important impact on treatment outcome, integration into society and can vary over the course of the disorder. To deal with and treat reduced or absent illness insight, we need to better understand its functional and structural correlates. Previous studies showed regionally abnormal brain volume in brain areas related to cognitive control and self-reference. However, little is known about associations between illness insight and structural and functional network strength in patients with SZ. This study employed a cross-sectional design to examine structural and functional differences between patients with SZ (n = 74) and healthy controls (n = 47) using structural and resting-state functional magnetic resonance imaging (MRI). Voxel-based morphometry was performed on structural data, and the amplitude of low frequency fluctuations (ALFF) was calculated for functional data. To investigate abnormal structure/function interrelationships and their association with illness insight, we used parallel independent component analysis (pICA). Significant group (SZ vs. HC) differences were detected in distinct structural and functional networks, predominantly comprising frontoparietal, temporal and cerebellar regions. Significant associations were found between illness insight and two distinct structural networks comprising frontoparietal (pre- and postcentral gyrus, inferior parietal lobule, thalamus, and precuneus) and posterior cortical regions (cuneus, precuneus, lingual, posterior cingulate, and middle occipital gyrus). Finally, we found a significant relationship between illness insight and functional network comprising temporal regions (superior temporal gyrus). This study suggests that aberrant structural and functional integrity of neural systems subserving cognitive control, memory and self-reference are tightly coupled to illness insight in SZ.
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Affiliation(s)
- Marie-Luise Otte
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115, Heidelberg, Germany
| | - Mike M Schmitgen
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115, Heidelberg, Germany
| | - Nadine D Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115, Heidelberg, Germany
| | - Katharina M Kubera
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115, Heidelberg, Germany
| | - Vince D Calhoun
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Stefan Fritze
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lena S Geiger
- Department of Psychiatry and Psychotherapy, Research Group Systems Neuroscience in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Research Group Systems Neuroscience in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ulrich W Seidl
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115, Heidelberg, Germany
- Department of Psychiatry and Psychotherapy, SHG-Kliniken Saarbrücken, Saarbrücken, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychiatry and Psychotherapy, Research Group Systems Neuroscience in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Robert Christian Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115, Heidelberg, Germany.
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3
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Kitajima K, Tamura S, Sasabayashi D, Nakajima S, Iwata Y, Ueno F, Takai Y, Takahashi J, Caravaggio F, Mar W, Torres-Carmona E, Noda Y, Gerretsen P, Luca VD, Mimura M, Hirano S, Nakao T, Onitsuka T, Remington G, Graff-Guerrero A, Hirano Y. Decreased cortical gyrification and surface area in the left medial parietal cortex in patients with treatment-resistant and ultratreatment-resistant schizophrenia. Psychiatry Clin Neurosci 2023; 77:2-11. [PMID: 36165228 PMCID: PMC10092309 DOI: 10.1111/pcn.13482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 01/06/2023]
Abstract
AIM Validating the vulnerabilities and pathologies underlying treatment-resistant schizophrenia (TRS) is an important challenge in optimizing treatment. Gyrification and surface area (SA), reflecting neurodevelopmental features, have been linked to genetic vulnerability to schizophrenia. The aim of this study was to identify gyrification and SA abnormalities specific to TRS. METHODS We analyzed 3T magnetic resonance imaging findings of 24 healthy controls (HCs), 20 responders to first-line antipsychotics (FL-Resp), and 41 patients with TRS, including 19 clozapine responders (CLZ-Resp) and 22 FL- and clozapine-resistant patients (patients with ultratreatment-resistant schizophrenia [URS]). The local gyrification index (LGI) and associated SA were analyzed across groups. Diagnostic accuracy was verified by receiver operating characteristic curve analysis. RESULTS Both CLZ-Resp and URS had lower LGI values than HCs (P = 0.041, Hedges g [gH ] = 0.75; P = 0.013, gH = 0.96) and FL-Resp (P = 0.007, gH = 1.00; P = 0.002, gH = 1.31) in the left medial parietal cortex (Lt-MPC). In addition, both CLZ-Resp and URS had lower SA in the Lt-MPC than FL-Resp (P < 0.001, gH = 1.22; P < 0.001, gH = 1.75). LGI and SA were positively correlated in non-TRS (FL-Resp) (ρ = 0.64, P = 0.008) and TRS (CLZ-Resp + URS) (ρ = 0.60, P < 0.001). The areas under the receiver operating characteristic curve for non-TRS versus TRS with LGI and SA in the Lt-MPC were 0.79 and 0.85, respectively. SA in the Lt-MPC was inversely correlated with negative symptoms (ρ = -0.40, P = 0.018) and clozapine plasma levels (ρ = -0.35, P = 0.042) in TRS. CONCLUSION LGI and SA in the Lt-MPC, a functional hub in the default-mode network, were abnormally reduced in TRS compared with non-TRS. Thus, altered LGI and SA in the Lt-MPC might be structural features associated with genetic vulnerability to TRS.
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Affiliation(s)
- Kazutoshi Kitajima
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Tamura
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.,Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Yusuke Iwata
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Fumihiko Ueno
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Yoshifumi Takai
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junichi Takahashi
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Neuropsychiatry, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Fernando Caravaggio
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Wanna Mar
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Edgardo Torres-Carmona
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yoshihiro Noda
- Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Philip Gerretsen
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Vincenzo de Luca
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Masaru Mimura
- Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Shogo Hirano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Onitsuka
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Gary Remington
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yoji Hirano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
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4
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Karpenko O. Compliance and insight as factors of recovery in patients with schizophrenia spectrum disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:41-48. [DOI: 10.17116/jnevro202212201241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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5
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Mäntylä T, Kieseppä T, Suvisaari J, Raij TT. Delineating insight-processing-related functional activations in the precuneus in first-episode psychosis patients. Psychiatry Res Neuroimaging 2021; 317:111347. [PMID: 34403968 DOI: 10.1016/j.pscychresns.2021.111347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/19/2021] [Accepted: 04/18/2021] [Indexed: 11/24/2022]
Abstract
Poor insight is a central characteristic of psychotic disorders, and it has been suggested to result from a general dysfunction in self-reflection. However, brain processing of clinical insight and more general self-reflection has not been directly compared. We compared tasks on (1) self-reflection on psychosis-related mental functioning (clinical insight, in patients only), (2) self-reflection on mental functioning unrelated to psychosis (general metacognition), and (3) semantic control during blood-oxygenation-level-dependent (BOLD) functional magnetic resonance imaging with 19 first-episode psychosis patients and 24 control participants. Arterial-spin-labeling (ASL) images were collected at rest. Clinical insight was evaluated with the Schedule for the Assessment of Insight. In patients, posterosuperior precuneus showed stronger activation during the insight task than during the semantic control task, while anteroinferior precuneus and posterior cingulate cortex (PCC) showed stronger activation during the insight task than during the general metacognition task. No significant group differences in brain activation emerged during the general metacognition task. Although the BOLD measures did not correlate with clinical insight measures, ASL-measured cerebral blood flow (CBF) values did correlate when extracted from the task-selective precuneus/PCC areas: higher CBF correlated with higher clinical insight scores. These results suggest that regions in the posteromedial cortex are selective for clinical insight.
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Affiliation(s)
- Teemu Mäntylä
- Mental Health Team, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland; P.O. Box 13000, FI-00076 Aalto, Finland; Department of Psychology and Logopedics, University of Helsinki, P.O. Box 21, FIN-00014 Helsinki, Finland.
| | - Tuula Kieseppä
- Mental Health Team, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland; Department of Psychiatry, Helsinki University and Helsinki University Hospital, P.O. Box 590, FIN-00029, Helsinki, Finland.
| | - Jaana Suvisaari
- Mental Health Team, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland.
| | - Tuukka T Raij
- Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland; P.O. Box 13000, FI-00076 Aalto, Finland; Department of Psychiatry, Helsinki University and Helsinki University Hospital, P.O. Box 590, FIN-00029, Helsinki, Finland.
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6
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Fu Y, Luo X, Zeng Q, Li K, Zhang T, Li Z, Xu X, Hong L, Chen Y, Zhang M, Liu Z. Effects of Anosognosia on Static and Dynamic Amplitudes of Low-Frequency Fluctuation in Mild Cognitive Impairment. Front Aging Neurosci 2021; 13:705097. [PMID: 35221980 PMCID: PMC8867082 DOI: 10.3389/fnagi.2021.705097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Anosognosia is a significant symptom in patients with mild cognitive impairment (MCI) while the underlying neurological mechanism behind it is still unclear. Methods: A total of 121 subjects were included and classified into three groups, including 39 normal controls (NCs), 42 individuals with MCI without anosognosia (MCI-NA), and 40 individuals with MCI with anosognosia (MCI-A), based on their everyday cognition (ECog) questionnaire (discrepancy score). Resting-state functional MRIs were acquired from all the subjects, and the static amplitudes of low-frequency fluctuation (sALFF) and dynamic ALFF (dALFF) variance were investigated to evaluate the intrinsic functional network strength and stability, respectively, and both were corrected by age, sex, education, and gray matter volume. Eventually, correlation analyses were conducted to explore the relationship between brain activity changes and cognitive status in all the subjects. Results: No significant difference was found between MCI-A and MCI-NA (P > 0.05) in cognitive ability. Regarding intrinsic brain activity, MCI-A had increased sALFF and dALFF variance in the anterior cingulate cortex (ACC) relative to MCI-NA, as well as decreased sALFF and dALFF variance in the precuneus relative to MCI-NA and controls. Moreover, MCI-A had decreased sALFF in the inferior temporal gyrus (ITG) and paracentral lobule (PCL) compared to MCI-NA. Among all the subjects, correlation analyses showed that the sALFF and dALFF variance in the precuneus was related to the Ecog discrepancy score (r = 0.232 and 0.235, respectively), immediate story recall (r = 0.200 and 0.277, respectively), and delayed story recall (r = 0.255 and 0.298, respectively). Conclusion: Alterations of intrinsic brain activation in the ACC and precuneus seem to be associated with the anosognosia symptom in patients with MCI.
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Affiliation(s)
- Yanv Fu
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Luo
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qingze Zeng
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Kaicheng Li
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Tianyi Zhang
- Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Zheyu Li
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaopei Xu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Luwei Hong
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yanxing Chen
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhirong Liu
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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7
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Sendi MSE, Zendehrouh E, Ellis CA, Liang Z, Fu Z, Mathalon DH, Ford JM, Preda A, van Erp TGM, Miller RL, Pearlson GD, Turner JA, Calhoun VD. Aberrant Dynamic Functional Connectivity of Default Mode Network in Schizophrenia and Links to Symptom Severity. Front Neural Circuits 2021; 15:649417. [PMID: 33815070 PMCID: PMC8013735 DOI: 10.3389/fncir.2021.649417] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/24/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Schizophrenia affects around 1% of the global population. Functional connectivity extracted from resting-state functional magnetic resonance imaging (rs-fMRI) has previously been used to study schizophrenia and has great potential to provide novel insights into the disorder. Some studies have shown abnormal functional connectivity in the default mode network (DMN) of individuals with schizophrenia, and more recent studies have shown abnormal dynamic functional connectivity (dFC) in individuals with schizophrenia. However, DMN dFC and the link between abnormal DMN dFC and symptom severity have not been well-characterized. Method: Resting-state fMRI data from subjects with schizophrenia (SZ) and healthy controls (HC) across two datasets were analyzed independently. We captured seven maximally independent subnodes in the DMN by applying group independent component analysis and estimated dFC between subnode time courses using a sliding window approach. A clustering method separated the dFCs into five reoccurring brain states. A feature selection method modeled the difference between SZs and HCs using the state-specific FC features. Finally, we used the transition probability of a hidden Markov model to characterize the link between symptom severity and dFC in SZ subjects. Results: We found decreases in the connectivity of the anterior cingulate cortex (ACC) and increases in the connectivity between the precuneus (PCu) and the posterior cingulate cortex (PCC) (i.e., PCu/PCC) of SZ subjects. In SZ, the transition probability from a state with weaker PCu/PCC and stronger ACC connectivity to a state with stronger PCu/PCC and weaker ACC connectivity increased with symptom severity. Conclusions: To our knowledge, this was the first study to investigate DMN dFC and its link to schizophrenia symptom severity. We identified reproducible neural states in a data-driven manner and demonstrated that the strength of connectivity within those states differed between SZs and HCs. Additionally, we identified a relationship between SZ symptom severity and the dynamics of DMN functional connectivity. We validated our results across two datasets. These results support the potential of dFC for use as a biomarker of schizophrenia and shed new light upon the relationship between schizophrenia and DMN dynamics.
