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Korann V, Thonse U, Garani R, Jacob A, Ramkiran S, Praharaj SK, Bharath RD, Kumar V, Varambally S, Venkatasubramanian G, Rao NP. Association between urban upbringing and functional brain connectivity in schizophrenia. Indian J Psychiatry 2024; 66:71-81. [PMID: 38419936 PMCID: PMC10898520 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_560_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/26/2023] [Accepted: 12/25/2023] [Indexed: 03/02/2024] Open
Abstract
Background Environmental factors considerably influence the development of the human cortex during the perinatal period, early childhood, and adolescence. Urban upbringing in the first 15 years of life is a known risk factor for schizophrenia (SCZ). Though the risk of urban birth and upbringing is well-examined from an epidemiological perspective, the biological mechanisms underlying urban upbringing remain unknown. The effect of urban birth and upbringing on functional brain connectivity in SCZ patients is not yet examined. Methods This is a secondary data analysis of three studies that included 87 patients with SCZ and 70 healthy volunteers (HV) aged 18 to 50 years. We calculated the developmental urbanicity index using a validated method in earlier studies. Following standard pre-processing of resting functional magnetic resonance imaging (fMRI) scans, seed-return on investment (ROI) functional connectivity analysis was performed. Results The results showed a significant association between urban birth and upbringing on functional connectivity in SCZ patients and HV (P < 0.05). In SCZ patients, connections from the right caudate, anterior cingulate cortex, left and right intracalcarine cortices, left and right lingual gyri, left posterior parahippocampal cortex to the cerebellum, fusiform gyri, lateral occipital cortex, and amygdala were significantly associated with the urbanicity index (P < 0.05). Conclusions These study findings suggest a significant association between urban birth and upbringing on functional brain connectivity in regions involved in reward processing and social cognition in SCZ. Assessment of social cognition could have implications in developing an in-depth understanding of this impairment in persons with SCZ.
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Affiliation(s)
- Vittal Korann
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Umesh Thonse
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ranjini Garani
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
- Douglas Research Centre, Montreal, Quebec, Canada
| | - Arpitha Jacob
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Shukti Ramkiran
- Department of Psychiatry, Psychotherapy and Psychosomatics, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Samir K. Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rose D. Bharath
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Vijay Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Naren P. Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Thomas M, Rakesh D, Whittle S, Sheridan M, Upthegrove R, Cropley V. The neural, stress hormone and inflammatory correlates of childhood deprivation and threat in psychosis: A systematic review. Psychoneuroendocrinology 2023; 157:106371. [PMID: 37651860 DOI: 10.1016/j.psyneuen.2023.106371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
Childhood adversity increases the risk of developing psychosis, but the biological mechanisms involved are unknown. Disaggregating early adverse experiences into core dimensions of deprivation and threat may help to elucidate these mechanisms. We therefore systematically searched the literature investigating associations between deprivation and threat, and neural, immune and stress hormone systems in individuals on the psychosis spectrum. Our search yielded 74 articles, from which we extracted and synthesized relevant findings. While study designs were heterogeneous and findings inconsistent, some trends emerged. In psychosis, deprivation tended to correlate with lower global cortical volume, and some evidence supported threat-related variation in prefrontal cortex morphology. Greater threat exposure was also associated with higher C-reactive protein, and higher and lower cortisol measures. When examined, associations in controls were less evident. Overall, findings indicate that deprivation and threat may associate with partially distinct biological mechanisms in the psychosis spectrum, and that associations may be stronger than in controls. Dimensional approaches may help disentangle the biological correlates of childhood adversity in psychosis, but more studies are needed.
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Affiliation(s)
- Megan Thomas
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia.
| | - Divyangana Rakesh
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia; Neuroimaging Department, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, United Kingdom
| | - Sarah Whittle
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia
| | - Margaret Sheridan
- Department of Psychology & Neuroscience, University of North Carolina, United States
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, United Kingdom; Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, United Kingdom
| | - Vanessa Cropley
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia
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3
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Trait related aberrant connectivity in clinically stable patients with schizophrenia: A seed based resting state fMRI study. Brain Imaging Behav 2022; 16:2705-2714. [PMID: 36241961 DOI: 10.1007/s11682-022-00731-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 11/02/2022]
Abstract
Aberrant resting-state connectivity within and between the Default Mode Network, the Executive Control Network, and the Salience Network is well-established in schizophrenia. Meta-analyses have identified that bilateral lingual gyrus is as the only region showing hyperactivity in schizophrenia and there are reports of increased connectivity between the lingual gyrus and other brain regions in schizophrenia. It is not clear whether these abnormalities represent state or trait markers of the illness, i.e., if they are only present during the acute phase of the illness (state) or if they reflect a predisposition to schizophrenia (trait). In this study, we used a seed-based functional connectivity analysis to investigate brain networks in schizophrenia patients who are in the stable phase of their illness and assess functional connectivity using seeds in the lingual gyrus, the posterior cingulate, the right dorsolateral prefrontal cortex (dlPFC), the right anterior insula (rAI) and the right orbital frontoinsula. Twenty patients with schizophrenia in a stable phase of their illness (as defined by the course of illness and Signs and Symptoms of Psychotic Illness (SSPI) scores) and 20 age and sex-matched healthy controls underwent resting-state functional Magnetic Resonance Imaging (rs-fMRI). Data was analysed using the Data Processing Assistant for Resting-State fMRI Advanced Edition (DPARSFA) V3.1 ( http://rfmri.org/DPARSF ) and the statistical parametric mapping software 8 (SPM8). Compared with healthy controls, patients with schizophrenia showed increased connectivity between the left lingual gyrus and the middle frontal gyrus, and the cingulate cortex. Lingual gyrus hyper-connectivity may be a stable trait neuroimaging marker for schizophrenia. Our findings suggest that aberrant connectivity in major resting-state networks may not be present after the acute illness has stabilised.
