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Hwang ZA, Li CW, Hsu AL, Wu CW, Chan WP, Huang MC. Assessment of resting cerebral perfusion between methamphetamine-associated psychosis and schizophrenia through arterial spin labeling MRI. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01857-1. [PMID: 38970667 DOI: 10.1007/s00406-024-01857-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/20/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE The clinical manifestations of methamphetamine (METH)-associated psychosis (MAP) and acute paranoid schizophrenia (SCZ) are similar. This study aims to assess regional cerebral blood flow (rCBF) in individuals who use METH and in those with SCZ using the MRI arterial spin labeling (ASL) technique. METHODS We prospectively recruited 68 participants and divided them into four groups: MAP (N = 15), SCZ (N = 13), METH users with no psychosis (MNP; N = 22), and normal healthy controls (CRL; N = 18). We measured rCBF using an MRI three-dimensional pseudo-continuous ASL sequence. Clinical variables were assessed using the Positive and Negative Syndrome Scale (PANSS) and Brief Assessment of Cognition in Schizophrenia (BACS). Group-level rCBF differences were analyzed using a two-sample t-test. RESULTS Decreased rCBF was found in the precuneus, premotor cortex, caudate nucleus, dorsolateral prefrontal cortex, and thalamus in the MNP group compared with the CRL group. The MAP group had significantly decreased rCBF in the precuneus, hippocampus, anterior insula, inferior temporal gyrus, inferior orbitofrontal gyrus, and superior occipital gyrus compared with the MNP group. Increased rCBF in the precuneus and premotor cortex was seen in the MAP group compared with the SCZ group. rCBF in the precuneus and premotor cortex significantly correlated negatively with the PANSS but correlated positively with BACS scores in the MAP and SCZ groups. CONCLUSION METH exposure was associated with decreased rCBF in the precuneus and premotor cortex. Patients with MAP exhibited higher rCBF than those with SCZ, implying preserved insight and favorable outcomes. rCBF can therefore potentially serve as a diagnostic approach to differentiate patients with MAP from those with SCZ.
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Affiliation(s)
- Zhen-An Hwang
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Wei Li
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- GE Healthcare, Taipei, Taiwan
| | - Ai-Ling Hsu
- Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Changwei W Wu
- Graduate Institute of Mind, Brain and Consciousness (GIMBC), Taipei Medical University, Taipei, Taiwan
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Ming-Chyi Huang
- Department of Addiction Sciences, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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2
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Ren W, Wang M, Wang Q, Huang Q, Feng S, Tao J, Wen C, Xu M, He J, Yang C, Zhao K, Yu X. Altered functional connectivity in patients with post-stroke fatigue: A resting-state fMRI study. J Affect Disord 2024; 350:468-475. [PMID: 38224743 DOI: 10.1016/j.jad.2024.01.129] [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: 08/12/2023] [Revised: 11/24/2023] [Accepted: 01/12/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Post-stroke fatigue (PSF) was a common complication after stroke. This study aimed to explore the neuroimaging mechanism of PSF, which was rarely studied. METHODS Patients with the first episode of ischemic stroke were recruited from the First Affiliated Hospital of Wenzhou Medical University between March 2021 and December 2022. The fatigue severity scale (FSS) was used to assess fatigue symptoms. PSF was diagnosed by a neurologist based on the FSS score and PSF diagnostic criteria. All the patients were scanned by resting-state functional MRI (rs-fMRI). Precuneus, the posterior node of default-mode network (pDMN), was related to fatigue. Therefore, imaging data were further analyzed by the seed-based resting-state functional connectivity (FC) approach, with the left (PCUN.L) and right precuneus (PCUN.R) being the seeds. RESULTS A total of 70 patients with acute ischemic stroke were finally recruited, comprising 40 patients with PSF and 30 patients without PSF. Both the PCUN.L and PCUN.R seeds (pDMN) exhibited decreased FC with the prefrontal lobes located at the anterior part of DMN (aDMN), and the FC values were negatively correlated with FSS scores (both p < 0.001). These two seeds also exhibited increased FC with the right insula, and the FC values were positively correlated with FSS scores (both p < 0.05). CONCLUSION The abnormal FC between the aDMN and pDMN was associated with PSF. Besides, the insula, related to interoception, might also play an important role in PSF.
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Affiliation(s)
- Wenwei Ren
- Department of Psychiatry, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Mengpu Wang
- School of Mental Health, The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou, China; School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Qiongzhang Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Qiqi Huang
- Pediatric nursing unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shengchuang Feng
- Centre for Lifelong Learning and Individualised Cognition, Nanyang Technological University, Singapore
| | - Jiejie Tao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Caiyun Wen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Minjie Xu
- Lishui Second People's Hospital Affiliated to Wenzhou Medical University, Lishui, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chuang Yang
- Department of Psychiatry, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ke Zhao
- School of Mental Health, Wenzhou Medical University, Wenzhou, China; Lishui Second People's Hospital Affiliated to Wenzhou Medical University, Lishui, China; The Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Xin Yu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China; Peking University Institute of Mental Health (Sixth Hospital), Beijing, China; National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China; Beijing Municipal Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.