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Affiliation(s)
- Mohammad S E Sendi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United States.,Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States.,Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States
| | - Elaheh Zendehrouh
- Department of Computer Science, Georgia State University, Atlanta, GA, United States
| | - Charles A Ellis
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United States.,Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States
| | - Zhijia Liang
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States
| | - Zening Fu
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States
| | - Daniel H Mathalon
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.,Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
| | - Judith M Ford
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.,Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
| | - Adrian Preda
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, United States
| | - Theo G M van Erp
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, United States
| | - Robyn L Miller
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States.,Department of Computer Science, Georgia State University, Atlanta, GA, United States
| | - Godfrey D Pearlson
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
| | - Jessica A Turner
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States.,Department of Psychology, Neuroscience Institute, Georgia State University, Atlanta, GA, United States
| | - Vince D Calhoun
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United States.,Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States.,Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States.,Department of Computer Science, Georgia State University, Atlanta, GA, United States.,Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States.,Department of Psychology, Neuroscience Institute, Georgia State University, Atlanta, GA, United States
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8
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Shen Z, Yu L, Zhao Z, Jin K, Pan F, Hu S, Li S, Xu Y, Xu D, Huang M. Gray Matter Volume and Functional Connectivity in Hypochondriasis: A Magnetic Resonance Imaging and Support Vector Machine Analysis. Front Hum Neurosci 2020; 14:596157. [PMID: 33343319 PMCID: PMC7738430 DOI: 10.3389/fnhum.2020.596157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/23/2020] [Indexed: 12/19/2022] Open
Abstract
Objective: Patients with hypochondriasis hold unexplainable beliefs and a fear of having a lethal disease, with poor compliances and treatment response to psychotropic drugs. Although several studies have demonstrated that patients with hypochondriasis demonstrate abnormalities in brain structure and function, gray matter volume (GMV) and functional connectivity (FC) in hypochondriasis still remain unclear. Methods: The present study collected T1-weighted and resting-state functional magnetic resonance images from 21 hypochondriasis patients and 22 well-matched healthy controls (HCs). We first analyzed the difference in the GMV between the two groups. We then used the regions showing a difference in GMV between two groups as seeds to perform functional connectivity (FC) analysis. Finally, a support vector machine (SVM) was applied to the imaging data to distinguish hypochondriasis patients from HCs. Results: Compared with the HCs, the hypochondriasis group showed decreased GMV in the left precuneus, and increased GMV in the left medial frontal gyrus. FC analyses revealed decreased FC between the left medial frontal gyrus and cuneus, and between the left precuneus and cuneus. A combination of both GMV and FC in the left precuneus, medial frontal gyrus, and cuneus was able to discriminate the hypochondriasis patients from HCs with a sensitivity of 0.98, specificity of 0.93, and accuracy of 0.95. Conclusion: Our study suggests that smaller left precuneus volumes and decreased FC between the left precuneus and cuneus seem to play an important role of hypochondriasis. Future studies are needed to confirm whether this finding is generalizable to patients with hypochondriasis.
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Affiliation(s)
- Zhe Shen
- Department of Psychiatry, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province, Hangzhou, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Liang Yu
- Department of Anesthesiology and Pain, The Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiyong Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Kangyu Jin
- Department of Psychiatry, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province, Hangzhou, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Fen Pan
- Department of Psychiatry, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province, Hangzhou, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Shaohua Hu
- Department of Psychiatry, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province, Hangzhou, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Shangda Li
- Department of Psychiatry, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province, Hangzhou, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Yi Xu
- Department of Psychiatry, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province, Hangzhou, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Dongrong Xu
- Columbia University and New York State Psychiatric Institute, Riverside Drive, New York, NY, United States
| | - Manli Huang
- Department of Psychiatry, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province, Hangzhou, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
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9
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Kottaram A, Johnston LA, Tian Y, Ganella EP, Laskaris L, Cocchi L, McGorry P, Pantelis C, Kotagiri R, Cropley V, Zalesky A. Predicting individual improvement in schizophrenia symptom severity at 1-year follow-up: Comparison of connectomic, structural, and clinical predictors. Hum Brain Mapp 2020; 41:3342-3357. [PMID: 32469448 PMCID: PMC7375115 DOI: 10.1002/hbm.25020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 01/13/2020] [Accepted: 04/13/2020] [Indexed: 12/25/2022] Open
Abstract
In a machine learning setting, this study aims to compare the prognostic utility of connectomic, brain structural, and clinical/demographic predictors of individual change in symptom severity in individuals with schizophrenia. Symptom severity at baseline and 1-year follow-up was assessed in 30 individuals with a schizophrenia-spectrum disorder using the Brief Psychiatric Rating Scale. Structural and functional neuroimaging was acquired in all individuals at baseline. Machine learning classifiers were trained to predict whether individuals improved or worsened with respect to positive, negative, and overall symptom severity. Classifiers were trained using various combinations of predictors, including regional cortical thickness and gray matter volume, static and dynamic resting-state connectivity, and/or baseline clinical and demographic variables. Relative change in overall symptom severity between baseline and 1-year follow-up varied markedly among individuals (interquartile range: 55%). Dynamic resting-state connectivity measured within the default-mode network was the most accurate single predictor of change in positive (accuracy: 87%), negative (83%), and overall symptom severity (77%) at follow-up. Incorporating predictors based on regional cortical thickness, gray matter volume, and baseline clinical variables did not markedly improve prediction accuracy and the prognostic utility of these predictors in isolation was moderate (<70%). Worsening negative symptoms at 1-year follow-up were predicted by hyper-connectivity and hypo-dynamism within the default-mode network at baseline assessment, while hypo-connectivity and hyper-dynamism predicted worsening positive symptoms. Given the modest sample size investigated, we recommend giving precedence to the relative ranking of the predictors investigated in this study, rather than the prediction accuracy estimates.
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Affiliation(s)
- Akhil Kottaram
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leigh A Johnston
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Brain Centre Imaging Unit, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ye Tian
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Eleni P Ganella
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Cooperative Research Centre for Mental Health, Carlton, Victoria, Australia
| | - Liliana Laskaris
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Neural Engineering, Department of Electrical and Electronic Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Luca Cocchi
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Patrick McGorry
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Cooperative Research Centre for Mental Health, Carlton, Victoria, Australia.,Centre for Neural Engineering, Department of Electrical and Electronic Engineering, The University of Melbourne, Melbourne, Victoria, Australia.,North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia.,Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia
| | - Ramamohanarao Kotagiri
- Department of Computing and Information Systems, The University of Melbourne, Melbourne, Victoria, Australia
| | - Vanessa Cropley
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Hawthorn, Victoria, Australia
| | - Andrew Zalesky
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia
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10
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Alzueta E, Melcón M, Jensen O, Capilla A. The 'Narcissus Effect': Top-down alpha-beta band modulation of face-related brain areas during self-face processing. Neuroimage 2020; 213:116754. [PMID: 32194280 PMCID: PMC7181170 DOI: 10.1016/j.neuroimage.2020.116754] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 12/24/2022] Open
Abstract
Self-related information, such as one's own face, is prioritized by our cognitive system. Whilst recent theoretical developments suggest that this is achieved by an interplay between bottom-up and top-down attentional mechanisms, their underlying neural dynamics are still poorly understood. Furthermore, it is still matter of discussion as to whether these attentional mechanisms are truly self-specific or instead driven by face familiarity. To address these questions, we used EEG to record the brain activity of twenty-five healthy participants whilst identifying their own face, a friend's face and a stranger's face. Time-frequency analysis revealed a greater sustained power decrease in the alpha and beta frequency bands for the self-face, which emerged at late latencies and was maintained even when the face was no longer present. Critically, source analysis showed that this activity was generated in key brain regions for self-face recognition, such as the fusiform gyrus. As in the Myth of Narcissus, our results indicate that one's own face might have the potential to hijack attention. We suggest that this effect is specific to the self and driven by a top-down attentional control mechanism, which might facilitate further processing of personally relevant events.
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Affiliation(s)
- Elisabet Alzueta
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain.
| | - María Melcón
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ole Jensen
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Almudena Capilla
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain.
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11
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Larabi DI, Renken RJ, Cabral J, Marsman JBC, Aleman A, Ćurčić-Blake B. Trait self-reflectiveness relates to time-varying dynamics of resting state functional connectivity and underlying structural connectomes: Role of the default mode network. Neuroimage 2020; 219:116896. [PMID: 32470573 DOI: 10.1016/j.neuroimage.2020.116896] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cognitive insight is defined as the ability to reflect upon oneself (i.e. self-reflectiveness), and to not be overly confident of one's own (incorrect) beliefs (i.e. self-certainty). These abilities are impaired in several disorders, while they are essential for the evaluation and regulation of one's behavior. We hypothesized that cognitive insight is a dynamic process, and therefore examined how it relates to temporal dynamics of resting state functional connectivity (FC) and underlying structural network characteristics in 58 healthy individuals. METHODS Cognitive insight was measured with the Beck Cognitive Insight Scale. FC characteristics were calculated after obtaining four FC states with leading eigenvector dynamics analysis. Gray matter (GM) and DTI connectomes were based on GM similarity and probabilistic tractography. Structural graph characteristics, such as path length, clustering coefficient, and small-world coefficient, were calculated with the Brain Connectivity Toolbox. FC and structural graph characteristics were correlated with cognitive insight. RESULTS Individuals with lower cognitive insight switched more and spent less time in a globally synchronized state. Additionally, individuals with lower self-reflectiveness spent more time in, had a higher probability of, and had a higher chance of switching to a state entailing default mode network (DMN) areas. With lower self-reflectiveness, DTI-connectomes were segregated less (i.e. lower global clustering coefficient) with lower embeddedness of the left angular gyrus specifically (i.e. lower local clustering coefficient). CONCLUSIONS Our results suggest less stable functional and structural networks in individuals with poorer cognitive insight, specifically self-reflectiveness. An overly present DMN appears to play a key role in poorer self-reflectiveness.