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Sendi MSE, Zendehrouh E, Turner JA, Calhoun VD. Dynamic patterns within the default mode network in schizophrenia subgroups. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1640-1643. [PMID: 34891600 DOI: 10.1109/embc46164.2021.9629825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In this study, resting-state functional magnetic resonance imaging (rs-fMRI) data of 125 schizophrenia (SZ) subjects were analyzed. Based on SZ demographic information and cognitive scores and using an unsupervised clustering method, we identified subgroups of patients and compared DMN dynamic functional connectivity (dFC) between the groups. We captured seven independent subnodes, including anterior cingulate cortex (ACC), posterior cingulate cortex (PCC), and precuneus (PCu), in the DMN by applying group independent component analysis (group-ICA) and estimated dFC between component time courses using a sliding window approach. By using k-means clustering, we separated the dFCs into three reoccurring brain states. Using the statistical method, we compared the state-specific DMN connectivity pattern between two SZ subgroups. In addition, we used a transition probability matrix of a hidden Markov model (HMM) and occupancy rate (OCR) of each state between two SZ subgroups. We found SZ subjects with higher positive and negative syndrome scale (PNASS) showed lower within ACC and lower ACC and PCC connectivity (or ACC/PCC). In addition, we found the transition from state1 to same state is significantly different between two groups, while this result was not significant after multiple comparison tests.
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Functional brain network dysfunctions in subjects at high-risk for psychosis: A meta-analysis of resting-state functional connectivity. Neurosci Biobehav Rev 2021; 128:90-101. [PMID: 34119524 DOI: 10.1016/j.neubiorev.2021.06.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/08/2021] [Indexed: 01/10/2023]
Abstract
Although emerging evidence suggests that altered functional connectivity (FC) of large-scale neural networks is associated with disturbances in individuals at high-risk for psychosis, the findings are still far to be conclusive. We conducted a meta-analysis of seed-based resting-state functional magnetic resonance imaging studies that compared individuals at clinical high-risk for psychosis (CHR), first-degree relatives of patients with schizophrenia, or subjects who reported psychotic-like experiences with healthy controls. Twenty-nine studies met the inclusion criteria. The MetaNSUE method was used to analyze connectivity comparisons and symptom correlations. Our results showed a significant hypo-connectivity within the salience network (p = 0.012, uncorrected) in the sample of CHR individuals (n = 810). Additionally, we found a positive correlation between negative symptom severity and FC between the default mode network and both the salience network (p < 0.001, r = 0.298) and the central executive network (p = 0.003, r = 0.23) in the CHR group. This meta-analysis lends support for the hypothesis that large-scale network dysfunctions represent a core neural deficit underlying psychosis development.
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Krabbendam L, van Vugt M, Conus P, Söderström O, Abrahamyan Empson L, van Os J, Fett AKJ. Understanding urbanicity: how interdisciplinary methods help to unravel the effects of the city on mental health. Psychol Med 2021; 51:1099-1110. [PMID: 32156322 DOI: 10.1017/s0033291720000355] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Twenty-first century urbanization poses increasing challenges for mental health. Epidemiological studies have shown that mental health problems often accumulate in urban areas, compared to rural areas, and suggested possible underlying causes associated with the social and physical urban environments. Emerging work indicates complex urban effects that depend on many individual and contextual factors at the neighbourhood and country level and novel experimental work is starting to dissect potential underlying mechanisms. This review summarizes findings from epidemiology and population-based studies, neuroscience, experimental and experience-based research and illustrates how a combined approach can move the field towards an increased understanding of the urbanicity-mental health nexus.
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Affiliation(s)
- Lydia Krabbendam
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BTAmsterdam, The Netherlands
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, LondonSE5 8AF, UK
| | - Mark van Vugt
- Department of Experimental and Applied Psychology, Faculty of Behavioral and Movement Sciences, Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BTAmsterdam, The Netherlands
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Clinique de Cery, Prilly, Switzerland
| | - Ola Söderström
- Institut de Géographie, Université de Neuchâtel, Espace Louis-Agassiz, 2000, Neuchâtel, Switzerland
| | - Lilith Abrahamyan Empson
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Clinique de Cery, Prilly, Switzerland
| | - Jim van Os
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, LondonSE5 8AF, UK
- Department of Psychiatry, UMC Utrecht Brain Center, Utrecht, The Netherlands
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anne-Kathrin J Fett
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BTAmsterdam, The Netherlands
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, LondonSE5 8AF, UK
- Department of Psychology, City, University of London, Northampton Square, LondonEC1V 0HB, UK
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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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Chan SY, Brady R, Hwang M, Higgins A, Nielsen K, Öngür D, Hall MH. Heterogeneity of Outcomes and Network Connectivity in Early-Stage Psychosis: A Longitudinal Study. Schizophr Bull 2020; 47:138-148. [PMID: 32572485 PMCID: PMC7825010 DOI: 10.1093/schbul/sbaa079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Imaging studies in psychotic disorders typically examine cross-sectional relationships between magnetic resonance imaging (MRI) signals and diagnosis or symptoms. We sought to examine changes in network connectivity identified using resting-state functional MRI (fMRI) corresponding to divergent functional recovery trajectories and relapse in early-stage psychosis (ESP). Prior studies have linked schizophrenia to hyperconnectivity in the default mode network (DMN). Given the correlations between the DMN and behavioral impairments in psychosis, we hypothesized that dynamic changes in DMN connectivity reflect the heterogeneity of outcomes in ESP. Longitudinal data were collected from 66 ESP patients and 20 healthy controls. Longitudinal cluster analysis identified subgroups of patients with similar trajectories in terms of symptom severity and functional outcomes. DMN connectivity was measured in a subset of patients (n = 36) longitudinally over 2 scans separated by a mean of 12 months. We then compared connectivity between patients and controls, and among the different outcome trajectory subgroups. Among ESP participants, 4 subgroups were empirically identified corresponding to: "Poor," "Middle," "Catch-up," and "Good" trajectory outcomes in the complete dataset (n = 36), and an independent replication (n = 30). DMN connectivity changes differed significantly between functional subgroups (F3,32 = 6.06, P-FDR corrected = .01); DMN connectivity increased over time in the "Poor" outcome cluster (β = +0.145) but decreased over time in the "Catch-up" cluster (β = -0.212). DMN connectivity is dynamic and correlates with a change in functional status over time in ESP. This approach identifies a brain-based marker that reflects important neurobiological processes required to sustain functional recovery.