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3
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Wasserthal S, Lehmann M, Neumann C, Delis A, Philipsen A, Hurlemann R, Ettinger U, Schultz J. Effects of NMDA-receptor blockade by ketamine on mentalizing and its neural correlates in humans: a randomized control trial. Sci Rep 2023; 13:17184. [PMID: 37821513 PMCID: PMC10567921 DOI: 10.1038/s41598-023-44443-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/08/2023] [Indexed: 10/13/2023] Open
Abstract
Schizophrenia is associated with various deficits in social cognition that remain relatively unaltered by antipsychotic treatment. While faulty glutamate signaling has been associated with general cognitive deficits as well as negative symptoms of schizophrenia, no direct link between manipulation of glutamate signaling and deficits in mentalizing has been demonstrated thus far. Here, we experimentally investigated whether ketamine, an uncompetitive N-methyl-D-aspartate receptor antagonist known to induce psychotomimetic effects, influences mentalizing and its neural correlates. In a randomized, placebo-controlled between-subjects experiment, we intravenously administered ketamine or placebo to healthy participants performing a video-based social cognition task during functional magnetic resonance imaging. Psychotomimetic effects of ketamine were assessed using the Positive and Negative Syndrome Scale. Compared to placebo, ketamine led to significantly more psychotic symptoms and reduced mentalizing performance (more "no mentalizing" errors). Ketamine also influenced blood oxygen level dependent (BOLD) response during mentalizing compared to placebo. Specifically, ketamine increased BOLD in right posterior superior temporal sulcus (pSTS) and increased connectivity between pSTS and anterior precuneus. These increases may reflect a dysfunctional shift of attention induced by ketamine that leads to mentalizing deficits. Our findings show that a psychotomimetic dose of ketamine impairs mentalizing and influences its neural correlates, a result compatible with the notion that deficient glutamate signaling may contribute to deficits in mentalizing in schizophrenia. The results also support efforts to seek novel psychopharmacological treatments for psychosis and schizophrenia targeting glutamatergic transmission.
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Affiliation(s)
- Sven Wasserthal
- Division of Medical Psychology, Department of Psychiatry and Psychotherapy, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Mirko Lehmann
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Claudia Neumann
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Achilles Delis
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital of Bonn, Bonn, Germany
| | - René Hurlemann
- Department of Psychiatry, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
| | | | - Johannes Schultz
- Center for Economics and Neuroscience, University of Bonn, Bonn, Germany
- Institute for Experimental Epileptology and Cognition Research, Medical Faculty, University of Bonn, Bonn, Germany
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Messina A, Cuccì G, Crescimanno C, Signorelli MS. Clinical anatomy of the precuneus and pathogenesis of the schizophrenia. Anat Sci Int 2023:10.1007/s12565-023-00730-w. [PMID: 37340095 DOI: 10.1007/s12565-023-00730-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/12/2023] [Indexed: 06/22/2023]
Abstract
Recent evidence has shown that the precuneus plays a role in the pathogenesis of schizophrenia. The precuneus is a structure of the parietal lobe's medial and posterior cortex, representing a central hub involved in multimodal integration processes. Although neglected for several years, the precuneus is highly complex and crucial for multimodal integration. It has extensive connections with different cerebral areas and is an interface between external stimuli and internal representations. In human evolution, the precuneus has increased in size and complexity, allowing the development of higher cognitive functions, such as visual-spatial ability, mental imagery, episodic memory, and other tasks involved in emotional processing and mentalization. This paper reviews the functions of the precuneus and discusses them concerning the psychopathological aspects of schizophrenia. The different neuronal circuits, such as the default mode network (DMN), in which the precuneus is involved and its alterations in the structure (grey matter) and the disconnection of pathways (white matter) are described.
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Affiliation(s)
- Antonino Messina
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy.
| | | | | | - Maria Salvina Signorelli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
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5
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Xue K, Chen J, Wei Y, Chen Y, Han S, Wang C, Zhang Y, Song X, Cheng J. Impaired large-scale cortico-hippocampal network connectivity, including the anterior temporal and posterior medial systems, and its associations with cognition in patients with first-episode schizophrenia. Front Neurosci 2023; 17:1167942. [PMID: 37342466 PMCID: PMC10277613 DOI: 10.3389/fnins.2023.1167942] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/08/2023] [Indexed: 06/23/2023] Open
Abstract
Background and objective The cortico-hippocampal network is an emerging neural framework with striking evidence that it supports cognition in humans, especially memory; this network includes the anterior temporal (AT) system, the posterior medial (PM) system, the anterior hippocampus (aHIPPO), and the posterior hippocampus (pHIPPO). This study aimed to detect aberrant patterns of functional connectivity within and between large-scale cortico-hippocampal networks in first-episode schizophrenia patients compared with a healthy control group via resting-state functional magnetic resonance imaging (rs-fMRI) and to explore the correlations of these aberrant patterns with cognition. Methods A total of 86 first-episode, drug-naïve schizophrenia patients and 102 healthy controls (HC) were recruited to undergo rs-fMRI examinations and clinical evaluations. We conducted large-scale edge-based network analysis to characterize the functional architecture of the cortico-hippocampus network and investigate between-group differences in within/between-network functional connectivity. Additionally, we explored the associations of functional connectivity (FC) abnormalities with clinical characteristics, including scores on the Positive and Negative Syndrome Scale (PANSS) and cognitive scores. Results Compared with the HC group, schizophrenia patients exhibited widespread alterations to within-network FC of the cortico-hippocampal network, with decreases in FC involving the precuneus (PREC), amygdala (AMYG), parahippocampal cortex (PHC), orbitofrontal cortex (OFC), perirhinal cortex (PRC), retrosplenial cortex (RSC), posterior cingulate cortex (PCC), angular gyrus (ANG), aHIPPO, and pHIPPO. Schizophrenia patients also showed abnormalities in large-scale between-network FC of the cortico-hippocampal network, in the form of significantly decreased FC between the AT and the PM, the AT and the aHIPPO, the PM and the aHIPPO, and the aHIPPO and the pHIPPO. A number of these signatures of aberrant FC were correlated with PANSS score (positive, negative, and total score) and with scores on cognitive test battery items, including attention/vigilance (AV), working memory (WM), verbal learning and memory (Verb_Lrng), visual learning and memory (Vis_Lrng), reasoning and problem-solving (RPS), and social cognition (SC). Conclusion Schizophrenia patients show distinct patterns of functional integration and separation both within and between large-scale cortico-hippocampal networks, reflecting a network imbalance of the hippocampal long axis with the AT and PM systems, which regulate cognitive domains (mainly Vis_Lrng, Verb_Lrng, WM, and RPS), and particularly involving alterations to FC of the AT system and the aHIPPO. These findings provide new insights into the neurofunctional markers of schizophrenia.