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Affiliation(s)
- Daouia I Larabi
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, Groningen, the Netherlands; Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Remco J Renken
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, Groningen, the Netherlands
| | - Joana Cabral
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
| | - Jan-Bernard C Marsman
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, Groningen, the Netherlands
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, Groningen, the Netherlands; University of Groningen, Department of Psychology, Groningen, the Netherlands
| | - Branislava Ćurčić-Blake
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, Groningen, the Netherlands
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12
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Xu P, Klaasen NG, Opmeer EM, Pijnenborg GHM, van Tol MJ, Liemburg EJ, Aleman A. Intrinsic mesocorticolimbic connectivity is negatively associated with social amotivation in people with schizophrenia. Schizophr Res 2019; 208:353-359. [PMID: 30711314 DOI: 10.1016/j.schres.2019.01.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/15/2019] [Accepted: 01/20/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Social amotivation is a core element of the negative symptoms of schizophrenia. However, it is still largely unknown which neural substrates underpin social amotivation in people with schizophrenia, though deficiencies in the mesocorticolimbic dopamine system have been proposed. METHODS We examined the association between social amotivation and substantia nigra/ventral tegmental area-seeded intrinsic connectivity in 84 people with schizophrenia using resting state functional magnetic resonance imaging. RESULTS Spontaneous fluctuations of midbrain dopaminergic regions were positively associated with striatal and prefrontal fluctuations in people with schizophrenia. Most importantly, social amotivation was negatively associated with functional connectivity between the midbrain's substantia nigra/ventral tegmental area and medial- and lateral prefrontal cortex, the temporoparietal junction, and dorsal and ventral striatum. These associations were observed independently of depressive and positive symptoms. CONCLUSIONS Our findings suggest that social amotivation in people with schizophrenia is associated with altered intrinsic connectivity of mesocorticolimbic pathways linked to cognitive control and reward processing. Dysconnectivity of dopaminergic neuronal ensembles that are fundamental to approach behavior and motivation may help explain the lack of initiative social behavior in people with social amotivation.
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Affiliation(s)
- Pengfei Xu
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen, China; Center for Neuroimaging, Shenzhen Institute of Neuroscience, Shenzhen, China; Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Nicky G Klaasen
- Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Esther M Opmeer
- Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Health and Social Work, University of applied sciences Windesheim, Zwolle, the Netherlands
| | - Gerdina H M Pijnenborg
- Department of Psychology, University of Groningen, the Netherlands; Department of Psychotic Disorders, GGZ Drenthe, Assen, the Netherlands
| | - Marie-José van Tol
- Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Edith J Liemburg
- Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - André Aleman
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen, China; Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Psychology, University of Groningen, the Netherlands
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13
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Damme KSF, Pelletier-Baldelli A, Cowan HR, Orr JM, Mittal VA. Distinct and opposite profiles of connectivity during self-reference task and rest in youth at clinical high risk for psychosis. Hum Brain Mapp 2019; 40:3254-3264. [PMID: 30941844 DOI: 10.1002/hbm.24595] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
Self-reference is impaired in psychotic disorders such as schizophrenia, associated with disability, and closely related to characteristic patterns of aberrant brain connectivity. However, at present, it is unclear whether self-reference is impacted in pathogenesis of the disorder. Alterations in connectivity during a self-reference task or resting-state in the psychosis risk (i.e., prodromal) period may yield important clues for biomarker development, as well as for novel treatment targets. This study examined a task-based and resting-state functional magnetic resonance imaging in individuals at clinical high risk (CHR) for psychosis (n = 22) and healthy control unaffected peers (n = 20). The self-reference task comprised three task conditions where subjects were asked if an adjective was relevant to themselves (self), a designated other individual (other), or to evaluate the word's spelling (letter). Connectivity analyses examined medial prefrontal cortex (mPFC) and posterior cingulate cortex (PCC), regions commonly found in conjunction analyses of self-reference, during both the self-reference task and rest. In task connectivity analyses, CHR individuals exhibited decreased mPFC-PCC connectivity when compared to controls. In resting-state analyses, CHR participants showed greater mPFC-PCC connectivity. Taken together, results suggest that psychosis-like alterations in mPFC-PCC connectivity is present prior to psychosis onset across both task and rest.
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Affiliation(s)
| | | | - Henry R Cowan
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Joseph M Orr
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas.,Texas A&M Institute for Neuroscience, Texas A&M University, College Station, Texas
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois.,Department of Psychiatry, Northwestern University, Chicago, Illinois.,Medical Social Sciences, Northwestern University, Chicago, Illinois.,Institute for Policy Research (IPR), Northwestern University, Chicago, Illinois.,Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston, Illinois
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14
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Tordesillas-Gutierrez D, Ayesa-Arriola R, Delgado-Alvarado M, Robinson JL, Lopez-Morinigo J, Pujol J, Dominguez-Ballesteros ME, David AS, Crespo-Facorro B. The right occipital lobe and poor insight in first-episode psychosis. PLoS One 2018; 13:e0197715. [PMID: 29856773 PMCID: PMC5983855 DOI: 10.1371/journal.pone.0197715] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/02/2018] [Indexed: 12/12/2022] Open
Abstract
Lack of insight is a core feature of non-affective psychosis and has been associated with poorer outcomes. Brain abnormalities underlying lack of insight have been suggested, mostly in the frontal lobe, although previous research showed mixed results. We used a voxel-based morphometry (VBM) analysis in 108 first-episode non-affective psychosis patients to investigate the pattern of brain structural abnormalities related to lack of insight. In addition, 77 healthy volunteers were compared with the patients classified as having poor and good insight. The shortened version of the Scale to Assess Unawareness of Mental Disorder was used to evaluate insight. Patients with poor insight (n = 68) compared with patients with good insight (n = 40) showed a single significant cluster (kc = 5834; PcFWE = 0.001) of reduced grey matter volume (GMV) in the right occipital lobe extending to its lateral and medial surfaces, the cuneus, and the middle temporal gyrus. In addition, GMV at this cluster showed a negative correlation with the score of the SUMD (r = -0.305; p = 0.001). When comparing patients with poor insight with healthy subjects overall reductions of GMV were found, mainly in frontal and occipital lobes. Hence, poor insight in non-affective psychosis seems to be associated with specific brain abnormalities in the right occipital and temporal cortical regions. Dysfunction in any combination of these areas may contribute to lack of insight in non-affective psychosis. Specifically, the 'right' hemisphere dysfunction underlying impaired insight in our sample is consistent with previously reported similarities between lack of insight in psychosis and anosognosia in neurological disorders.
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Affiliation(s)
- Diana Tordesillas-Gutierrez
- Neuroimaging Unit, Technological Facilities,Valdecilla Biomedical Research Institute IDIVAL, Santander, Cantabria, Spain
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Santander, Spain
- * E-mail:
| | - Rosa Ayesa-Arriola
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Santander, Spain
- Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain
| | - Manuel Delgado-Alvarado
- Neuroimaging Unit, Technological Facilities,Valdecilla Biomedical Research Institute IDIVAL, Santander, Cantabria, Spain
| | - Jennifer L. Robinson
- Department of Psychology, Auburn University, Auburn, Alabama, United States of America
- Department of Electrical and Computer Engineering, Auburn University, Auburn University Magnetic Resonance Imaging Research Center, Auburn, Alabama, United States of America
- Department of Kinesiology, Auburn University, Auburn, Alabama, United States of America
| | - Javier Lopez-Morinigo
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Jesus Pujol
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Santander, Spain
- MRI Research Unit, Hospital del Mar, Barcelona, Spain
| | | | - Anthony S. David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Benedicto Crespo-Facorro
- CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Santander, Spain
- Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain
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15
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Clark SV, Mittal VA, Bernard JA, Ahmadi A, King TZ, Turner JA. Stronger default mode network connectivity is associated with poorer clinical insight in youth at ultra high-risk for psychotic disorders. Schizophr Res 2018; 193:244-250. [PMID: 28688741 PMCID: PMC5756141 DOI: 10.1016/j.schres.2017.06.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/09/2017] [Accepted: 06/22/2017] [Indexed: 12/22/2022]
Abstract
Impaired clinical insight (CI) is a common symptom of psychotic disorders and a promising treatment target. However, to date, our understanding of how variability in CI is tied to underlying brain dysfunction in the clinical high-risk period is limited. Developing a stronger conception of this link will be a vital first step for efforts to determine if CI can serve as a useful prognostic indicator. The current study investigated whether variability in CI is related to major brain networks in adolescents and young adults at ultra high-risk (UHR) of developing psychosis. Thirty-five UHR youth were administered structured clinical interviews as well as an assessment for CI and underwent resting-state magnetic resonance imaging scans. Functional connectivity was calculated in the default mode network (DMN) and fronto-parietal network (FPN), two major networks that are dysfunctional in psychosis and are hypothesized to affect insight. Greater DMN connectivity between the posterior cingulate/precuneus and ventromedial prefrontal cortex (DMN) was related to poorer CI (R2=0.399). There were no significant relationships between insight and the FPN. This is the first study to relate a major brain network to clinical insight before the onset of psychosis. Findings are consistent with evidence if a hyperconnected DMN in schizophrenia and UHR, and similar to a previous study of insight and connectivity in schizophrenia. Results suggest that a strongly connected DMN may be related to poor self-awareness of subthreshold psychotic symptoms in UHR adolescents and young adults.
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Affiliation(s)
- Sarah V Clark
- Georgia State University, Department of Psychology, Atlanta, GA, USA.
| | - Vijay A Mittal
- Northwestern University, Department of Psychology, Evanston, Chicago, IL, USA; Northwestern University, Department of Psychiatry, Evanston, Chicago, IL, USA; Northwestern University, Institute for Policy Research, Evanston, Chicago, IL, USA; Northwestern University, Department of Medical Social Sciences, Evanston, Chicago, IL, USA
| | - Jessica A Bernard
- Texas A&M University, Department of Psychology, College Station, TX, USA
| | - Aral Ahmadi
- Georgia State University, Department of Psychology, Atlanta, GA, USA
| | - Tricia Z King
- Georgia State University, Department of Psychology, Atlanta, GA, USA
| | - Jessica A Turner
- Georgia State University, Department of Psychology, Atlanta, GA, USA; The Mind Research Network, Albuquerque, NM, USA
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16
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Shad MU. What do we know about insight into illness and its association with the underlying biology of schizophrenia? Schizophr Res 2018; 193:41-42. [PMID: 28864282 DOI: 10.1016/j.schres.2017.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/09/2017] [Accepted: 08/13/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Mujeeb U Shad
- Oregon Heath & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States; Oregon State Hospital, 2600 Center Street NE, Salem, OR 97301, United States.
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17
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Abstract
BACKGROUND Insight in schizophrenia is defined as awareness into illness, symptoms, and need for treatment and has long been associated with cognition, other psychopathological symptoms, and several adverse clinical and functional outcomes. However, the biological basis of insight is not clearly understood. OBJECTIVE The aim of this systematic review was to critically evaluate and summarize advances in the study of the biological basis of insight in schizophrenia and to identify gaps in this knowledge. METHODS A literature search of PubMed, CINAHL, PsycINFO, and EMBASE databases was conducted using search terms to identify articles relevant to the biology of insight in schizophrenia published in the last 6 years. Articles that focused on etiology of insight in schizophrenia and those that examined the neurobiology of insight in schizophrenia or psychoses were chosen for analysis. Articles on insight in conditions other than schizophrenia or psychoses and which did not investigate the neurobiological underpinnings of insight were excluded from the review. RESULTS Twenty-six articles met the inclusion criteria for this review. Of the 26 articles, 3 focused on cellular abnormalities and 23 were neuroimaging studies. Preliminary data identify the prefrontal cortex, cingulate cortex, and regions of the temporal and parietal lobe (precuneus, inferior parietal lobule) and hippocampus as the neural correlates of insight. DISCUSSION A growing body of literature attests to the neurobiological basis of insight in schizophrenia. Current evidence supports the neurobiological basis of insight in schizophrenia and identifies specific neural correlates for insight types and its dimensions. Further studies that examine the precise biological mechanisms of insight are needed to apply this knowledge to effective clinical intervention development.