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Affiliation(s)
- Shi Yu Chan
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA,Psychosis Neurobiology Laboratory, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,To whom correspondence should be addressed; Psychosis Neurobiology Lab/Schizophrenia and Bipolar Disorders Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478; tel: 1-617-855-3528, fax: 1-617-855-2895, e-mail:
| | - Roscoe Brady
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA
| | - Melissa Hwang
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA
| | - Amy Higgins
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA,Psychosis Neurobiology Laboratory, McLean Hospital, Belmont, MA
| | - Kathryn Nielsen
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA
| | - Dost Öngür
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA,Psychosis Neurobiology Laboratory, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Mei-Hua Hall
- Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, Belmont, MA,Psychosis Neurobiology Laboratory, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
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Evans BE, Huizink AC, Greaves-Lord K, Tulen JHM, Roelofs K, van der Ende J. Urbanicity, biological stress system functioning and mental health in adolescents. PLoS One 2020; 15:e0228659. [PMID: 32187199 PMCID: PMC7080241 DOI: 10.1371/journal.pone.0228659] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 01/21/2020] [Indexed: 11/19/2022] Open
Abstract
Growing up in an urban area has been associated with an increased chance of mental health problems in adults, but less is known about this association in adolescents. We examined whether current urbanicity was associated with mental health problems directly and indirectly via biological stress system functioning. Participants (n = 323) were adolescents from the Dutch general population. Measures included home and laboratory assessments of autonomic nervous system and hypothalamic-pituitary-adrenal axis functioning, neighborhood-level urbanicity and socioeconomic status, and mother- and adolescent self-reported mental health problems. Structural equation models showed that urbanicity was not associated with mental health problems directly. Urbanicity was associated with acute autonomic nervous system and hypothalamic-pituitary-adrenal axis reactivity such that adolescents who lived in more urban areas showed blunted biological stress reactivity. Furthermore, there was some evidence for an indirect effect of urbanicity on mother-reported behavioral problems via acute autonomic nervous system reactivity. Urbanicity was not associated with overall autonomic nervous system and hypothalamic-pituitary-adrenal axis reactivity or basal hypothalamic-pituitary-adrenal axis functioning. Although we observed some evidence for associations between urbanicity, biological stress reactivity and mental health problems, most of the tested associations were not statistically significant. Measures of long-term biological stress system functioning may be more relevant to the study of broader environmental factors such as urbanicity.
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Affiliation(s)
- Brittany E. Evans
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden
- * E-mail:
| | - Anja C. Huizink
- Section of Clinical Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Kirstin Greaves-Lord
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joke H. M. Tulen
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Karin Roelofs
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Multivariate classification of schizophrenia and its familial risk based on load-dependent attentional control brain functional connectivity. Neuropsychopharmacology 2020; 45:613-621. [PMID: 31581175 PMCID: PMC7021788 DOI: 10.1038/s41386-019-0532-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/01/2019] [Accepted: 09/15/2019] [Indexed: 01/01/2023]
Abstract
Patients with schizophrenia (SCZ), as well as their unaffected siblings (SIB), show functional connectivity (FC) alterations during performance of tasks involving attention. As compared with SCZ, these alterations are present in SIB to a lesser extent and are more pronounced during high cognitive demand, thus possibly representing one of the pathways in which familial risk is translated into the SCZ phenotype. Our aim is to measure the separability of SCZ and SIB from healthy controls (HC) using attentional control-dependent FC patterns, and to test to which extent these patterns span a continuum of neurofunctional alterations between HC and SCZ. 65 SCZ with 65 age and gender-matched HC and 39 SIB with 39 matched HC underwent the Variable Attentional Control (VAC) task. Load-dependent connectivity matrices were generated according to correct responses in each VAC load. Classification performances of high, intermediate and low VAC load FC on HC-SCZ and HC-SIB cohorts were tested through machine learning techniques within a repeated nested cross-validation framework. HC-SCZ classification models were applied to the HC-SIB cohort, and vice-versa. A high load-related decreased FC pattern discriminated between HC and SCZ with 66.9% accuracy and with 57.7% accuracy between HC and SIB. A high load-related increased FC network separated SIB from HC (69.6% accuracy), but not SCZ from HC (48.5% accuracy). Our findings revealed signatures of attentional FC abnormalities shared by SCZ and SIB individuals. We also found evidence for potential, SIB-specific FC signature, which may point to compensatory neurofunctional mechanisms in persons at familial risk for schizophrenia.
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11
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Lemmers-Jansen IL, Fett AKJ, van Os J, Veltman DJ, Krabbendam L. Trust and the city: Linking urban upbringing to neural mechanisms of trust in psychosis. Aust N Z J Psychiatry 2020; 54:138-149. [PMID: 31409094 DOI: 10.1177/0004867419865939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Elevated prevalence of non-affective psychotic disorders is often found in densely populated areas. This functional magnetic resonance imaging study investigates if reduced trust, a component of impaired social functioning in patients with psychotic disorder, is associated with urban upbringing. METHODS In total, 39 patients (22 first episode and 17 clinical high risk) and 30 healthy controls, aged 16-29, performed two multi-round trust games, with a cooperative and unfair partner during functional magnetic resonance imaging scanning. Baseline trust was operationalized as the first investment made, and changes of trust as changes in investments made over the 20 trials during the games. Urban exposure during upbringing (0-15 years) was defined as higher urban (≥2500 inhabitants/km2) or lower urban (<2500 inhabitants/km2). RESULTS Patients displayed lower baseline trust (first investment) than controls, regardless of urbanicity exposure. During cooperative interactions, lower-urban patients showed increasing investments. In addition, during cooperative interactions, group-by-developmental urbanicity interactions were found in the right and left amygdalae, although for the latter only at trend level. Higher urbanicity was associated with decreased activation of the left amygdala in patients and controls during investments and with increased activation of the right and left amygdalae in patients only, during repayments. During unfair interactions, no associations of urbanicity with behavior or brain activation were found. CONCLUSION Urban upbringing was unrelated to baseline trust. Associations with urbanicity were stronger for patients compared to controls, suggesting greater susceptibility to urbanicity effects during the developmental period. Higher-urban patients failed to compensate for the initial distrust specifically during repeated cooperative interactions. This finding highlights potential implications for social functioning. Urban upbringing was linked to differential amygdala activation, suggesting altered mechanisms of feedback learning, but this was not associated with trust game behavior.