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Affiliation(s)
- Kangkang Xue
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
- Engineering Research Center of Brain Function Development and Application of Henan Province, Zhengzhou, China
| | - Jingli Chen
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
- Engineering Research Center of Brain Function Development and Application of Henan Province, Zhengzhou, China
| | - Yarui Wei
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
- Engineering Research Center of Brain Function Development and Application of Henan Province, Zhengzhou, China
| | - Yuan Chen
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
- Engineering Research Center of Brain Function Development and Application of Henan Province, Zhengzhou, China
| | - Shaoqiang Han
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
- Engineering Research Center of Brain Function Development and Application of Henan Province, Zhengzhou, China
| | - Caihong Wang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
- Engineering Research Center of Brain Function Development and Application of Henan Province, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
- Engineering Research Center of Brain Function Development and Application of Henan Province, Zhengzhou, China
| | - Xueqin Song
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province, Zhengzhou, China
- Engineering Research Center of Brain Function Development and Application of Henan Province, Zhengzhou, China
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Li Q, Yao L, You W, Liu J, Deng S, Li B, Luo L, Zhao Y, Wang Y, Wang Y, Zhang Q, Long F, Sweeney JA, Gu S, Li F, Gong Q. Controllability of Functional Brain Networks and Its Clinical Significance in First-Episode Schizophrenia. Schizophr Bull 2022; 49:659-668. [PMID: 36402458 PMCID: PMC10154712 DOI: 10.1093/schbul/sbac177] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND HYPOTHESIS Disrupted control of brain state transitions may contribute to the diverse dysfunctions of cognition, emotion, and behavior that are fundamental to schizophrenia. Control theory provides the rationale for evaluating brain state transitions from a controllability perspective, which may help reveal the brain mechanism for clinical features such as cognitive control deficits associated with schizophrenia. We hypothesized that brain controllability would be altered in patients with schizophrenia, and that controllability of brain networks would be related to clinical symptomatology. STUDY DESIGN Controllability measurements of functional brain networks, including average controllability and modal controllability, were calculated and compared between 125 first-episode never-treated patients with schizophrenia and 133 healthy controls (HCs). Associations between controllability metrics and clinical symptoms were evaluated using sparse canonical correlation analysis. STUDY RESULTS Compared to HCs, patients showed significantly increased average controllability (PFDR = .023) and decreased modal controllability (PFDR = .023) in dorsal anterior cingulate cortex (dACC). General psychopathology symptoms and positive symptoms were positively correlated with average controllability in regions of default mode network and negatively associated with average controllability in regions of sensorimotor, dorsal attention, and frontoparietal networks. CONCLUSIONS Our findings suggest that altered controllability of functional activity in dACC may play a critical role in the pathophysiology of schizophrenia, consistent with the importance of this region in cognitive and brain state control operations. The demonstration of associations of functional controllability with psychosis symptoms suggests that the identified alterations in average controllability of brain function may contribute to the severity of acute psychotic illness in schizophrenia.
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Affiliation(s)
- Qian Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory, Sichuan University, Chengdu 610041, Sichuan, P.R. China
| | - Li Yao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory, Sichuan University, Chengdu 610041, Sichuan, P.R. China
| | - Wanfang You
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory, Sichuan University, Chengdu 610041, Sichuan, P.R. China
| | - Jiang Liu
- Department of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Shikuang Deng
- Department of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Bin Li
- Department of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Lekai Luo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory, Sichuan University, Chengdu 610041, Sichuan, P.R. China
| | - Youjin Zhao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory, Sichuan University, Chengdu 610041, Sichuan, P.R. China
| | - Yuxia Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory, Sichuan University, Chengdu 610041, Sichuan, P.R. China
| | - Yaxuan Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory, Sichuan University, Chengdu 610041, Sichuan, P.R. China
| | - Qian Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory, Sichuan University, Chengdu 610041, Sichuan, P.R. China
| | - Fenghua Long
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory, Sichuan University, Chengdu 610041, Sichuan, P.R. China
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, P.R. China.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Shi Gu
- Department of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Fei Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory, Sichuan University, Chengdu 610041, Sichuan, P.R. China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory, Sichuan University, Chengdu 610041, Sichuan, P.R. China
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7
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Zhao L, Bo Q, Zhang Z, Chen Z, Wang Y, Zhang D, Li T, Yang N, Zhou Y, Wang C. Altered Dynamic Functional Connectivity in Early Psychosis Between the Salience Network and Visual Network. Neuroscience 2022; 491:166-175. [DOI: 10.1016/j.neuroscience.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
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8
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Meller T, Schmitt S, Ettinger U, Grant P, Stein F, Brosch K, Grotegerd D, Dohm K, Meinert S, Förster K, Hahn T, Jansen A, Dannlowski U, Krug A, Kircher T, Nenadić I. Brain structural correlates of schizotypal signs and subclinical schizophrenia nuclear symptoms in healthy individuals. Psychol Med 2022; 52:342-351. [PMID: 32578531 PMCID: PMC8842196 DOI: 10.1017/s0033291720002044] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/23/2020] [Accepted: 05/27/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Subclinical psychotic-like experiences (PLE), resembling key symptoms of psychotic disorders, are common throughout the general population and possibly associated with psychosis risk. There is evidence that such symptoms are also associated with structural brain changes. METHODS In 672 healthy individuals, we assessed PLE and associated distress with the symptom-checklist-90R (SCL-90R) scales 'schizotypal signs' (STS) and 'schizophrenia nuclear symptoms' (SNS) and analysed associations with voxel- and surfaced-based brain structural parameters derived from structural magnetic resonance imaging at 3 T with CAT12. RESULTS For SNS, we found a positive correlation with the volume in the left superior parietal lobule and the precuneus, and a negative correlation with the volume in the right inferior temporal gyrus [p < 0.05 cluster-level Family Wise Error (FWE-corrected]. For STS, we found a negative correlation with the volume of the left and right precentral gyrus (p < 0.05 cluster-level FWE-corrected). Surface-based analyses did not detect any significant clusters with the chosen statistical threshold of p < 0.05. However, in exploratory analyses (p < 0.001, uncorrected), we found a positive correlation of SNS with gyrification in the left insula and rostral middle frontal gyrus and of STS with the left precuneus and insula, as well as a negative correlation of STS with gyrification in the left temporal pole. CONCLUSIONS Our results show that brain structures in areas implicated in schizophrenia are also related to PLE and its associated distress in healthy individuals. This pattern supports a dimensional model of the neural correlates of symptoms of the psychotic spectrum.