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18
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Francis MM, Hummer TA, Leonhardt BL, Vohs JL, Yung MG, Mehdiyoun NF, Lysaker PH, Breier A. Association of medial prefrontal resting state functional connectivity and metacognitive capacity in early phase psychosis. Psychiatry Res Neuroimaging 2017; 262:8-14. [PMID: 28208070 DOI: 10.1016/j.pscychresns.2016.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 11/08/2016] [Accepted: 12/08/2016] [Indexed: 02/07/2023]
Abstract
Metacognition refers to a range of cognitive processes that allow one to form complex ideas of self and others and to use this information to navigate psychosocial challenges. Several studies in both early-phase and prolonged schizophrenia have demonstrated not only that significant deficits in metacognitive ability are present, but importantly that they are associated with significant functional impairment and decreased quality of life. In spite of the importance of metacognitive impairment in schizophrenia, relatively little is known about the biological substrates that may contribute to this dysfunction. In this study, we examined the relationship between resting state functional connectivity of the medial prefrontal cortex (mPFC), a structure shown in prior voxel-based morphometry studies to be associated with metacognition, with metacognitive function in an early-phase psychosis cohort (n=18). Analyses revealed a positive association of resting state functional connectivity between the mPFC and precuneus and posterior cingulate structures and metacognitive ability. These results provide evidence of disrupted resting state connectivity in structures relevant to metacognitive dysfunction in early-phase psychosis, which may have implications for pathophysiological models of complex cognitive deficits in this illness.
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Affiliation(s)
- Michael M Francis
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Eskenazi Health Midtown Community Mental Health Center, 720 Eskenazi Avenue, Outpatient Care Center, Lower Level, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Program, 2601 Cold Spring Rd., Research Unit (8-2048), Indianapolis, IN 46222, USA.
| | - Tom A Hummer
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA.
| | - Bethany L Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Eskenazi Health Midtown Community Mental Health Center, 720 Eskenazi Avenue, Outpatient Care Center, Lower Level, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Program, 2601 Cold Spring Rd., Research Unit (8-2048), Indianapolis, IN 46222, USA.
| | - Jenifer L Vohs
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Eskenazi Health Midtown Community Mental Health Center, 720 Eskenazi Avenue, Outpatient Care Center, Lower Level, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Program, 2601 Cold Spring Rd., Research Unit (8-2048), Indianapolis, IN 46222, USA.
| | - Matt G Yung
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA.
| | - Nicole F Mehdiyoun
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Eskenazi Health Midtown Community Mental Health Center, 720 Eskenazi Avenue, Outpatient Care Center, Lower Level, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Program, 2601 Cold Spring Rd., Research Unit (8-2048), Indianapolis, IN 46222, USA.
| | - Paul H Lysaker
- Department of Psychiatry, Indiana University School of Medicine, Roudebush VA Medical Hospital, 1481 W 10th St., Indianapolis, IN 46202, USA.
| | - Alan Breier
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Suite 4800, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Eskenazi Health Midtown Community Mental Health Center, 720 Eskenazi Avenue, Outpatient Care Center, Lower Level, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Program, 2601 Cold Spring Rd., Research Unit (8-2048), Indianapolis, IN 46222, USA.
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19
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Fox JM, Abram SV, Reilly JL, Eack S, Goldman MB, Csernansky JG, Wang L, Smith MJ. Default mode functional connectivity is associated with social functioning in schizophrenia. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:392-405. [PMID: 28358526 DOI: 10.1037/abn0000253] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Individuals with schizophrenia display notable deficits in social functioning. Research indicates that neural connectivity within the default mode network (DMN) is related to social cognition and social functioning in healthy and clinical populations. However, the association between DMN connectivity, social cognition, and social functioning has not been studied in schizophrenia. For the present study, the authors used resting-state neuroimaging data to evaluate connectivity between the main DMN hubs (i.e., the medial prefrontal cortex [mPFC] and the posterior cingulate cortex-anterior precuneus [PPC]) in individuals with schizophrenia (n = 28) and controls (n = 32). The authors also examined whether DMN connectivity was associated with social functioning via social attainment (measured by the Specific Levels of Functioning Scale) and social competence (measured by the Social Skills Performance Assessment), and if social cognition mediates the association between DMN connectivity and these measures of social functioning. Results revealed that DMN connectivity did not differ between individuals with schizophrenia and controls. However, connectivity between the mPFC and PCC hubs was significantly associated with social competence and social attainment in individuals with schizophrenia but not in controls as reflected by a significant group-by-connectivity interaction. Social cognition did not mediate the association between DMN connectivity and social functioning in individuals with schizophrenia. The findings suggest that fronto-parietal DMN connectivity in particular may be differentially associated with social functioning in schizophrenia and controls. As a result, DMN connectivity may be used as a neuroimaging marker to monitor treatment response or as a potential target for interventions that aim to enhance social functioning in schizophrenia. (PsycINFO Database Record
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Affiliation(s)
- Jaclyn M Fox
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | | | - James L Reilly
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Shaun Eack
- School of Social Work, University of Pittsburgh
| | - Morris B Goldman
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - John G Csernansky
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Matthew J Smith
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
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20
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Larabi DI, Liemburg EJ, Pijnenborg GHM, Sibeijn-Kuiper A, de Vos AE, Bais L, Knegtering H, Ćurčić-Blake B, Aleman A. Association between prefrontal N-acetylaspartate and insight in psychotic disorders. Schizophr Res 2017; 179:112-118. [PMID: 27658999 DOI: 10.1016/j.schres.2016.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 11/29/2022]
Abstract
Insight is impaired in most patients with psychosis and has been associated with poorer prognosis. The exact neural basis of impaired insight is still unknown, but it may involve disrupted prefrontal neural connectivity. Numerous studies have indeed found white matter (WM) abnormalities in psychosis. The association between prefrontal WM abnormalities and insight has not been studied yet by means of proton magnetic resonance spectroscopy (1H-MRS). 1H-MRS can be used to measure N-acetylaspartate (NAA), which is considered to be a marker of neuronal integrity. We measured insight with the Birchwood Insight Scale (BIS) as well as item G12 of the Positive and Negative Syndrome Scale (PANSS) in 88 patients with psychosis. Prefrontal WM concentrations of NAA and ratios of NAA to creatine (Cr) were assessed with 1H-MRS. Nonparametric partial correlational analyses were conducted between NAA concentrations and insight controlling for illness duration, standardized antipsychotic dose, symptom scores, voxel grey matter content and voxel cerebrospinal fluid content. We found a significant correlation between reduced NAA/Cr ratios and poorer insight as measured with the BIS, which remained significant after additional correction for full width at half maximum, signal/noise and age. This is the first study reporting a relationship between lower prefrontal concentrations of a marker of neuronal integrity and impaired insight, providing further evidence that prefrontal pathology may play an important role in impaired insight in psychosis. This may be explained by the involvement of the prefrontal cortex in several executive and metacognitive functions, such as cognitive flexibility and perspective taking.
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Affiliation(s)
- Daouia I Larabi
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Antonius Deusinglaan 2, Groningen, The Netherlands.
| | - Edith J Liemburg
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Antonius Deusinglaan 2, Groningen, The Netherlands; Lentis Psychiatric Institute, Hereweg 80, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Hanzeplein 1, Groningen, The Netherlands
| | - Gerdina H M Pijnenborg
- GGZ Drenthe, Department of Psychotic Disorders, Dennenweg 9, Assen, The Netherlands; University of Groningen, Department of Psychology, Grote Kruisstraat 2/1, Groningen, The Netherlands
| | - Anita Sibeijn-Kuiper
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Antonius Deusinglaan 2, Groningen, The Netherlands
| | - Annerieke E de Vos
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Antonius Deusinglaan 2, Groningen, The Netherlands; GGZ Drenthe, Department of Psychotic Disorders, Dennenweg 9, Assen, The Netherlands
| | - Leonie Bais
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Antonius Deusinglaan 2, Groningen, The Netherlands; Lentis Psychiatric Institute, Hereweg 80, Groningen, The Netherlands
| | - Henderikus Knegtering
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Antonius Deusinglaan 2, Groningen, The Netherlands; Lentis Psychiatric Institute, Hereweg 80, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Hanzeplein 1, Groningen, The Netherlands
| | - Branislava Ćurčić-Blake
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Antonius Deusinglaan 2, Groningen, The Netherlands
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Neuroimaging Center, Antonius Deusinglaan 2, Groningen, The Netherlands; University of Groningen, Department of Psychology, Grote Kruisstraat 2/1, Groningen, The Netherlands
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21
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Wang Y, Tang W, Fan X, Zhang J, Geng D, Jiang K, Zhu D, Song Z, Xiao Z, Liu D. Resting-state functional connectivity changes within the default mode network and the salience network after antipsychotic treatment in early-phase schizophrenia. Neuropsychiatr Dis Treat 2017; 13:397-406. [PMID: 28223812 PMCID: PMC5308583 DOI: 10.2147/ndt.s123598] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Abnormal resting-state functional connectivity (FC), particularly in the default mode network (DMN) and the salience network (SN), has been reported in schizophrenia, but little is known about the effects of antipsychotics on these networks. The purpose of this study was to examine the effects of atypical antipsychotics on DMN and SN and the relationship between these effects and symptom improvement in patients with schizophrenia. METHODS This was a prospective study of 33 patients diagnosed with schizophrenia and treated with antipsychotics at Shanghai Mental Health Center. Thirty-three healthy controls matched for age and gender were recruited. All subjects underwent functional magnetic resonance imaging (fMRI). Healthy controls were scanned only once; patients were scanned before and after 6-8 weeks of treatment. RESULTS In the DMN, the patients exhibited increased FC after treatment in the right superior temporal gyrus, right medial frontal gyrus, and left superior frontal gyrus and decreased FC in the right posterior cingulate/precuneus (P<0.005). In the SN, the patients exhibited decreased FC in the right cerebellum anterior lobe and left insula (P<0.005). The FC in the right posterior cingulate/precuneus in the DMN negatively correlated with the difference between the Clinical Global Impression (CGI) score pre/post-treatment (r=-0.564, P=0.023) and negative trends with the difference in the Positive and Negative Syndrome Scale (PANSS) total score pre/post-treatment (r=-0.475, P=0.063) and the difference in PANSS-positive symptom scores (r=-0.481, P=0.060). CONCLUSION These findings suggest that atypical antipsychotics could regulate the FC of certain key brain regions within the DMN in early-phase schizophrenia, which might be related to symptom improvement. However, the effects of atypical antipsychotics on SN are less clear.