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Affiliation(s)
- Imke Lj Lemmers-Jansen
- Department of Clinical, Neuro & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,The Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anne-Kathrin J Fett
- Department of Clinical, Neuro & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,The Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Psychology, City, University of London, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychiatry, Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands.,Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU Medical Center, Amsterdam, The Netherlands
| | - Lydia Krabbendam
- Department of Clinical, Neuro & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,The Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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12
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Guo S, He N, Liu Z, Linli Z, Tao H, Palaniyappan L. Brain-Wide Functional Dysconnectivity in Schizophrenia: Parsing Diathesis, Resilience, and the Effects of Clinical Expression. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:21-29. [PMID: 31775531 PMCID: PMC6966251 DOI: 10.1177/0706743719890174] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The functional dysconnectivity observed from functional magnetic resonance imaging (fMRI) studies in schizophrenia is also seen in unaffected siblings indicating its association with the genetic diathesis. We intended to apportion resting-state dysconnectivity into components that represent genetic diathesis, clinical expression or treatment effect, and resilience. METHODS fMRI data were acquired from 28 schizophrenia patients, 28 unaffected siblings, and 60 healthy controls. Based on Dosenbach's atlas, we extracted time series of 160 regions of interest. After constructing functional network, we investigated between-group differences in strength and diversity of functional connectivity and topological properties of undirected graphs. RESULTS Using analysis of variance, we found 88 dysconnectivities. Post hoc t tests revealed that 62.5% were associated with genetic diathesis and 21.6% were associated with clinical expression. Topologically, we observed increased degree, clustering coefficient, and global efficiency in the sibling group compared to both patients and controls. CONCLUSION A large portion of the resting-state functional dysconnectivity seen in patients represents a genetic diathesis effect. The most prominent network-level disruption is the dysconnectivity among nodes of the default mode and salience networks. Despite their predisposition, unaffected siblings show a pattern of resilience in the emergent connectomic topology. Our findings could potentially help refine imaging genetics approaches currently used in the pursuit of the pathophysiology of schizophrenia.
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Affiliation(s)
- Shuixia Guo
- MOE-LCSM, School of Mathematics and Statistics, Hunan Normal University, Changsha, People's Republic of China.,Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, People's Republic of China
| | - Ningning He
- MOE-LCSM, School of Mathematics and Statistics, Hunan Normal University, Changsha, People's Republic of China
| | - Zhening Liu
- Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Zeqiang Linli
- MOE-LCSM, School of Mathematics and Statistics, Hunan Normal University, Changsha, People's Republic of China
| | - Haojuan Tao
- Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Lena Palaniyappan
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.,Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
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13
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Systematic review and multi-modal meta-analysis of magnetic resonance imaging findings in 22q11.2 deletion syndrome: Is more evidence needed? Neurosci Biobehav Rev 2019; 107:143-153. [DOI: 10.1016/j.neubiorev.2019.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 08/07/2019] [Accepted: 09/02/2019] [Indexed: 11/20/2022]
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14
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Costa E Silva JA, Steffen RE. Urban environment and psychiatric disorders: a review of the neuroscience and biology. Metabolism 2019; 100S:153940. [PMID: 31610855 DOI: 10.1016/j.metabol.2019.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/04/2019] [Indexed: 10/25/2022]
Abstract
Most of the world's population now lives in cities. While living in cities have both health risks and benefits, mental health has been usually considered to be negatively affected by urbanicity. While mental health disorders have complex etiology and multiple causes, it has been shown in multiple observational studies that mood and anxiety disorders are more prevalent in urban centers and incidence has been increasing. In addition, the incidence of schizophrenia is strongly increased in people born and raised in cities. Studies on the effects of urbanicity on the brain, however, are more challenging to conduct, since individual and environmental factors are hard to distinguish. The main objective of this article is to review studies on how specific neural processes mediate those associations between urbanicity and psychiatric disorders and how environmental factors affect genetic regulation (epigenetics). Neuroimaging studies have shown how urban stressors might affect the brain by conducting experiments using functional magnetic resonance imaging (fMRI). There have been demonstrations that urban upbringing and city living have dissociable impacts on social evaluative stress processing in humans. City living was associated with increased amygdala activity and the urban upbringing has been shown to affect the perigenual anterior cingulate cortex, a key region for regulation of amygdala activity, negative affect and stress. In addition, studies on epigenetics have shown associations between exposure to features of the environment and methylation patterns. The goal of understanding how urban environments act as a risk factor for mental disorders may be pursued on several levels. It can be approached by measuring the effects of economic factors (unemployment, socioeconomic status), social condition (social network support), environmental exposures (toxins, air pollution, noise, light), that must be weighed to identify how it contributes to mental disorders.
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Affiliation(s)
| | - Ricardo E Steffen
- Rio de Janeiro State University (UERJ), Institute of Social Medicine, Department of Health Policy and Management, Rio de Janeiro, Brazil.
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15
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Arroyo Relión JD, Kessler D, Levina E, Taylor SF. NETWORK CLASSIFICATION WITH APPLICATIONS TO BRAIN CONNECTOMICS. Ann Appl Stat 2019; 13:1648-1677. [PMID: 33408802 DOI: 10.1214/19-aoas1252] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
While statistical analysis of a single network has received a lot of attention in recent years, with a focus on social networks, analysis of a sample of networks presents its own challenges which require a different set of analytic tools. Here we study the problem of classification of networks with labeled nodes, motivated by applications in neuroimaging. Brain networks are constructed from imaging data to represent functional connectivity between regions of the brain, and previous work has shown the potential of such networks to distinguish between various brain disorders, giving rise to a network classification problem. Existing approaches tend to either treat all edge weights as a long vector, ignoring the network structure, or focus on graph topology as represented by summary measures while ignoring the edge weights. Our goal is to design a classification method that uses both the individual edge information and the network structure of the data in a computationally efficient way, and that can produce a parsimonious and interpretable representation of differences in brain connectivity patterns between classes. We propose a graph classification method that uses edge weights as predictors but incorporates the network nature of the data via penalties that promote sparsity in the number of nodes, in addition to the usual sparsity penalties that encourage selection of edges. We implement the method via efficient convex optimization and provide a detailed analysis of data from two fMRI studies of schizophrenia.