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Affiliation(s)
- Tina Meller
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Rudolf-Bultmann-Str. 8, 35039Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Hans-Meerwein-Str. 6, 35032Marburg, Germany
| | - Simon Schmitt
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Rudolf-Bultmann-Str. 8, 35039Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Hans-Meerwein-Str. 6, 35032Marburg, Germany
| | - Ulrich Ettinger
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, 53111Bonn, Germany
| | - Phillip Grant
- Psychology School, Fresenius University of Applied Sciences, Marienburgstr. 6, 60528Frankfurt am Main, Germany
- Faculty of Life Science Engineering, Technische Hochschule Mittelhessen University of Applied Sciences, Giessen, Germany
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Rudolf-Bultmann-Str. 8, 35039Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Hans-Meerwein-Str. 6, 35032Marburg, Germany
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Rudolf-Bultmann-Str. 8, 35039Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Hans-Meerwein-Str. 6, 35032Marburg, Germany
| | - Dominik Grotegerd
- Department of Psychiatry and Psychotherapy, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1, Building A9, 48149Münster, Germany
| | - Katharina Dohm
- Department of Psychiatry and Psychotherapy, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1, Building A9, 48149Münster, Germany
| | - Susanne Meinert
- Department of Psychiatry and Psychotherapy, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1, Building A9, 48149Münster, Germany
| | - Katharina Förster
- Department of Psychiatry and Psychotherapy, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1, Building A9, 48149Münster, Germany
| | - Tim Hahn
- Department of Psychiatry and Psychotherapy, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1, Building A9, 48149Münster, Germany
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Rudolf-Bultmann-Str. 8, 35039Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Hans-Meerwein-Str. 6, 35032Marburg, Germany
- Core-Facility BrainImaging, Faculty of Medicine, Philipps-Universität, Rudolf-Bultmann-Str. 8, 35039Marburg, Germany
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1, Building A9, 48149Münster, Germany
| | - Axel Krug
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Rudolf-Bultmann-Str. 8, 35039Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Hans-Meerwein-Str. 6, 35032Marburg, Germany
- Marburg University Hospital – UKGM, Rudolf-Bultmann-Str. 8, 35039Marburg, Germany
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Rudolf-Bultmann-Str. 8, 35039Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Hans-Meerwein-Str. 6, 35032Marburg, Germany
- Marburg University Hospital – UKGM, Rudolf-Bultmann-Str. 8, 35039Marburg, Germany
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Rudolf-Bultmann-Str. 8, 35039Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Hans-Meerwein-Str. 6, 35032Marburg, Germany
- Marburg University Hospital – UKGM, Rudolf-Bultmann-Str. 8, 35039Marburg, Germany
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9
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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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10
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Chen VCH, Kao CJ, Tsai YH, McIntyre RS, Weng JC. Mapping Brain Microstructure and Network Alterations in Depressive Patients with Suicide Attempts Using Generalized Q-Sampling MRI. J Pers Med 2021; 11:jpm11030174. [PMID: 33802354 PMCID: PMC7998726 DOI: 10.3390/jpm11030174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 12/28/2022] Open
Abstract
Depressive disorder is one of the leading causes of disability worldwide, with a high prevalence and chronic course. Depressive disorder carries an increased risk of suicide. Alterations in brain structure and networks may play an important role in suicidality among depressed patients. Diffusion magnetic resonance imaging (MRI) is a noninvasive method to map white-matter fiber orientations and provide quantitative parameters. This study investigated the neurological structural differences and network alterations in depressed patients with suicide attempts by using generalized q-sampling imaging (GQI). Our study recruited 155 participants and assigned them into three groups: 44 depressed patients with a history of suicide attempts (SA), 56 depressed patients without a history of suicide attempts (D) and 55 healthy controls (HC). We used the GQI to analyze the generalized fractional anisotropy (GFA) and normalized quantitative anisotropy (NQA) values in voxel-based statistical analysis, topological parameters in graph theoretical analysis and subnetwork connectivity in network-based statistical analysis. GFA indicates the measurement of neural anisotropy and represents white-matter integrity; NQA indicates the amount of anisotropic spins that diffuse along fiber orientations and represents white-matter compactness. In the voxel-based statistical analysis, we found lower GFA and NQA values in the SA group than in the D and HC groups and lower GFA and NQA values in the D group than in the HC group. In the graph theoretical analysis, the SA group demonstrated higher local segregation and lower global integration among the three groups. In the network-based statistical analysis, the SA group showed stronger subnetwork connections in the frontal and parietal lobes, and the D group showed stronger subnetwork connections in the parietal lobe than the HC group. Alternations were found in the structural differences and network measurements in healthy controls and depressed patients with and without a history of suicide attempt.
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Affiliation(s)
- Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (V.C.-H.C.); (Y.-H.T.)
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Chun-Ju Kao
- Department of Medical Imaging and Radiological Sciences, Bachelor Program in Artificial Intelligence, Chang Gung University, No. 259, Wenhua 1st Rd., Taoyuan 33302, Taiwan;
| | - Yuan-Hsiung Tsai
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (V.C.-H.C.); (Y.-H.T.)