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Affiliation(s)
- Yingchan Wang
- First-Episode Schizophrenia and Early Psychosis Program, Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
| | - Weijun Tang
- Department of Radiology, Huashan Hospital, Fu Dan University, Shanghai, People's Republic of China
| | - Xiaoduo Fan
- Psychotic Disorders Program, UMass Memorial Medical Center, UMass Medical School, Worcester, MA, USA
| | - Jianye Zhang
- First-Episode Schizophrenia and Early Psychosis Program, Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fu Dan University, Shanghai, People's Republic of China
| | - Kaida Jiang
- First-Episode Schizophrenia and Early Psychosis Program, Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
| | - Dianming Zhu
- First-Episode Schizophrenia and Early Psychosis Program, Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
| | - Zhenhua Song
- First-Episode Schizophrenia and Early Psychosis Program, Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
| | - Zeping Xiao
- First-Episode Schizophrenia and Early Psychosis Program, Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
| | - Dengtang Liu
- First-Episode Schizophrenia and Early Psychosis Program, Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
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22
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Hu ML, Zong XF, Mann JJ, Zheng JJ, Liao YH, Li ZC, He Y, Chen XG, Tang JS. A Review of the Functional and Anatomical Default Mode Network in Schizophrenia. Neurosci Bull 2016; 33:73-84. [PMID: 27995564 DOI: 10.1007/s12264-016-0090-1] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 10/14/2016] [Indexed: 12/26/2022] Open
Abstract
Schizophrenia is a severe mental disorder characterized by impaired perception, delusions, thought disorder, abnormal emotion regulation, altered motor function, and impaired drive. The default mode network (DMN), since it was first proposed in 2001, has become a central research theme in neuropsychiatric disorders, including schizophrenia. In this review, first we define the DMN and describe its functional activity, functional and anatomical connectivity, heritability, and inverse correlation with the task positive network. Second, we review empirical studies of the anatomical and functional DMN, and anti-correlation between DMN and the task positive network in schizophrenia. Finally, we review preliminary evidence about the relationship between antipsychotic medications and regulation of the DMN, review the role of DMN as a treatment biomarker for this disease, and consider the DMN effects of individualized therapies for schizophrenia.
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Affiliation(s)
- Mao-Lin Hu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Departments of Psychiatry and Radiology, Columbia University, New York, NY, 10032, USA
- Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Xiao-Fen Zong
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Departments of Psychiatry and Radiology, Columbia University, New York, NY, 10032, USA
- Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - J John Mann
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Departments of Psychiatry and Radiology, Columbia University, New York, NY, 10032, USA
| | - Jun-Jie Zheng
- Key Laboratory for NeuroInformation of the Ministry of Education, School of Life Science and Technology and Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Yan-Hui Liao
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience, David Geffen School of Medicine, Los Angeles, CA, 90024, USA
| | - Zong-Chang Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Ying He
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Xiao-Gang Chen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
- Mental Health Institute of Central South University, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, The Second Xiangya Hospital of Central South University, Changsha, 410011, China.
| | - Jin-Song Tang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience, David Geffen School of Medicine, Los Angeles, CA, 90024, USA.
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23
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Ebisch SJH, Aleman A. The fragmented self: imbalance between intrinsic and extrinsic self-networks in psychotic disorders. Lancet Psychiatry 2016; 3:784-790. [PMID: 27374147 DOI: 10.1016/s2215-0366(16)00045-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 12/22/2022]
Abstract
Self-disturbances are among the core features of schizophrenia and related psychotic disorders. The basic structure of the self could depend on the balance between intrinsic and extrinsic self-processing. We discuss studies on self-related processing in psychotic disorders that provide converging evidence for disrupted communication between neural networks subserving the so-called intrinsic self and extrinsic self. This disruption might be mainly caused by impaired integrity of key brain hubs. The intrinsic self has been associated with cortical midline structures involved in self-referential processing, autobiographical memory, and emotional evaluation. Additionally, we highlight central aspects of the extrinsic self in its interaction with the environment using sensorimotor networks, including self-experience in sensation and actions. A deficient relationship between these self-aspects because of disrupted between-network interactions offers a framework to explain core clinical features of psychotic disorders. In particular, we show how relative isolation and reduced modularity of networks subserving intrinsic and extrinsic self-processing might trigger the emergence of hallucinations and delusions, and why patients with psychosis typically have difficulties with self-other relationships and do not recognise mental problems.
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Affiliation(s)
- Sjoerd J H Ebisch
- Department of Neuroscience, Imaging & Clinical Sciences, Institute of Advanced Biomedical Technologies (ITAB), G d'Annunzio University, Chieti, Italy.
| | - André Aleman
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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24
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Spaniel F, Tintera J, Rydlo J, Ibrahim I, Kasparek T, Horacek J, Zaytseva Y, Matejka M, Fialova M, Slovakova A, Mikolas P, Melicher T, Görnerova N, Höschl C, Hajek T. Altered Neural Correlate of the Self-Agency Experience in First-Episode Schizophrenia-Spectrum Patients: An fMRI Study. Schizophr Bull 2016; 42:916-25. [PMID: 26685867 PMCID: PMC4903049 DOI: 10.1093/schbul/sbv188] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The phenomenology of the clinical symptoms indicates that disturbance of the sense of self be a core marker of schizophrenia. AIMS To compare neural activity related to the self/other-agency judgment in patients with first-episode schizophrenia-spectrum disorders (FES, n = 35) and healthy controls (HC, n = 35). METHOD A functional magnetic resonance imaging (fMRI) using motor task with temporal distortion of the visual feedback was employed. A task-related functional connectivity was analyzed with the use of independent component analysis (ICA). RESULTS (1) During self-agency experience, FES showed a deficit in cortical activation in medial frontal gyrus (BA 10) and posterior cingulate gyrus, (BA 31; P < .05, Family-Wise Error [FWE] corrected). (2) Pooled-sample task-related ICA revealed that the self/other-agency judgment was dependent upon anti-correlated default mode and central-executive networks (DMN/CEN) dynamic switching. This antagonistic mechanism was substantially impaired in FES during the task. DISCUSSION During self-agency experience, FES demonstrate deficit in engagement of cortical midline structures along with substantial attenuation of anti-correlated DMN/CEN activity underlying normal self/other-agency discriminative processes.
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Affiliation(s)
- Filip Spaniel
- National Institute of Mental Health, Klecany, Czech Republic; 3rd Faculty of Medicine, Charles University, Prague, Czech Republic;
| | - Jaroslav Tintera
- National Institute of Mental Health, Klecany, Czech Republic;,MR-Unit ZRIR, IKEM, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Rydlo
- National Institute of Mental Health, Klecany, Czech Republic;,MR-Unit ZRIR, IKEM, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ibrahim Ibrahim
- National Institute of Mental Health, Klecany, Czech Republic;,MR-Unit ZRIR, IKEM, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Tomas Kasparek
- Department of Psychiatry, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Horacek
- National Institute of Mental Health, Klecany, Czech Republic;,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Yuliya Zaytseva
- National Institute of Mental Health, Klecany, Czech Republic
| | - Martin Matejka
- National Institute of Mental Health, Klecany, Czech Republic;,Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Marketa Fialova
- National Institute of Mental Health, Klecany, Czech Republic;,Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Andrea Slovakova
- National Institute of Mental Health, Klecany, Czech Republic;,Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Pavol Mikolas
- National Institute of Mental Health, Klecany, Czech Republic;,Psychiatric Hospital Bohnice, Prague, Czech Republic
| | - Tomas Melicher
- National Institute of Mental Health, Klecany, Czech Republic;,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Natalie Görnerova
- National Institute of Mental Health, Klecany, Czech Republic;,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Cyril Höschl
- National Institute of Mental Health, Klecany, Czech Republic;,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Hajek
- National Institute of Mental Health, Klecany, Czech Republic;,Department of Psychiatry, Dalhousie University, Halifax, Canada
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25
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Vohs JL, George S, Leonhardt BL, Lysaker PH. An integrative model of the impairments in insight in schizophrenia: emerging research on causal factors and treatments. Expert Rev Neurother 2016; 16:1193-204. [PMID: 27278672 DOI: 10.1080/14737175.2016.1199275] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Poor insight, or unawareness of some major aspect of mental illness, is a major barrier to wellness when it interferes with persons seeking out treatment or forming their own understanding of the challenges they face. One barrier to addressing impaired insight is the absence of a comprehensive model of how poor insight develops. AREAS COVERED To explore this issue we review how poor insight is the result of multiple phenomena which interfere with the construction of narrative accounts of psychiatric challenges, rather than a single social or biological cause. Expert commentary: We propose an integrative model of poor insight in schizophrenia which involves the interaction of symptoms, deficits in neurocognition, social cognition, metacognition, and stigma. Emerging treatments for poor insight including therapies which focus on the development of metacognition are discussed.
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Affiliation(s)
- Jenifer L Vohs
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Sunita George
- b School of Psychological Sciences , University of Indianapolis , Indianapolis , IN , USA
| | - Bethany L Leonhardt
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Paul H Lysaker
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.,c Roudebush VA Medical Hospital , Indianapolis , IN , USA
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26
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Ćurčić-Blake B, van der Meer L, Pijnenborg GHM, David AS, Aleman A. Insight and psychosis: Functional and anatomical brain connectivity and self-reflection in Schizophrenia. Hum Brain Mapp 2015; 36:4859-68. [PMID: 26467308 DOI: 10.1002/hbm.22955] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/11/2015] [Accepted: 08/17/2015] [Indexed: 01/01/2023] Open
Abstract
Impaired insight into illness, associated with worse treatment outcome, is common in schizophrenia. Insight has been related to the self-reflective processing, centred on the medial frontal cortex. We hypothesized that anatomical and functional routes to and from the ventromedial prefrontal cortex (vmPFC) would differ in patients according to their degree of impaired insight. Forty-five schizophrenia patients and 19 healthy subjects performed a self-reflection task during fMRI, and underwent diffusion tensor imaging. Using dynamic causal modelling we observed increased effective connectivity from the posterior cingulate cortex (PCC), inferior parietal lobule (IPL), and dorsal mPFC (dmPFC) towards the vmPFC with poorer insight and decrease from vmPFC to the IPL. Stronger connectivity from the PCC to vmPFC during judgment of traits related to self was associated with poorer insight. We found small-scale significant changes in white matter integrity associated with clinical insight. Self-reflection may be influenced by synaptic changes that lead to the observed alterations in functional connectivity accompanied by the small-scale but measurable alterations in anatomical connections. Our findings may point to a neural compensatory response to an impairment of connectivity between self-processing regions. Similarly, the observed hyper-connectivity might be a primary deficit linked to inefficiency in the component cognitive processes that lead to impaired insight. We suggest that the stronger cognitive demands placed on patients with poor insight is reflected in increased effective connectivity during the task in this study.