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Functional connectivity of the default mode network is associated with prospection in schizophrenia patients and individuals with social anhedonia. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:412-420. [PMID: 30822447 DOI: 10.1016/j.pnpbp.2019.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Prospection, which is closely related to negative symptoms in patients with schizophrenia, is mainly associated with the Default Mode Network (DMN). Although abnormalities of the DMN have been reported in schizophrenia patients and at-risk individuals, little is known about the relationship between functional connectivity of the DMN and prospection in these clinical and subclinical populations. METHOD Study 1 recruited 40 schizophrenia patients and 29 healthy controls, while 31 individuals with social anhedonia (SocAhn) and 28 controls participated in Study 2. Participants in both studies were asked to complete a prospection task and underwent resting-state functional MRI scans. Eleven regions of interest (ROIs) in the DMN were defined. Functional connectivity between each ROI and whole brain voxels were calculated and compared between groups (schizophrenia vs. control and SocAhn vs. control). Correlation analysis was conducted between altered functional connectivity and prospection variables in the schizophrenia and SocAhn groups. RESULTS Schizophrenia patients showed both hyper-connectivity and hypo-connectivity at the medial temporal lobe (MTL) subsystem of the DMN. Decreased connectivity between the ventral medial prefrontal cortex (vMPFC) and the right superior temporal gyrus (rSTG) was correlated with poor thought/emotion details in prospection. In individuals with SocAhn, decreased connectivity between the retrosplenial cortex (Rsp), a region of the MTL subsystem, and the right fusiform gyrus, was found and this was correlated with their prospection performance. CONCLUSION Altered functional connectivity of the key nodes of the MTL subsystem was found in both patients with schizophrenia and individuals with SocAhn. Moreover, hypo-connectivity of the vMPFC was found to be correlated with prospection impairments in schizophrenia patients.
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17
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Rebello K, Moura LM, Pinaya WHL, Rohde LA, Sato JR. Default Mode Network Maturation and Environmental Adversities During Childhood. ACTA ACUST UNITED AC 2018; 2:2470547018808295. [PMID: 32440587 PMCID: PMC7219900 DOI: 10.1177/2470547018808295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/28/2018] [Indexed: 12/14/2022]
Abstract
Default mode network (DMN) plays a central role in cognition and brain disorders.
It has been shown that adverse environmental conditions impact neurodevelopment,
but how these conditions impact in DMN maturation is still poorly understood.
This article reviews representative neuroimaging functional studies addressing
the interactions between DMN development and environmental factors, focusing on
early life adversities, a critical period for brain changes. Studies focused on
this period of life offer a special challenge: to disentangle the
neurodevelopmental connectivity changes from those related to environmental
conditions. We first summarized the literature on DMN maturation, providing an
overview of both typical and atypical development patterns in childhood and
early adolescence. Afterward, we focused on DMN changes associated with chronic
exposure to environmental adversities during childhood. This summary suggests
that changes in DMN development could be a potential allostatic neural feature
associated with an embodiment of environmental circumstances. Finally, we
discuss about some key methodological issues that should be considered in
paradigms addressing environmental adversities and open questions for future
investigations.
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Affiliation(s)
- Keila Rebello
- Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Brazil
| | - Luciana M Moura
- Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Brazil
| | - Walter H L Pinaya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Luis A Rohde
- Department of Psychiatry, Federal University of Rio Grande do Sul, Brazil
| | - João R Sato
- Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Brazil
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18
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Rikandi E, Mäntylä T, Lindgren M, Kieseppä T, Suvisaari J, Raij TT. Connectivity of the precuneus-posterior cingulate cortex with the anterior cingulate cortex-medial prefrontal cortex differs consistently between control subjects and first-episode psychosis patients during a movie stimulus. Schizophr Res 2018; 199:235-242. [PMID: 29588124 DOI: 10.1016/j.schres.2018.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 01/10/2018] [Accepted: 03/11/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Functional connectivity is altered in psychotic disorders. Multiple findings concentrate on the default mode network, anchored on the precuneus-posterior cingulate cortex (PC-PCC). However, the nature of the alterations varies between studies and connectivity alterations have not been studied during an ecologically valid natural stimulus. In the present study, we investigated the functional and structural connectivity of a PC-PCC region, where functioning differentiated first-episode psychosis patients from control subjects during free viewing of a movie in our earlier study. METHODS 14 first-episode psychosis patients and 12 control subjects were imaged with GE 3T, and 29 patients and 19 control subjects were imaged with a Siemens Skyra 3T scanner while watching scenes from the movie Alice in Wonderland. Group differences in functional connectivity were analysed for both scanners separately and results were compared to identify any overlap. Diffusion tensor measures of 26 patients and 19 control subjects were compared for the related white matter tracts, identified by deterministic tractography. RESULTS Functional connectivity was increased in patients across scanners between the midline regions of the PC-PCC and the anterior cingulate cortex-medial prefrontal cortex (ACC-mPFC). We found no group differences in any of the diffusion tensor imaging measures. CONCLUSIONS Already in the early stages of psychosis functional connectivity between the midline structures of the PC-PCC and the ACC-mPFC is consistently increased during naturalistic stimulus.