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Roger S. McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Department of Psychiatry, University of Toronto, Toronto, ON M5S, Canada;
- Institute of Medical Science, University of Toronto, Toronto, ON M5S, Canada
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON M5S, Canada
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Department of Medical Imaging and Radiological Sciences, Bachelor Program in Artificial Intelligence, Chang Gung University, No. 259, Wenhua 1st Rd., Taoyuan 33302, Taiwan;
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan 33302, Taiwan
- Correspondence: ; Tel.: +886-3-2118800 (ext. 5394)
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11
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Elowe J, Conus P. Much ado about everything: A literature review of insight in first episode psychosis and schizophrenia. Eur Psychiatry 2020; 39:73-79. [DOI: 10.1016/j.eurpsy.2016.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/29/2022] Open
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12
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Zhu Q, Li H, Huang J, Xu X, Guan D, Zhang D. Hybrid Functional Brain Network With First-Order and Second-Order Information for Computer-Aided Diagnosis of Schizophrenia. Front Neurosci 2019; 13:603. [PMID: 31316330 PMCID: PMC6587891 DOI: 10.3389/fnins.2019.00603] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 05/27/2019] [Indexed: 01/17/2023] Open
Abstract
Brain functional connectivity network (BFCN) analysis has been widely used in the diagnosis of mental disorders, such as schizophrenia. In BFCN methods, brain network construction is one of the core tasks due to its great influence on the diagnosis result. Most of the existing BFCN construction methods only consider the first-order relationship existing in each pair of brain regions and ignore the useful high-order information, including multi-region correlation in the whole brain. Some early schizophrenia patients have subtle changes in brain function networks, which cannot be detected in conventional BFCN construction methods. It is well-known that the high-order method is usually more sensitive to the subtle changes in signal than the low-order method. To exploit high-order information among brain regions, we define the triplet correlation among three brain regions, and derive the second-order brain network based on the connectivity difference and ordinal information in each triplet. For making full use of the complementary information in different brain networks, we proposed a hybrid approach to fuse the first- and second-order brain networks. The proposed method is applied to identify the biomarkers of schizophrenia. The experimental results on six schizophrenia datasets (totally including 439 patients and 426 controls) show that the proposed method outperforms the existing brain network methods in the diagnosis of schizophrenia.
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Affiliation(s)
- Qi Zhu
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China.,Collaborative Innovation Center of Novel Software Technology and Industrialization, Nanjing, China
| | - Huijie Li
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Jiashuang Huang
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Xijia Xu
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Department of Psychiatry, Medical School, Nanjing Brain Hospital, Nanjing University, Nanjing, China
| | - Donghai Guan
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Daoqiang Zhang
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
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13
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Evidence of brain network aberration in healthy subjects with urban upbringing - A multimodal DTI and VBM study. Schizophr Res 2019; 208:133-137. [PMID: 30987925 DOI: 10.1016/j.schres.2019.03.027] [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: 01/26/2018] [Revised: 02/01/2019] [Accepted: 03/26/2019] [Indexed: 12/25/2022]
Abstract
City living represents not only the allegory of modern life, but also - due to attractive living conditions, employment and infrastructure - a crucial reality for a growing portion of the global society. Regarding the remarkable increase of the schizophrenia incidence in individuals exposed to an urban environment during upbringing the understanding of responsible pathogenetic mechanisms is important. Schizophrenia has been conceptualized as a disorder of brain dysconnectivity. We investigated the association between urban upbringing and gray matter as well as white matter in a large sample of healthy subjects (n = 290). Voxelwise analyses revealed a strong inverse correlation of early life urbanicity and gray matter volume of the bilateral dorsolateral prefrontal cortices (DLPFC) and the right inferior parietal lobe (IPL) as well as the white matter characteristics in the left superior longitudinal fasciculus (SLF). A positive correlation was found for the gray matter volume of the left precuneus. These results may point to an altered brain development associated with urban upbringing, which not only affects single brain regions but a fronto-parietal network. Considering a DLPFC susceptibility to stress, our findings support the hypothesis of the pathogenetic role of social stress in an urban environment.
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14
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Gerretsen P, Rajji TK, Shah P, Shahab S, Sanches M, Graff-Guerrero A, Menon M, Pollock BG, Mamo DC, Mulsant BH, Voineskos AN. Impaired illness awareness in schizophrenia and posterior corpus callosal white matter tract integrity. NPJ SCHIZOPHRENIA 2019; 5:8. [PMID: 31036809 PMCID: PMC6488582 DOI: 10.1038/s41537-019-0076-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/19/2019] [Indexed: 12/17/2022]
Abstract
Impaired illness awareness (Imp-IA) in schizophrenia is associated with interhemispheric imbalance, resulting in left hemisphere dominance, primarily within the posterior parietal area (PPA). This may represent an interhemispheric “disconnection syndrome” between PPAs. To test this hypothesis, we aimed to determine if diffusion-based measures of white matter integrity were disrupted in the corpus callosal tracts linking PPAs (i.e., splenium) in patients with Imp-IA in schizophrenia. T1-weighted and diffusion-weighted scans were acquired on a 1.5T GE scanner for 100 participants with a DSM-IV-TR diagnosis of schizophrenia and 134 healthy controls aged 18 to 79 years. The corpus callosal white matter tracts were compared among patients with Imp-IA (n = 40), intact illness awareness (n = 60), and healthy controls. White matter disruption was measured with fractional anisotropy (FA) and mean diffusivity (MD). Group differences in FA were found in the splenium, with patients with Imp-IA having the lowest FA, which remained significant after controlling for sex, age, global cognition, and premorbid intelligence. No group differences in MD were observed. Splenial white matter tracts of the corpus callosum appear compromised in patients with Imp-IA. Transcallosal interhemispheric PPA white matter disruption may represent a “disconnection syndrome”, manifesting as Imp-IA in schizophrenia. Future studies are required to investigate the effects of noninvasive brain stimulation interventions, such as transcranial direct current or magnetic stimulation, on Imp-IA in association with white matter changes in patients with schizophrenia.