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Affiliation(s)
- Branislava Ćurčić-Blake
- Department of Neuroscience, University of Groningen, BCN Neuroimaging Center (NIC), University Medical Center, Groningen, The Netherlands
| | - Lisette van der Meer
- Department of Neuroscience, University of Groningen, BCN Neuroimaging Center (NIC), University Medical Center, Groningen, The Netherlands.,Department of Rehabilitation, Lentis, Zuidlaren, The Netherlands
| | - Gerdina H M Pijnenborg
- Department of Clinical Psychosis and Experimental Psychopathalogy, University of Groningen, Grote Kruisstraat, The Netherlands.,Department of Psychotic Disorders, GGZ Drenthe, Assen, The Netherlands
| | - Anthony S David
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, Denmark, Hill, United Kingdom
| | - André Aleman
- Department of Neuroscience, University of Groningen, BCN Neuroimaging Center (NIC), University Medical Center, Groningen, The Netherlands
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27
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Phillips RC, Salo T, Carter CS. Distinct neural correlates for attention lapses in patients with schizophrenia and healthy participants. Front Hum Neurosci 2015; 9:502. [PMID: 26500517 PMCID: PMC4594500 DOI: 10.3389/fnhum.2015.00502] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/28/2015] [Indexed: 11/13/2022] Open
Abstract
Momentary lapses in attention are common in healthy populations. This phenomenon has recently received increased investigation, particularly in relationship to the default mode network (DMN). Previous research has suggested that these lapses may be due to intrusive task-irrelevant thoughts. The study of this phenomenon in schizophrenia, which is characterized by a wide variety of cognitive deficits including deficits in attention, has not previously been explored. We used the AX Continuous Performance Task to investigate attention lapses in healthy participants as well as patients with schizophrenia. We found distinct patterns of network activation between these two groups. Lapses in healthy participants were associated with DMN activation, while in patients, the same behavioral phenomenon was associated with deactivations in frontal-parietal control network (FPCN) regions. When considered in contrast to the results observed in healthy participants, these results suggest an additional origin of attention lapses in patients derived from a loss of task-related context, rather than intrusive task-irrelevant thoughts.
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Affiliation(s)
- Ryan C Phillips
- Translational Cognitive and Affective Neuroscience Lab, UC Davis Center for Neuroscience, University of California, Davis Davis, CA, USA
| | - Taylor Salo
- Translational Cognitive and Affective Neuroscience Lab, UC Davis Center for Neuroscience, University of California, Davis Davis, CA, USA
| | - Cameron S Carter
- Translational Cognitive and Affective Neuroscience Lab, UC Davis Center for Neuroscience, University of California, Davis Davis, CA, USA
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28
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Macgregor A, Norton J, Bortolon C, Robichon M, Rolland C, Boulenger JP, Raffard S, Capdevielle D. Insight of patients and their parents into schizophrenia: Exploring agreement and the influence of parental factors. Psychiatry Res 2015; 228:879-86. [PMID: 26043807 DOI: 10.1016/j.psychres.2015.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 03/10/2015] [Accepted: 05/03/2015] [Indexed: 10/23/2022]
Abstract
Poor insight is found in up to 80% of schizophrenia patients and has been associated with multiple factors of which cognitive functioning, social and environmental factors. Few studies have explored associations between patient insight and that of their biological parents', and the influence of parental factors. Insight was assessed in 41 patients and their biological parents with Amador's Scale for the assessment of Unawareness of Mental Disorder (SUMD). Parents' knowledge about schizophrenia and critical attitudes were assessed with validated self-report questionnaires. Both groups underwent cognitive assessments for working memory and executive functioning. Insight in patients and their parents was not associated for any of the SUMD dimensions but a significant correlation was found between patient and parent awareness of treatment effect for patient-parent dyads with frequent daily contact. Low parental critical attitude was associated with higher patient awareness of symptoms and a high parental memory task score with high patient insight. Our study is the first to suggest a possible influence of parental factors such as critical attitudes and cognitive performance on patient insight.
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Affiliation(s)
- Alexandra Macgregor
- Université Montpellier, Montpellier, France; University Department of Adult Psychiatry, Hôpital la Colombière, Montpellier University Hospital, Montpellier, France.
| | - Joanna Norton
- INSERM, U-1061, Hôpital la Colombiere, Montpellier, France; Université Montpellier, Montpellier, France
| | - Catherine Bortolon
- University Department of Adult Psychiatry, Hôpital la Colombière, Montpellier University Hospital, Montpellier, France; Epsylon Laboratory Dynamic of Human Abilities & Health Behaviors, Université Paul Valéry, Montpellier, France
| | - Melissa Robichon
- University Department of Adult Psychiatry, Hôpital la Colombière, Montpellier University Hospital, Montpellier, France
| | - Camille Rolland
- University Department of Adult Psychiatry, Hôpital la Colombière, Montpellier University Hospital, Montpellier, France
| | - Jean-Philippe Boulenger
- University Department of Adult Psychiatry, Hôpital la Colombière, Montpellier University Hospital, Montpellier, France; Université Montpellier, Montpellier, France
| | - Stéphane Raffard
- University Department of Adult Psychiatry, Hôpital la Colombière, Montpellier University Hospital, Montpellier, France; Epsylon Laboratory Dynamic of Human Abilities & Health Behaviors, Université Paul Valéry, Montpellier, France
| | - Delphine Capdevielle
- University Department of Adult Psychiatry, Hôpital la Colombière, Montpellier University Hospital, Montpellier, France; INSERM, U-1061, Hôpital la Colombiere, Montpellier, France; Université Montpellier, Montpellier, France
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Shad MU, Keshavan MS. Neurobiology of insight deficits in schizophrenia: An fMRI study. Schizophr Res 2015; 165:220-6. [PMID: 25957484 PMCID: PMC4457549 DOI: 10.1016/j.schres.2015.04.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 04/15/2015] [Accepted: 04/17/2015] [Indexed: 12/20/2022]
Abstract
Prior research has shown insight deficits in schizophrenia to be associated with specific neuroimaging changes (primarily structural) especially in the prefrontal sub-regions. However, little is known about the functional correlates of impaired insight. Seventeen patients with schizophrenia (mean age 40.0±10.3; M/F=14/3) underwent fMRI on a Philips 3.0 T Achieva system while performing on a self-awareness task containing self- vs. other-directed sentence stimuli. SPM5 was used to process the imaging data. Preprocessing consisted of realignment, coregistration, and normalization, and smoothing. A regression analysis was used to examine the relationship between brain activation in response to self-directed versus other-directed sentence stimuli and average scores on behavioral measures of awareness of symptoms and attribution of symptoms to the illness from Scale to Assess Unawareness of Mental Disorders. Family Wise Error correction was employed in the fMRI analysis. Average scores on awareness of symptoms (1=aware; 5=unaware) were associated with activation of multiple brain regions, including prefrontal, parietal and limbic areas as well as basal ganglia. However, average scores on correct attribution of symptoms (1=attribute; 5=misattribute) were associated with relatively more localized activation of prefrontal cortex and basal ganglia. These findings suggest that unawareness and misattribution of symptoms may have different neurobiological basis in schizophrenia. While symptom unawareness may be a function of a more complex brain network, symptom misattribution may be mediated by specific brain regions.
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Wei Q, Li M, Kang Z, Li L, Diao F, Zhang R, Wang J, Zheng L, Wen X, Zhang J, Zhao J, Huang R. ZNF804A rs1344706 is associated with cortical thickness, surface area, and cortical volume of the unmedicated first episode schizophrenia and healthy controls. Am J Med Genet B Neuropsychiatr Genet 2015; 168B:265-73. [PMID: 25921517 DOI: 10.1002/ajmg.b.32308] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 02/18/2015] [Indexed: 01/25/2023]
Abstract
The effects of ZNF804A rs1344706, a prominent susceptibility gene for schizophrenia, on gray matter (GM) structure in unmedicated schizophrenia (SZ) patients are still unknown, although several previous studies investigated the effects in medicated SZ patients and healthy controls (HC). Analyzing cortical thickness, surface area, and GM volume simultaneously may provide a more precise and complete picture of the effects. We genotyped 59 unmedicated first episode SZ patients and 60 healthy controls for the ZNF804A single nucleotide polymorphism (SNP) rs1344706, and examined between-group differences in cortical thickness, surface area, and cortical volume using a full-factorial 2 × 2 analysis of variance (ANOVA). We found the risk allele (T) in ZNF804A rs1344706, compared to the non-risk allele (G), was associated with thinner cortex in the bilateral precuneus, left precentral gyrus, and several other regions, associated with a smaller cortical surface area in the left superior parietal, precuneus cortex and left superior frontal, and associated with a lower cortical volume in the left superior frontal, left precentral, and right precuneus in SZ patients. In contrast, in the controls, the T allele was associated with the increased cortical measurements compared to the G allele in the same regions as those mentioned above. ZNF804A rs1344706 has significant, but different, effects on cortical thickness, surface area, and cortical volume in multiple regions of the brain cortex. Our findings suggest that ZNF804A rs1344706 may aggravate the risk for schizophrenia by exerting its effects on cortical thickness, surface area, and cortical volume in these brain regions.
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Affiliation(s)
- Qinling Wei
- Departmentof Psychiatry, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P. R. China.,Mental Health Institute, the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, P. R. China
| | - Meng Li
- Brain Imaging Center, Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, South China Normal University, Guangzhou, P. R. China
| | - Zhuang Kang
- Graduate School of Southern Medical University, Guangzhou, P. R. China.,Department of Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P. R. China
| | - Leijun Li
- Departmentof Psychiatry, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P. R. China
| | - Feici Diao
- Departmentof Psychiatry, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P. R. China
| | - Ruibin Zhang
- Brain Imaging Center, Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, South China Normal University, Guangzhou, P. R. China
| | - Junjing Wang
- Brain Imaging Center, Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, South China Normal University, Guangzhou, P. R. China
| | - Liangrong Zheng
- Departmentof Psychiatry, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P. R. China
| | - Xue Wen
- Brain Imaging Center, Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, South China Normal University, Guangzhou, P. R. China
| | - Jinbei Zhang
- Departmentof Psychiatry, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P. R. China
| | - Jingping Zhao
- Mental Health Institute, the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, P. R. China
| | - Ruiwang Huang
- Brain Imaging Center, Center for the Study of Applied Psychology, Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, South China Normal University, Guangzhou, P. R. China
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31
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Dean AC, Kohno M, Morales AM, Ghahremani DG, London ED. Denial in methamphetamine users: Associations with cognition and functional connectivity in brain. Drug Alcohol Depend 2015; 151:84-91. [PMID: 25840750 PMCID: PMC4447566 DOI: 10.1016/j.drugalcdep.2015.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/18/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite harmful consequences of drug addiction, it is common for individuals with substance use disorders to deny having problems with drugs. Emerging evidence suggests that some drug users lack insight into their behavior due to neurocognitive dysfunction, but little research has examined potential neurocognitive contributions to denial. METHODS This study explored the relationship between denial, cognitive performance and functional connectivity in brain. The participants were 58 non-treatment-seeking, methamphetamine-dependent participants who completed the URICA precontemplation scale, a self-report measure of denial of drug problems warranting change, as well as a cognitive test battery. A subset of participants (N = 21) had functional MRI scans assessing resting-state functional connectivity. Given literature indicating roles of the rostral anterior cingulate (rACC), anterior insula and precuneus in self-awareness, relationships between denial and resting-state connectivity were tested using seeds placed in these regions. RESULTS The results revealed a negative relationship between denial and an overall cognitive battery score (p = 0.001), the effect being driven particularly by performance on tests of memory and executive function. Denial was negatively associated with strength of connectivity between the rACC and regions of the frontal lobe (precentral gyri, left ventromedial prefrontal cortex, left orbitofrontal cortex), limbic system (left amygdala, left hippocampus and left parahippocampal gyrus), occipital lobes and cerebellum; and between the precuneus and the midbrain and cerebellum. Anterior insula connectivity was unrelated to denial. CONCLUSIONS These findings suggest that denial by methamphetamine users is linked with a cognitive and neural phenotype that may impede the development of insight into their behavior.