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Affiliation(s)
- Eva Rikandi
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Centre, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland; Department of Psychology and Logopedics, Faculty of Medicine, Helsinki University, Helsinki, Finland.
| | - Teemu Mäntylä
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Centre, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland; Department of Psychology and Logopedics, Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Maija Lindgren
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Tuula Kieseppä
- Department of Psychiatry, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Suvisaari
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Tuukka T Raij
- Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Centre, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland; Department of Psychiatry, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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19
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Greenwald JD, Shafritz KM. An Integrative Neuroscience Framework for the Treatment of Chronic Pain: From Cellular Alterations to Behavior. Front Integr Neurosci 2018; 12:18. [PMID: 29875641 PMCID: PMC5974053 DOI: 10.3389/fnint.2018.00018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/04/2018] [Indexed: 12/21/2022] Open
Abstract
Chronic pain can result from many pain syndromes including complex regional pain syndrome (CRPS), phantom limb pain and chronic low back pain, among others. On a molecular level, chronic pain syndromes arise from hypersensitization within the dorsal horn of the spinal cord, a process known as central sensitization. Central sensitization involves an upregulation of ionotropic and metabotropic glutamate receptors (mGluRs) similar to that of long-term potentiation (LTP). Regions of the brain in which LTP occurs, such as the amygdala and hippocampus, are implicated in fear- and memory-related brain circuity. Chronic pain dramatically influences patient quality of life. Individuals with chronic pain may develop pain-related anxiety and pain-related fear. The syndrome also alters functional connectivity in the default-mode network (DMN) and salience network. On a cellular/molecular level, central sensitization may be reversed through degradative glutamate receptor pathways. This, however, rarely happens. Instead, cortical brain regions may serve in a top-down regulatory capacity for the maintenance or alleviation of pain. Specifically, the medial prefrontal cortex (mPFC), which plays a critical role in fear-related brain circuits, the DMN, and salience network may be the driving forces in this process. On a cellular level, the mPFC may form new neural circuits through LTP that may cause extinction of pre-existing pain pathways found within fear-related brain circuits, the DMN, and salience network. In order to promote new LTP connections between the mPFC and other key brain structures, such as the amygdala and insula, we propose a holistic rehabilitation program including cognitive behavioral therapy (CBT) and revolving around: (1) cognitive reappraisals; (2) mindfulness meditation; and (3) functional rehabilitation. Unlike current medical interventions focusing upon pain-relieving medications, we do not believe that chronic pain treatment should focus on reversing the effects of central sensitization. Instead, we propose here that it is critical to focus on non-invasive efforts to promote new neural circuits originating from the mPFC.
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Affiliation(s)
- Jess D. Greenwald
- Department of Psychology, Hofstra University, Hempstead, NY, United States
| | - Keith M. Shafritz
- Department of Psychology, Hofstra University, Hempstead, NY, United States
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, United States
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20
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Reed JL, D’Ambrosio E, Marenco S, Ursini G, Zheutlin AB, Blasi G, Spencer BE, Romano R, Hochheiser J, Reifman A, Sturm J, Berman KF, Bertolino A, Weinberger DR, Callicott JH. Interaction of childhood urbanicity and variation in dopamine genes alters adult prefrontal function as measured by functional magnetic resonance imaging (fMRI). PLoS One 2018; 13:e0195189. [PMID: 29634738 PMCID: PMC5892884 DOI: 10.1371/journal.pone.0195189] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/13/2018] [Indexed: 12/29/2022] Open
Abstract
Brain phenotypes showing environmental influence may help clarify unexplained associations between urban exposure and psychiatric risk. Heritable prefrontal fMRI activation during working memory (WM) is such a phenotype. We hypothesized that urban upbringing (childhood urbanicity) would alter this phenotype and interact with dopamine genes that regulate prefrontal function during WM. Further, dopamine has been hypothesized to mediate urban-associated factors like social stress. WM-related prefrontal function was tested for main effects of urbanicity, main effects of three dopamine genes-catechol-O-methyltransferase (COMT), dopamine receptor D1 (DRD1), and dopamine receptor D2 (DRD2)-and, importantly, dopamine gene-by-urbanicity interactions. For COMT, three independent human samples were recruited (total n = 487). We also studied 253 subjects genotyped for DRD1 and DRD2. 3T fMRI activation during the N-back WM task was the dependent variable, while childhood urbanicity, dopamine genotype, and urbanicity-dopamine interactions were independent variables. Main effects of dopamine genes and of urbanicity were found. Individuals raised in an urban environment showed altered prefrontal activation relative to those raised in rural or town settings. For each gene, dopamine genotype-by-urbanicity interactions were shown in prefrontal cortex-COMT replicated twice in two independent samples. An urban childhood upbringing altered prefrontal function and interacted with each gene to alter genotype-phenotype relationships. Gene-environment interactions between multiple dopamine genes and urban upbringing suggest that neural effects of developmental environmental exposure could mediate, at least partially, increased risk for psychiatric illness in urban environments via dopamine genes expressed into adulthood.