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Affiliation(s)
- Philip Gerretsen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, Canada. .,University of Toronto, Toronto, ON, Canada.
| | - Tarek K Rajji
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, Canada.,University of Toronto, Toronto, ON, Canada
| | - Parita Shah
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, Canada.,University of Toronto, Toronto, ON, Canada
| | - Saba Shahab
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, Canada.,University of Toronto, Toronto, ON, Canada
| | - Marcos Sanches
- University of Toronto, Toronto, ON, Canada.,Krembil Centre for Neuroinformatics - CAMH, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, Canada.,University of Toronto, Toronto, ON, Canada
| | - Mahesh Menon
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Bruce G Pollock
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, Canada.,University of Toronto, Toronto, ON, Canada
| | | | - Benoit H Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, Canada.,University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, Canada.,University of Toronto, Toronto, ON, Canada
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15
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Chuang SP, Wu JYW, Wang CS. Self-perception of mental illness, and subjective and objective cognitive functioning in people with schizophrenia. Neuropsychiatr Dis Treat 2019; 15:967-976. [PMID: 31118637 PMCID: PMC6499497 DOI: 10.2147/ndt.s193239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/05/2019] [Indexed: 11/23/2022] Open
Abstract
Background: People with schizophrenia may have a negative self-perception of mental illness. However, the relationship between the self-perception of illness and subjective and objective cognitive functioning remains unclear. Method: Thirty-seven people with schizophrenia were enrolled in the study group. All subjects completed self-reported self-perception of mental illness questionnaires (Birchwood Insight Scale [BIS], Internalized Stigma of Mental Illness [ISMI]), subjective cognitive functioning (Scale to Investigate Cognition in Schizophrenia [SSTICS]) and objective cognitive functioning (Luria Nebraska Neuropsychological Battery [LNNB]). Results: Spearman's rank analysis showed that awareness of illness (domain of insight) was positively associated with most domains of SSTICS and ISMI. Total insight was positively correlated with alienation (domain of ISMI). Need for treatment (domain of insight) was negatively correlated with stigma resistance (domain of ISMI). Awareness of symptoms (domain of insight) and total insight were negatively associated with receptive speech and arithmetic (LNNB subtest), respectively. ISMI was positively correlated with most domains of SSTICS, but not with LNNB. The group with good insight had higher scores in attention (domain of SSTICS) and total SSTICS and alienation, stereotype endorsement, social withdrawal (domains of ISMI) and total ISMI than the group with poor insight. The group with mild to moderate internalized stigma had higher scores in explicit memory, attention, language, praxia (domains of SSTICS) and total SSTICS than the group with no internalized stigma. Conclusion: We identified that awareness of illness (domain of insight), internalized stigma were significantly associated with most domains of SSTICS, but not with LNNB. Total insight and awareness of symptoms (domain of insight) were significantly associated with receptive speech and arithmetic (LNNB subtest), respectively. Schizophrenia with higher insight or more internalized stigma reported more subjective cognitive impairment. Future studies with larger samples involving follow up are necessary to verify our findings and extend the applicability.
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Affiliation(s)
- Shu Ping Chuang
- Department of Psychiatry, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Jo Yung Wei Wu
- Department of Counseling and Guidance, National University of Tainan, Tainan, Taiwan.,Good-Day Psychology Clinic, Tainan, Taiwan
| | - Chien Shu Wang
- Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
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16
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Ma Q, Zhang T, Zanetti MV, Shen H, Satterthwaite TD, Wolf DH, Gur RE, Fan Y, Hu D, Busatto GF, Davatzikos C. Classification of multi-site MR images in the presence of heterogeneity using multi-task learning. Neuroimage Clin 2018; 19:476-486. [PMID: 29984156 PMCID: PMC6029565 DOI: 10.1016/j.nicl.2018.04.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/09/2018] [Accepted: 04/28/2018] [Indexed: 12/21/2022]
Abstract
With the advent of Big Data Imaging Analytics applied to neuroimaging, datasets from multiple sites need to be pooled into larger samples. However, heterogeneity across different scanners, protocols and populations, renders the task of finding underlying disease signatures challenging. The current work investigates the value of multi-task learning in finding disease signatures that generalize across studies and populations. Herein, we present a multi-task learning type of formulation, in which different tasks are from different studies and populations being pooled together. We test this approach in an MRI study of the neuroanatomy of schizophrenia (SCZ) by pooling data from 3 different sites and populations: Philadelphia, Sao Paulo and Tianjin (50 controls and 50 patients from each site), which posed integration challenges due to variability in disease chronicity, treatment exposure, and data collection. Some existing methods are also tested for comparison purposes. Experiments show that classification accuracy of multi-site data outperformed that of single-site data and pooled data using multi-task feature learning, and also outperformed other comparison methods. Several anatomical regions were identified to be common discriminant features across sites. These included prefrontal, superior temporal, insular, anterior cingulate cortex, temporo-limbic and striatal regions consistently implicated in the pathophysiology of schizophrenia, as well as the cerebellum, precuneus, and fusiform, middle temporal, inferior parietal, postcentral, angular, lingual and middle occipital gyri. These results indicate that the proposed multi-task learning method is robust in finding consistent and reliable structural brain abnormalities associated with SCZ across different sites, in the presence of multiple sources of heterogeneity.
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Affiliation(s)
- Qiongmin Ma
- College of Mechatronics and Automation, National University of Defense Technology, Changsha, Hunan 410073, China; Center for Biomedical Image Computing and Analytics, and Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States; Beijing Institute of System Engineering, China.
| | - Tianhao Zhang
- Center for Biomedical Image Computing and Analytics, and Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Marcus V Zanetti
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Hui Shen
- College of Mechatronics and Automation, National University of Defense Technology, Changsha, Hunan 410073, China
| | | | - Daniel H Wolf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Yong Fan
- Center for Biomedical Image Computing and Analytics, and Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Dewen Hu
- College of Mechatronics and Automation, National University of Defense Technology, Changsha, Hunan 410073, China
| | - Geraldo F Busatto
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics, and Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
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17
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Heredity characteristics of schizophrenia shown by dynamic functional connectivity analysis of resting-state functional MRI scans of unaffected siblings. Neuroreport 2018; 27:843-8. [PMID: 27295028 DOI: 10.1097/wnr.0000000000000622] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Previous static resting-state functional connectivity (FC) MRI (rs-fcMRI) studies have suggested certain heredity characteristics of schizophrenia. Recently, dynamic rs-fcMRI analysis, which can better characterize the time-varying nature of intrinsic activity and connectivity and may therefore unveil the special connectivity patterns that are always lost in static FC analysis, has shown a potential neuroendophenotype of schizophrenia. In this study, we have extended previous static rs-fcMRI studies to a dynamic study by exploring whether healthy siblings share aberrant dynamic FC patterns with schizophrenic patients, which may imply a potential risk for siblings to develop schizophrenia. We utilized the dynamic rs-fcMRI method using a sliding window approach to evaluate FC discrepancies within transient states across schizophrenic patients, unaffected siblings, and matched healthy controls. Statistical analysis showed five trait-related connections that are related to cingulo-opercular, occipital, and default mode networks, reflecting the shared connectivity alterations between schizophrenic patients and their unaffected siblings. The findings suggested that schizophrenic patients and their unaffected siblings shared common transient functional disconnectivity, implying a potential risk for the healthy siblings of developing schizophrenia.