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Affiliation(s)
- Andy C. Dean
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience, David Geffen School of Medicine, Los Angeles, CA, 90024, USA,Brain Research Institute, David Geffen School of Medicine, Los Angeles, CA, 90024, USA,Corresponding author: Andy C. Dean (), UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA, United States of America 90095-1759, Tel: +1 310 825 5839; fax: +1 310 825 0812
| | - Milky Kohno
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience, David Geffen School of Medicine, Los Angeles, CA, 90024, USA
| | - Angelica M. Morales
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience, David Geffen School of Medicine, Los Angeles, CA, 90024, USA
| | - Dara G. Ghahremani
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience, David Geffen School of Medicine, Los Angeles, CA, 90024, USA
| | - Edythe D. London
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience, David Geffen School of Medicine, Los Angeles, CA, 90024, USA,Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, Los Angeles, CA, 90024 USA,Brain Research Institute, David Geffen School of Medicine, Los Angeles, CA, 90024, USA
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32
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Gerretsen P, Menon M, Mamo DC, Fervaha G, Remington G, Pollock BG, Graff-Guerrero A. Impaired insight into illness and cognitive insight in schizophrenia spectrum disorders: resting state functional connectivity. Schizophr Res 2014; 160:43-50. [PMID: 25458571 PMCID: PMC4429527 DOI: 10.1016/j.schres.2014.10.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/10/2014] [Accepted: 10/14/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Impaired insight into illness (clinical insight) in schizophrenia has negative effects on treatment adherence and clinical outcomes. Schizophrenia is described as a disorder of disrupted brain connectivity. In line with this concept, resting state networks (RSNs) appear differentially affected in persons with schizophrenia. Therefore, impaired clinical, or the related construct of cognitive insight (which posits that impaired clinical insight is a function of metacognitive deficits), may reflect alterations in RSN functional connectivity (fc). Based on our previous research, which showed that impaired insight into illness was associated with increased left hemisphere volume relative to right, we hypothesized that impaired clinical insight would be associated with increased connectivity in the DMN with specific left hemisphere brain regions. METHODS Resting state MRI scans were acquired for participants with schizophrenia or schizoaffective disorder (n=20). Seed-to-voxel and ROI-to-ROI fc analyses were performed using the CONN-fMRI fc toolbox v13 for established RSNs. Clinical and cognitive insight were measured with the Schedule for the Assessment of Insight-Expanded Version and Beck Cognitive Insight Scale, respectively, and included as the regressors in fc analyses. RESULTS As hypothesized, impaired clinical insight was associated with increased connectivity in the default mode network (DMN) with the left angular gyrus, and also in the self-referential network (SRN) with the left insula. Cognitive insight was associated with increased connectivity in the dorsal attention network (DAN) with the right inferior frontal cortex (IFC) and left anterior cingulate cortex (ACC). CONCLUSION Increased connectivity in DMN and SRN with the left angular gyrus and insula, respectively, may represent neural correlates of impaired clinical insight in schizophrenia spectrum disorders, and is consistent with the literature attributing impaired insight to left hemisphere dominance. Increased connectivity in the DAN with the IFC and ACC in relation to cognitive insight may facilitate enhanced mental flexibility in this sample.
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Affiliation(s)
- Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Canada,Geriatric Mental Health Program, Centre for Addiction & Mental Health, Canada,Department of Psychiatry, University of Toronto, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Mahesh Menon
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Canada,Department of Psychiatry, University of British Columbia, Canada
| | - David C. Mamo
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Canada,Department of Psychiatry, University of Toronto, Canada,Department of Psychiatry, Faculties of Medicine and Health Science, University of Malta, Msida, Malta
| | - Gagan Fervaha
- Schizophrenia Program, Centre for Addiction & Mental Health, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Gary Remington
- Schizophrenia Program, Centre for Addiction & Mental Health, Canada,Department of Psychiatry, University of Toronto, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Bruce G. Pollock
- Geriatric Mental Health Program, Centre for Addiction & Mental Health, Canada,Department of Psychiatry, University of Toronto, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Canada; Geriatric Mental Health Program, Centre for Addiction & Mental Health, Canada; Department of Psychiatry, University of Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
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33
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The neuropsychology of self-reflection in psychiatric illness. J Psychiatr Res 2014; 54:55-63. [PMID: 24685311 PMCID: PMC4022422 DOI: 10.1016/j.jpsychires.2014.03.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/10/2014] [Accepted: 03/07/2014] [Indexed: 01/02/2023]
Abstract
The development of robust neuropsychological measures of social and affective function-which link critical dimensions of mental health to their underlying neural circuitry-could be a key step in achieving a more pathophysiologically-based approach to psychiatric medicine. In this article, we summarize research indicating that self-reflection (the inward attention to personal thoughts, memories, feelings, and actions) may be a useful model for developing such a paradigm, as there is evidence that self-reflection is (1) measurable with self-report scales and performance-based tests, (2) linked to the activity of a specific neural circuit, and (3) dimensionally related to mental health and various forms of psychopathology.
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Dresler M, Wehrle R, Spoormaker VI, Steiger A, Holsboer F, Czisch M, Hobson JA. Neural correlates of insight in dreaming and psychosis. Sleep Med Rev 2014; 20:92-9. [PMID: 25092021 DOI: 10.1016/j.smrv.2014.06.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 06/06/2014] [Accepted: 06/14/2014] [Indexed: 12/17/2022]
Abstract
The idea that dreaming can serve as a model for psychosis has a long and honourable tradition, however it is notoriously speculative. Here we demonstrate that recent research on the phenomenon of lucid dreaming sheds new light on the debate. Lucid dreaming is a rare state of sleep in which the dreamer gains insight into his state of mind during dreaming. Recent electroencephalogram (EEG) and functional magnetic resonance imaging (fMRI) data for the first time allow very specific hypotheses about the dream-psychosis relationship: if dreaming is a reasonable model for psychosis, then insight into the dreaming state and insight into the psychotic state should share similar neural correlates. This indeed seems to be the case: cortical areas activated during lucid dreaming show striking overlap with brain regions that are impaired in psychotic patients who lack insight into their pathological state. This parallel allows for new therapeutic approaches and ways to test antipsychotic medication.
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Affiliation(s)
- Martin Dresler
- Max Planck Institute of Psychiatry, Munich, Germany; Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands.
| | | | | | - Axel Steiger
- Max Planck Institute of Psychiatry, Munich, Germany
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35
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Dodell-Feder D, DeLisi LE, Hooker CI. The relationship between default mode network connectivity and social functioning in individuals at familial high-risk for schizophrenia. Schizophr Res 2014; 156:87-95. [PMID: 24768131 PMCID: PMC4082024 DOI: 10.1016/j.schres.2014.03.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 03/24/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
Abstract
Unaffected first-degree relatives of individuals with schizophrenia (i.e., those at familial high-risk [FHR]), demonstrate social dysfunction qualitatively similar though less severe than that of their affected relatives. These social difficulties may be the consequence of genetically conferred disruption to aspects of the default mode network (DMN), such as the dMPFC subsystem, which overlaps with the network of brain regions recruited during social cognitive processes. In the present study, we investigate this possibility, testing DMN connectivity and its relationship to social functioning in FHR using resting-state fMRI. Twenty FHR individuals and 17 controls underwent fMRI during a resting-state scan. Hypothesis-driven functional connectivity analyses examined ROI-to-ROI correlations between the DMN's hubs, and regions of the dMPFC subsystem and MTL subsystem. Connectivity values were examined in relationship to a measure of social functioning and empathy/perspective-taking. Results demonstrate that FHR exhibit reduced connectivity specifically within the dMPFC subsystem of the DMN. Certain ROI-to-ROI correlations predicted aspects of social functioning and empathy/perspective-taking across all participants. Together, the data indicate that disruption to the dMPFC subsystem of the DMN may be associated with familial risk for schizophrenia, and that these intrinsic connections may carry measurable consequences for social functioning.
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Affiliation(s)
| | - Lynn E. DeLisi
- Boston VA Medical Center, Brockton, MA 02301 USA,Department of Psychiatry, Harvard Medical School, Boston, MA 02215 USA
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36
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Vargas C, Pineda J, Calvo V, López-Jaramillo C. [Brain activitivation of euthymic patients with Type I bipolar disorder in resting state Default Mode Network]. ACTA ACUST UNITED AC 2014; 43:154-61. [PMID: 26575129 DOI: 10.1016/j.rcp.2014.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/19/2014] [Accepted: 02/27/2014] [Indexed: 01/21/2023]
Abstract
INTRODUCTION As there are still doubts about brain connectivity in type I bipolar disorder (BID), resting-state functional magnetic resonance imaging (RS-fMRI) studies are necessary during euthymia for a better control of confounding factors. OBJECTIVE To evaluate the differences in brain activation between euthymic BID patients and control subjects using resting state- functional-magnetic resonance imaging (RS-fMRI), and to identify the lithium effect in these activations. METHODS A cross-sectional study was conducted on 21 BID patients (10 receiving lithium only, and 11 non-medicated) and 12 healthy control subjects, using RS fMRI and independent component analysis (ICA). RESULTS Increased activation was found in the right hippocampus (P=.049) and posterior cingulate (P=.040) within the Default Mode Network (DMN) when BID and control group were compared. No statistically significant differences were identified between BID on lithium only therapy and non-medicated BID patients. CONCLUSIONS The results suggest that there are changes in brain activation and connectivity in BID even during euthymic phase and mainly within the DMN network, which could be relevant in affect regulation.
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Affiliation(s)
- Cristian Vargas
- Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Universidad de Antioquia, Medellín, Colombia
| | - Julián Pineda
- Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Universidad de Antioquia, Medellín, Colombia; Instituto de Alta Tecnología Médica IATM, Medellín, Colombia
| | - Víctor Calvo
- Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Universidad de Antioquia, Medellín, Colombia; Instituto de Alta Tecnología Médica IATM, Medellín, Colombia
| | - Carlos López-Jaramillo
- Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Universidad de Antioquia, Medellín, Colombia; Instituto de Alta Tecnología Médica IATM, Medellín, Colombia; Coordinador del Programa de Trastornos del Ánimo, Hospital San Vicente Fundación; Jefe del Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Universidad de Antioquia, Medellín, Colombia.
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Lehrer DS, Lorenz J. Anosognosia in schizophrenia: hidden in plain sight. INNOVATIONS IN CLINICAL NEUROSCIENCE 2014; 11:10-17. [PMID: 25152841 PMCID: PMC4140620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Poor insight is a cardinal symptom of schizophrenia that, while not universally and uniformly expressed in all patients, is among the most common of its manifestations. Available neurobiological and neurocognitive evidence linking the phenomenon to core pathophysiology of schizophrenia justifies extension of the anosognosia construct to schizophrenia-related insight deficits. Poor insight is a core attribute of schizophrenia, occurring in 57 to 98 percent of patients. Insight is an important outcome predictor, associated with treatment adherence, relapse frequency, symptom remission, psychosocial functioning, vocational attainment, and risk of violence toward self or others. Combined findings lend urgency to the importance of reducing psychotic relapse. This can only be achieved in the majority of patients with consistent medication adherence- something that is often exceedingly difficult in patients lacking belief in the fact of their illness. This article examines whether anosognosia, the unawareness of deficit or illness, should apply to our understanding of insight deficits in patients with schizophrenia. Although research in the field is limited at this time, there is hope that anosognosia as a symptom of schizophrenia will become a focus of further research and a critically important therapeutic target amenable to treatment. DESIGN This article is a literature review and conceptualization. CONCLUSION Limited research in the field gives cause for hope that anosognosia as a symptom of schizophrenia will become a critically important therapeutic target that is amendable to treatment.