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Affiliation(s)
- Jessica L. Reed
- Clinical and Translational Neuroscience Branch, Division of Intramural Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America
- Interdisciplinary Program in Neuroscience, Georgetown University Medical Center, Washington, District of Columbia, United States of America
- Experimental Therapeutics & Pathophysiology Branch, Division of Intramural Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Enrico D’Ambrosio
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, Maryland, United States of America
- Psychiatric Neuroscience Group, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Stefano Marenco
- Clinical and Translational Neuroscience Branch, Division of Intramural Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Gianluca Ursini
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, Maryland, United States of America
- Psychiatric Neuroscience Group, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Amanda B. Zheutlin
- Clinical and Translational Neuroscience Branch, Division of Intramural Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Giuseppe Blasi
- Psychiatric Neuroscience Group, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Barbara E. Spencer
- Clinical and Translational Neuroscience Branch, Division of Intramural Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Raffaella Romano
- Psychiatric Neuroscience Group, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Jesse Hochheiser
- Clinical and Translational Neuroscience Branch, Division of Intramural Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Ann Reifman
- Clinical and Translational Neuroscience Branch, Division of Intramural Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Justin Sturm
- Clinical and Translational Neuroscience Branch, Division of Intramural Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Karen F. Berman
- Clinical and Translational Neuroscience Branch, Division of Intramural Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Alessandro Bertolino
- Psychiatric Neuroscience Group, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Daniel R. Weinberger
- Clinical and Translational Neuroscience Branch, Division of Intramural Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, Maryland, United States of America
- Departments of Psychiatry, Neurology, Neuroscience and the McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Joseph H. Callicott
- Clinical and Translational Neuroscience Branch, Division of Intramural Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America
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de Bézenac CE, Sluming V, Alhazmi F, Corcoran R. Agency performance modulates resting-state variation in prefrontal brain regions. Neuropsychologia 2018; 111:16-25. [DOI: 10.1016/j.neuropsychologia.2017.12.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 11/30/2017] [Accepted: 12/22/2017] [Indexed: 11/16/2022]
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Associations between urban upbringing and cortical thickness and gyrification. J Psychiatr Res 2017; 95:114-120. [PMID: 28841461 DOI: 10.1016/j.jpsychires.2017.08.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/30/2017] [Accepted: 08/14/2017] [Indexed: 12/18/2022]
Abstract
Urbanicity has been linked to several psychiatric disorders, especially schizophrenia. Recent studies suggest effects of urban upbringing and stress on brain structure and function. Here, we used surface-based and voxel-based morphometry to study the effects of urban upbringing in different environments on variation in brain structure in a non-clinical sample. We recruited 85 young and healthy individuals from the community and recorded urban vs. rural background in their first 15 years of live. All participants underwent T1-weighted 3T MRI, which were then processed via CAT12 toolbox (in SPM12) to analyse cortical volume, thickness and gyrification. These parameters were correlated with an established measure of cumulative childhood and adolescence exposure to urban environments. We found significant (p < 0.05, FWE-corrected) negative correlations of cortical thickness with higher index of urban upbringing in the left dorsolateral prefrontal cortex, bilateral medial prefrontal cortices, as well as temporal cortices including the left superior temporal and left parahippocampal cortex. In contrast, results for volume and gyrification (incl. left posterior cingulate cortex) did not survive correction for multiple comparisons. We show a strong association of early-life urbanicity with cortical thickness in several areas, which are also impaired in schizophrenia patients. Along with other findings, these results converge on the dorsolateral prefrontal cortex as an area mediating this environmental risk.
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Crespi B, Leach E, Dinsdale N, Mokkonen M, Hurd P. Imagination in human social cognition, autism, and psychotic-affective conditions. Cognition 2016; 150:181-99. [DOI: 10.1016/j.cognition.2016.02.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 02/01/2016] [Accepted: 02/03/2016] [Indexed: 01/08/2023]
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24
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Antonucci LA, Taurisano P, Fazio L, Gelao B, Romano R, Quarto T, Porcelli A, Mancini M, Di Giorgio A, Caforio G, Pergola G, Popolizio T, Bertolino A, Blasi G. Association of familial risk for schizophrenia with thalamic and medial prefrontal functional connectivity during attentional control. Schizophr Res 2016; 173:23-9. [PMID: 27012899 DOI: 10.1016/j.schres.2016.03.014] [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] [Received: 06/30/2015] [Revised: 03/08/2016] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
Anomalies in behavioral correlates of attentional processing and related brain activity are crucial correlates of schizophrenia and associated with familial risk for this brain disorder. However, it is not clear how brain functional connectivity during attentional processes is key for schizophrenia and linked with trait vs. state related variables. To address this issue, we investigated patterns of functional connections during attentional control in healthy siblings of patients with schizophrenia, who share with probands genetic features but not variables related to the state of the disorder. 356 controls, 55 patients with schizophrenia on stable treatment with antipsychotics and 40 healthy siblings of patients with this brain disorder underwent the Variable Attentional Control (VAC) task during fMRI. Independent Component Analysis (ICA) is allowed to identify independent components (IC) of BOLD signal recorded during task performance. Results indicated reduced connectivity strength in patients with schizophrenia as well as in their healthy siblings in left thalamus within an attentional control component and greater connectivity in right medial prefrontal cortex (PFC) within the so-called Default Mode Network (DMN) compared to healthy individuals. These results suggest a relationship between familial risk for schizophrenia and brain functional networks during attentional control, such that this biological phenotype may be considered a useful intermediate phenotype in order to link genes effects to aspects of the pathophysiology of this brain disorder.
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Affiliation(s)
- Linda A Antonucci
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Università degli Studi di Bari "Aldo Moro", 70124 Bari, Italy; Department of Educational Science, Psychology and Communication Science, Università degli Studi di Bari "Aldo Moro", 70124 Bari, Italy
| | - Paolo Taurisano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Università degli Studi di Bari "Aldo Moro", 70124 Bari, Italy
| | - Leonardo Fazio
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Università degli Studi di Bari "Aldo Moro", 70124 Bari, Italy
| | - Barbara Gelao
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Università degli Studi di Bari "Aldo Moro", 70124 Bari, Italy
| | - Raffaella Romano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Università degli Studi di Bari "Aldo Moro", 70124 Bari, Italy
| | - Tiziana Quarto
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Università degli Studi di Bari "Aldo Moro", 70124 Bari, Italy; Cognitive Brain Research Unit, Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
| | - Annamaria Porcelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Università degli Studi di Bari "Aldo Moro", 70124 Bari, Italy
| | - Marina Mancini
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Università degli Studi di Bari "Aldo Moro", 70124 Bari, Italy
| | | | - Grazia Caforio
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Università degli Studi di Bari "Aldo Moro", 70124 Bari, Italy; Psychiatry Unit, Bari University Hospital, 70124 Bari, Italy
| | - Giulio Pergola
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Università degli Studi di Bari "Aldo Moro", 70124 Bari, Italy
| | - Teresa Popolizio
- IRCCS "Casa Sollievo della Sofferenza", 71013 S. Giovanni Rotondo (FG), Italy
| | - Alessandro Bertolino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Università degli Studi di Bari "Aldo Moro", 70124 Bari, Italy; Psychiatry Unit, Bari University Hospital, 70124 Bari, Italy
| | - Giuseppe Blasi
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Università degli Studi di Bari "Aldo Moro", 70124 Bari, Italy; Psychiatry Unit, Bari University Hospital, 70124 Bari, Italy.