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18
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Gou N, Liu Z, Palaniyappan L, Li M, Pan Y, Chen X, Tao H, Wu G, Ouyang X, Wang Z, Dou T, Xue Z, Pu W. Effects of DISC1 Polymorphisms on Resting-State Spontaneous Neuronal Activity in the Early-Stage of Schizophrenia. Front Psychiatry 2018; 9:137. [PMID: 29875705 PMCID: PMC5974222 DOI: 10.3389/fpsyt.2018.00137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/29/2018] [Indexed: 12/02/2022] Open
Abstract
Background: Localized abnormalities in the synchrony of spontaneous neuronal activity, measured with regional homogeneity (ReHo), has been consistently reported in patients with schizophrenia (SCZ) and their unaffected siblings. To date, little is known about the genetic influences affecting the spontaneous neuronal activity in SCZ. DISC1, a strong susceptible gene for SCZ, has been implicated in neuronal excitability and synaptic function possibly associated with regional spontaneous neuronal activity. This study aimed to examine the effects of DISC1 variations on the regional spontaneous neuronal activity in SCZ. Methods: Resting-state fMRI data were obtained from 28 SCZ patients and 21 healthy controls (HC) for ReHo analysis. Six single nucleotide polymorphisms (SNPs) of DISC1 gene were genotyped using the PCR and direct sequencing. Results: Significant diagnosis × genotype interactions were noted for three SNPs (rs821616, rs821617, and rs2738880). For rs821617, the interactions were localized to the precuneus, basal ganglia and pre-/post-central regions. Significant interactive effects were identified at the temporal and post-central gyri for rs821616 (Ser704Cys) and the inferior temporal gyrus for rs2738880. Furthermore, post-hoc analysis revealed that the DISC1 variations on these SNPs exerted different influences on ReHo between SCZ patients and HC. Conclusion: To our knowledge this is the first study to unpick the influence of DISC1 variations on spontaneous neuronal activity in SCZ; Given the emerging evidence that ReHo is a stable inheritable phenotype for schizophrenia, our findings suggest the DISC1 variations are possibly an inheritable source for the altered ReHo in this disorder.
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Affiliation(s)
- Ningzhi Gou
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Changsha, China
| | - Zhening Liu
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Changsha, China
| | - Lena Palaniyappan
- Departments of Psychiatry and Medical Biophysics & Robarts and Lawson Research Institutes, University of Western Ontario, London, ON, Canada
| | - Mingding Li
- Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunzhi Pan
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Changsha, China
| | - Xudong Chen
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Changsha, China
| | - Haojuan Tao
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Changsha, China
| | - Guowei Wu
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Changsha, China
| | - Xuan Ouyang
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Changsha, China
| | - Zheng Wang
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Changsha, China
| | - Taotao Dou
- Department of Neurosurgery, The First affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhimin Xue
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Changsha, China
| | - Weidan Pu
- Medical Psychological Center, Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute of Central South University, Changsha, China
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19
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Faget-Agius C, Vincenti A, Guedj E, Michel P, Richieri R, Alessandrini M, Auquier P, Lançon C, Boyer L. Defining functioning levels in patients with schizophrenia: A combination of a novel clustering method and brain SPECT analysis. Psychiatry Res Neuroimaging 2017; 270:32-38. [PMID: 29024925 DOI: 10.1016/j.pscychresns.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/11/2017] [Accepted: 09/07/2017] [Indexed: 01/16/2023]
Abstract
This study aims to define functioning levels of patients with schizophrenia by using a method of interpretable clustering based on a specific functioning scale, the Functional Remission Of General Schizophrenia (FROGS) scale, and to test their validity regarding clinical and neuroimaging characterization. In this observational study, patients with schizophrenia have been classified using a hierarchical top-down method called clustering using unsupervised binary trees (CUBT). Socio-demographic, clinical, and neuroimaging SPECT perfusion data were compared between the different clusters to ensure their clinical relevance. A total of 242 patients were analyzed. A four-group functioning level structure has been identified: 54 are classified as "minimal", 81 as "low", 64 as "moderate", and 43 as "high". The clustering shows satisfactory statistical properties, including reproducibility and discriminancy. The 4 clusters consistently differentiate patients. "High" functioning level patients reported significantly the lowest scores on the PANSS and the CDSS, and the highest scores on the GAF, the MARS and S-QoL 18. Functioning levels were significantly associated with cerebral perfusion of two relevant areas: the left inferior parietal cortex and the anterior cingulate. Our study provides relevant functioning levels in schizophrenia, and may enhance the use of functioning scale.
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Affiliation(s)
- Catherine Faget-Agius
- Aix-Marseille University, EA 3279, 13005 Marseille, France EA 3279 - Public Health: chronic diseases and quality of life, School of Medicine, Timone University, 13005 Marseille, France; Department of Psychiatry, Conception University Hospital, 147 Boulevard Baille, 13005 Marseille, France.