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Affiliation(s)
- Douglas S Lehrer
- Dr. Lehrer is from Wright State University Boonshoft School of Medicine, Department of Psychiatry, Dayton, Ohio, and Summit Behavioral Healthcare, Cincinnati, Ohio; Dr. Lorenz is from Wright State University Boonshoft School of Medicine, Department of Psychiatry, Dayton, Ohio, and USAF Medical Center, Wright-Patterson Air Force Base, Department of Mental Health, Ohio
| | - Jennifer Lorenz
- Dr. Lehrer is from Wright State University Boonshoft School of Medicine, Department of Psychiatry, Dayton, Ohio, and Summit Behavioral Healthcare, Cincinnati, Ohio; Dr. Lorenz is from Wright State University Boonshoft School of Medicine, Department of Psychiatry, Dayton, Ohio, and USAF Medical Center, Wright-Patterson Air Force Base, Department of Mental Health, Ohio
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Spalletta G, Piras F, Piras F, Caltagirone C, Orfei MD. The structural neuroanatomy of metacognitive insight in schizophrenia and its psychopathological and neuropsychological correlates. Hum Brain Mapp 2014; 35:4729-40. [PMID: 24700789 DOI: 10.1002/hbm.22507] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 02/17/2014] [Accepted: 02/25/2014] [Indexed: 12/21/2022] Open
Abstract
Lack of insight into illness is a multidimensional phenomenon that has relevant implications on clinical course and therapy compliance. Here, we focused on metacognitive insight in schizophrenia, that is, the ability to monitor one's changes in state of mind and sensations, with the aim of investigating its neuroanatomical, psychopathological, and neuropsychological correlates. Fifty-seven consecutive patients with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) diagnosis of schizophrenia were administered the Insight Scale, and comprehensive psychopathological and neuropsychological batteries. They underwent a high-resolution T1-weighted magnetic resonance imaging investigation. Gray matter (GM) and white matter (WM) volumes were analyzed on a voxel-by-voxel basis using Statistical Parametric Mapping 8. Reduced metacognitive insight was related to reduced GM volumes in the left ventrolateral prefrontal cortex, right dorsolateral prefrontal cortex and insula, and bilateral premotor area and putamen. Further, it was related to reduced WM volumes of the right superior longitudinal fasciculum, left corona radiata, left forceps minor, and bilateral cingulum. Increased metacognitive insight was related to increased depression severity and attentional control impairment, while the latter was related to increased GM volumes in brain areas linked to metacognitive insight. Results of this study suggest that prefrontal GM and WM bundles, all implied in cognitive control and self-reflection, may be the neuroanatomical correlates of metacognitive insight in schizophrenia. Further, higher metacognitive insight is hypothesized to be a risk factor for depression which may subsequently impair attention. This line of research may provide the basis for the development of cognitive interventions aimed at improving self-monitoring and compliance to treatment.
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Affiliation(s)
- Gianfranco Spalletta
- Department of Clinical and Behavioural Neurology, Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
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Lysaker PH, Vohs J, Hillis JD, Kukla M, Popolo R, Salvatore G, Dimaggio G. Poor insight into schizophrenia: contributing factors, consequences and emerging treatment approaches. Expert Rev Neurother 2013; 13:785-93. [PMID: 23898850 DOI: 10.1586/14737175.2013.811150] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Poor insight or unawareness of illness has been commonly observed in schizophrenia and has been long recognized as a potent barrier to treatment adherence and a risk factor for a range of poorer outcomes. Paradoxically, the achievement of insight often poses a different set of problems including depression and low self-esteem. One barrier to the treatment of poor insight has been a lack of understanding of the phenomenon, which causes poor insight to develop and persist over time. Without knowing what promotes poor insight, treatment to date has had little to offer beyond the supportive provision of information. To explore these issues, this article reviews emerging literature on the correlates of poor insight in schizophrenia, and newly developing ways of conceptualizing insight. It then details a number of innovative integrative group and individual treatment approaches in the early stages of development, which take into account some of the potential causal forces behind poor insight, including deficits in neurocognition, social cognition, metacognition and heightened self-stigma. A plan for further research is presented to develop a model of the factors whose interaction influences insight, and to refine and test integrative treatments.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Roudebush VA Medical Center, Indianapolis, IN 46202, USA.
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Swart M, Liemburg EJ, Kortekaas R, Wiersma D, Bruggeman R, Aleman A. Normal brain activation in schizophrenia patients during associative emotional learning. Psychiatry Res 2013; 214:269-76. [PMID: 24148912 DOI: 10.1016/j.pscychresns.2013.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 06/17/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
Abstract
Emotional deficits are among the core features of schizophrenia and both associative emotional learning and the related ability to verbalize emotions can be reduced. We investigated whether schizophrenia patients demonstrated impaired function of limbic and prefrontal areas during associative emotional learning. Patients and controls filled out an alexithymia questionnaire and performed an associative emotional learning task with positive, negative and neutral picture-word pairs during fMRI scanning. After scanning, they indicated for each pair whether they remembered it. We conducted standard GLM analysis and Independent Component Analysis (ICA). Both the GLM results and task-related ICA components were compared between groups. The alexithymia questionnaire indicated more cognitive-emotional processing difficulties in patients than controls, but equal experienced intensity of affective states. Patients remembered less picture-word pairs, irrespective of valence. GLM analysis showed significant visual, temporal, amygdalar/hippocampal, and prefrontal activation in all subjects. ICA identified a network of brain areas similar to GLM, mainly in response to negative stimuli. Neither analysis showed differences between patients and controls during learning. Although in previous studies schizophrenia patients showed abnormalities in both memory and emotion processing, neural circuits involved in cross-modal associative emotional learning may remain intact to a certain degree, which may have potential consequences for treatment.
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Affiliation(s)
- Marte Swart
- Lentis Research, Lentis Center for Mental Healthcare, Groningen, The Netherlands
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Tang J, Liao Y, Song M, Gao JH, Zhou B, Tan C, Liu T, Tang Y, Chen J, Chen X. Aberrant default mode functional connectivity in early onset schizophrenia. PLoS One 2013; 8:e71061. [PMID: 23923052 PMCID: PMC3726582 DOI: 10.1371/journal.pone.0071061] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 06/24/2013] [Indexed: 01/22/2023] Open
Abstract
Background The default mode network (DMN) has been linked to a number of mental disorders including schizophrenia. However, the abnormal connectivity of DMN in early onset schizophrenia (EOS) has been rarely reported. Methods Independent component analysis (ICA) was used to investigate functional connectivity (FC) of the DMN in 32 first-episode adolescents with EOS and 32 age and gender-matched healthy controls. Results Compared to healthy controls, patients with EOS showed increased FC between the medial frontal gyrus and other areas of the DMN. Partial correlation analyses showed that the FC of medial frontal gyrus significantly correlated with PANSS-positive symptoms (partial correlation coefficient = 0.538, Bonferoni corrected P = 0.018). Limitations Although the sample size of participants was comparable with most fMRI studies to date, it was still relatively small. Pediatric brains were registered to the MNI adult brain template. However, possible age-specific differences in spatial normalization that arise from registering pediatric brains to the MNI adult brain template may have little effect on fMRI results. Conclusion This study provides evidence for functional abnormalities of DMN in first-episode EOS. These abnormalities could be a source of abnormal introspectively-oriented mental actives.
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Affiliation(s)
- Jinsong Tang
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China
- Hunan Province Technology Institute of Psychiatry, Changsha, Hunan, PR China
| | - Yanhui Liao
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China
- Hunan Province Technology Institute of Psychiatry, Changsha, Hunan, PR China
| | - Ming Song
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, PR China
| | - Jia-Hong Gao
- Department of Radiology, University of Chicago, Chicago, Illinois, United States of America
| | - Bing Zhou
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Changlian Tan
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Tieqiao Liu
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China
- Hunan Province Technology Institute of Psychiatry, Changsha, Hunan, PR China
| | - Yanqing Tang
- Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Jindong Chen
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China
- Hunan Province Technology Institute of Psychiatry, Changsha, Hunan, PR China
- * E-mail: (XC); (JC)
| | - Xiaogang Chen
- Institute of Mental Health, the Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China
- Hunan Province Technology Institute of Psychiatry, Changsha, Hunan, PR China
- The State Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, PR China
- * E-mail: (XC); (JC)
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Mishra A, Rogers BP, Chen LM, Gore JC. Functional connectivity-based parcellation of amygdala using self-organized mapping: a data driven approach. Hum Brain Mapp 2013; 35:1247-60. [PMID: 23418140 DOI: 10.1002/hbm.22249] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 10/22/2012] [Accepted: 12/03/2012] [Indexed: 11/09/2022] Open
Abstract
The overall goal of this work is to demonstrate how resting state functional magnetic resonance imaging (fMRI) signals may be used to objectively parcellate functionally heterogeneous subregions of the human amygdala into structures characterized by similar patterns of functional connectivity. We hypothesize that similarity of functional connectivity of subregions with other parts of the brain can be a potential basis to segment and cluster voxels using data driven approaches. In this work, self-organizing map (SOM) was implemented to cluster the connectivity maps associated with each voxel of the human amygdala, thereby defining distinct subregions. The functional separation was optimized by evaluating the overall differences in functional connectivity between the subregions at group level. Analysis of 25 resting state fMRI data sets suggests that SOM can successfully identify functionally independent nuclei based on differences in their inter subregional functional connectivity, evaluated statistically at various confidence levels. Although amygdala contains several nuclei whose distinct roles are implicated in various functions, our objective approach discerns at least two functionally distinct volumes comparable to previous parcellation results obtained using probabilistic tractography and cytoarchitectonic analysis. Association of these nuclei with various known functions and a quantitative evaluation of their differences in overall functional connectivity with lateral orbital frontal cortex and temporal pole confirms the functional diversity of amygdala. The data driven approach adopted here may be used as a powerful indicator of structure-function relationships in the amygdala and other functionally heterogeneous structures as well.
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Affiliation(s)
- Arabinda Mishra
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University, Nashville, Tennessee; Department of Radiology and Radiological Science, Vanderbilt University, Nashville, Tennessee
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Garcia I, Kim C, Arenkiel BR. Genetic strategies to investigate neuronal circuit properties using stem cell-derived neurons. Front Cell Neurosci 2012; 6:59. [PMID: 23264761 PMCID: PMC3524522 DOI: 10.3389/fncel.2012.00059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 11/30/2012] [Indexed: 01/28/2023] Open
Abstract
The mammalian brain is anatomically and functionally complex, and prone to diverse forms of injury and neuropathology. Scientists have long strived to develop cell replacement therapies to repair damaged and diseased nervous tissue. However, this goal has remained unrealized for various reasons, including nascent knowledge of neuronal development, the inability to track and manipulate transplanted cells within complex neuronal networks, and host graft rejection. Recent advances in embryonic stem cell (ESC) and induced pluripotent stem cell (iPSC) technology, alongside novel genetic strategies to mark and manipulate stem cell-derived neurons, now provide unprecedented opportunities to investigate complex neuronal circuits in both healthy and diseased brains. Here, we review current technologies aimed at generating and manipulating neurons derived from ESCs and iPSCs toward investigation and manipulation of complex neuronal circuits, ultimately leading to the design and development of novel cell-based therapeutic approaches.
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Affiliation(s)
- Isabella Garcia
- Program in Developmental Biology, Baylor College of Medicine Houston, TX, USA ; Medical Scientist Training Program, Baylor College of Medicine Houston, TX, USA
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