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25
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Modulation of brain network parameters associated with subclinical psychotic symptoms. Prog Neuropsychopharmacol Biol Psychiatry 2016; 66:54-62. [PMID: 26615765 DOI: 10.1016/j.pnpbp.2015.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 10/16/2015] [Accepted: 11/23/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Static deficits in small-world properties of brain networks have been described in clinical psychosis, but task-related modulation of network properties has been scarcely studied. Our aim was to assess the modulation of those properties and its association with subclinical psychosis and cognition in the general population. METHOD Closeness centrality and small-worldness were compared between pre-stimulus baseline and response windows of an odd-ball task in 200 healthy individuals. The correlation between modulation of network parameters and clinical (scores in the Community Assessment of Psychological Experiences) and cognitive measures (performance in the dimensions included in the Brief Assessment of Cognition in Schizophrenia battery) was analyzed, as well as between these measures and the corresponding network parameters during baseline and response windows during task performance. RESULTS In the theta band, closeness centrality decreased and small-worldness increased in the response window. Centrality and small-worldness modulation were, respectively, directly and inversely associated with subclinical symptoms. CONCLUSIONS A widespread modulation of network properties in theta band was observed, with a transient increase of small-worldness during the response window, compatible with a transiently more integrated cortical activity associated to cognition. This supports the relevance of electroencephalography to study of normal and altered cognition and its substrates. A relative deficit in the ability to reorganize brain networks may contribute to subclinical psychotic symptoms.
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Wang Y, Liu WH, Li Z, Wei XH, Jiang XQ, Geng FL, Zou LQ, Lui SSY, Cheung EFC, Pantelis C, Chan RCK. Altered corticostriatal functional connectivity in individuals with high social anhedonia. Psychol Med 2016; 46:125-135. [PMID: 26315390 DOI: 10.1017/s0033291715001592] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Dysregulation of the striatum and altered corticostriatal connectivity have been associated with psychotic disorders. Social anhedonia has been identified as a predictor for the development of schizophrenia spectrum disorders. The aim of the present study was to examine corticostriatal functional connectivity in individuals with high social anhedonia. METHOD Twenty-one participants with high social anhedonia score and 30 with low social anhedonia score measured by the Chinese version of the Revised Social Anhedonia Scale were recruited from university undergraduates (age 17-21 years) to undergo resting-state functional MRI scans. Six subdivisions of the striatum in each hemisphere were defined as seeds. Voxel-wise functional connectivity analyses were conducted between each seed and the whole brain voxels, followed by repeated-measures ANOVA for the group effect. RESULTS Participants with high social anhedonia showed hyper-connectivity between the ventral striatum and the anterior cingulate cortex and the insula, and between the dorsal striatum and the motor cortex. Hypo-connectivity in participants with high social anhedonia was also observed between the ventral striatum and the posterior cingulate cortex. Partial correlation analyses further showed that the functional connectivity between the ventral striatum and the prefrontal cortex was associated with pleasure experience and emotional suppression. CONCLUSIONS Our findings suggest that altered corticostriatal connectivity can be found in participants with high levels of social anhedonia. Since social anhedonia has been considered a predictor for schizophrenia spectrum disorders, our results may provide novel evidence on the early changes in brain functional connectivity in at-risk individuals.
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Affiliation(s)
- Y Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health,Institute of Psychology,Chinese Academy of Sciences,Beijing,China
| | - W-H Liu
- School of Health Management,Guangzhou Medical University,Guangzhou,China
| | - Z Li
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health,Institute of Psychology,Chinese Academy of Sciences,Beijing,China
| | - X-H Wei
- Department of Radiology,Guangzhou First People's Hospital,Guangzhou,China
| | - X-Q Jiang
- Department of Radiology,Guangzhou First People's Hospital,Guangzhou,China
| | - F-L Geng
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health,Institute of Psychology,Chinese Academy of Sciences,Beijing,China
| | - L-Q Zou
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health,Institute of Psychology,Chinese Academy of Sciences,Beijing,China
| | - S S Y Lui
- Castle Peak Hospital,Hong Kong Special Administrative Region,China
| | - E F C Cheung
- Castle Peak Hospital,Hong Kong Special Administrative Region,China
| | - C Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry,University of Melbourne and Melbourne Health,Melbourne,Victoria,Australia
| | - R C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health,Institute of Psychology,Chinese Academy of Sciences,Beijing,China
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27
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Collin G, van den Heuvel MP, Abramovic L, Vreeker A, de Reus MA, van Haren NEM, Boks MPM, Ophoff RA, Kahn RS. Brain network analysis reveals affected connectome structure in bipolar I disorder. Hum Brain Mapp 2015; 37:122-34. [PMID: 26454006 DOI: 10.1002/hbm.23017] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/18/2015] [Accepted: 09/24/2015] [Indexed: 12/14/2022] Open
Abstract
The notion that healthy brain function emerges from coordinated neural activity constrained by the brain's network of anatomical connections--i.e., the connectome--suggests that alterations in the connectome's wiring pattern may underlie brain disorders. Corroborating this hypothesis, studies in schizophrenia are indicative of altered connectome architecture including reduced communication efficiency, disruptions of central brain hubs, and affected "rich club" organization. Whether similar deficits are present in bipolar disorder is currently unknown. This study examines structural connectome topology in 216 bipolar I disorder patients as compared to 144 healthy controls, focusing in particular on central regions (i.e., brain hubs) and connections (i.e., rich club connections, interhemispheric connections) of the brain's network. We find that bipolar I disorder patients exhibit reduced global efficiency (-4.4%, P =0.002) and that this deficit relates (r = 0.56, P < 0.001) to reduced connectivity strength of interhemispheric connections (-13.0%, P = 0.001). Bipolar disorder patients were found not to show predominant alterations in the strength of brain hub connections in general, or of connections spanning brain hubs (i.e., "rich club" connections) in particular (all P > 0.1). These findings highlight a role for aberrant brain network architecture in bipolar I disorder with reduced global efficiency in association with disruptions in interhemispheric connectivity, while the central "rich club" system appears not to be particularly affected.
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Affiliation(s)
- Guusje Collin
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn P van den Heuvel
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lucija Abramovic
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annabel Vreeker
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel A de Reus
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Neeltje E M van Haren
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marco P M Boks
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel A Ophoff
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.,Center for Neurobehavioral Genetics, University of California Los Angeles, Los Angeles, California.,Department of Human Genetics, University of California Los Angeles, Los Angeles, California
| | - René S Kahn
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
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