| | - Aurélie Vincenti
- Aix-Marseille University, EA 3279, 13005 Marseille, France EA 3279 - Public Health: chronic diseases and quality of life, School of Medicine, Timone University, 13005 Marseille, France; Department of Psychiatry, Conception University Hospital, 147 Boulevard Baille, 13005 Marseille, France
| | - Eric Guedj
- Service Central de Biophysique et Médecine Nucléaire, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille, 13005 Marseille, France; Centre Européen de Recherche en Imagerie Médicale (CERIMED), Aix-Marseille University, Marseille 13005, France
| | - Pierre Michel
- Aix-Marseille University, EA 3279, 13005 Marseille, France EA 3279 - Public Health: chronic diseases and quality of life, School of Medicine, Timone University, 13005 Marseille, France; Department of Mathematics, Faculte des sciences de Luminy, Aix-Marseille University, 13009 Marseille, France
| | - Raphaëlle Richieri
- Aix-Marseille University, EA 3279, 13005 Marseille, France EA 3279 - Public Health: chronic diseases and quality of life, School of Medicine, Timone University, 13005 Marseille, France; Department of Psychiatry, Conception University Hospital, 147 Boulevard Baille, 13005 Marseille, France
| | - Marine Alessandrini
- Aix-Marseille University, EA 3279, 13005 Marseille, France EA 3279 - Public Health: chronic diseases and quality of life, School of Medicine, Timone University, 13005 Marseille, France; Department of Public Health, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille, 13005 Marseille, France
| | - Pascal Auquier
- Aix-Marseille University, EA 3279, 13005 Marseille, France EA 3279 - Public Health: chronic diseases and quality of life, School of Medicine, Timone University, 13005 Marseille, France; Department of Public Health, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille, 13005 Marseille, France
| | - Christophe Lançon
- Aix-Marseille University, EA 3279, 13005 Marseille, France EA 3279 - Public Health: chronic diseases and quality of life, School of Medicine, Timone University, 13005 Marseille, France; Department of Psychiatry, Conception University Hospital, 147 Boulevard Baille, 13005 Marseille, France
| | - Laurent Boyer
- Aix-Marseille University, EA 3279, 13005 Marseille, France EA 3279 - Public Health: chronic diseases and quality of life, School of Medicine, Timone University, 13005 Marseille, France; Department of Public Health, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille, 13005 Marseille, France
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20
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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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21
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Hua J, Brandt AS, Lee S, Blair NIS, Wu Y, Lui S, Patel J, Faria AV, Lim IAL, Unschuld PG, Pekar JJ, van Zijl PCM, Ross CA, Margolis RL. Abnormal Grey Matter Arteriolar Cerebral Blood Volume in Schizophrenia Measured With 3D Inflow-Based Vascular-Space-Occupancy MRI at 7T. Schizophr Bull 2017; 43:620-632. [PMID: 27539951 PMCID: PMC5464028 DOI: 10.1093/schbul/sbw109] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Metabolic dysfunction and microvascular abnormality may contribute to the pathogenesis of schizophrenia. Most previous studies of cerebral perfusion in schizophrenia measured total cerebral blood volume (CBV) and cerebral blood flow (CBF) in the brain, which reflect the ensemble signal from the arteriolar, capillary, and venular compartments of the microvasculature. As the arterioles are the most actively regulated blood vessels among these compartments, they may be the most sensitive component of the microvasculature to metabolic disturbances. In this study, we adopted the inflow-based vascular-space-occupancy (iVASO) MRI approach to investigate alterations in the volume of small arterial (pial) and arteriolar vessels (arteriolar cerebral blood volume [CBVa]) in the brain of schizophrenia patients. The iVASO approach was extended to 3-dimensional (3D) whole brain coverage, and CBVa was measured in the brains of 12 schizophrenia patients and 12 matched controls at ultra-high magnetic field (7T). Significant reduction in grey matter (GM) CBVa was found in multiple areas across the whole brain in patients (relative changes of 14%-51% and effect sizes of 0.7-2.3). GM CBVa values in several regions in the temporal cortex showed significant negative correlations with disease duration in patients. GM CBVa increase was also found in a few brain regions. Our results imply that microvascular abnormality may play a role in schizophrenia, and suggest GM CBVa as a potential marker for the disease. Further investigation is needed to elucidate whether such effects are due to primary vascular impairment or secondary to other causes, such as metabolic dysfunction.
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Affiliation(s)
- Jun Hua
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, MD;,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD
| | - Allison S. Brandt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - SeungWook Lee
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD
| | | | - Yuankui Wu
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, MD;,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD;,Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Su Lui
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China;,Department of Radiology, the Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jaymin Patel
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD
| | - Andreia V. Faria
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Issel Anne L. Lim
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, MD;,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD
| | - Paul G. Unschuld
- Division of Psychiatry Research and Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - James J. Pekar
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, MD;,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD
| | - Peter C. M. van Zijl
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, MD;,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD
| | - Christopher A. Ross
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD;,Department of Neurology and Program in Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD;,Departments of Neuroscience and Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Russell L. Margolis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD;,Department of Neurology and Program in Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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22
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Caletti E, Marotta G, Del Vecchio G, Paoli RA, Cigliobianco M, Prunas C, Zugno E, Bottinelli F, Brambilla P, Altamura AC. The metabolic basis of cognitive insight in psychosis: A positron emission tomography study. PLoS One 2017; 12:e0175803. [PMID: 28414766 PMCID: PMC5393874 DOI: 10.1371/journal.pone.0175803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 03/31/2017] [Indexed: 01/23/2023] Open
Abstract
The purpose of this study was to investigate the relationship between cognitive insight and cerebral metabolism in patients suffering from psychosis. The Beck Cognitive Insight Scale (BCIS) was administered to 63 patients with psychosis undergoing Positron Emission Tomography investigation. The sample was divided into two groups considering the BCIS score. Data were analyzed using Statistical Parametric Mapping. RESULTS patients with low insight, compared to those with high insight, showed decreased metabolism in the right fusiform gyrus, left precuneus, superior temporal gyrus and insula bilaterally, as well as increased metabolism in the left orbito-frontal gyrus (all p<0.005). Our results suggest that reduced posterior (occipito-temporo-insulo-parietal) and increased anterior (orbitofrontal) cerebral metabolism may sustain low cognitive insight in psychosis.
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Affiliation(s)
- Elisabetta Caletti
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Marotta
- Section of Nuclear Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Riccardo A. Paoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michela Cigliobianco
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cecilia Prunas
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Zugno
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Bottinelli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Brambilla
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Psychiatry and Behavioural Neurosciences, University of Texas at Houston, Houston, Texas, United States of America
| | - A. Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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23
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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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24
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Faget-Agius C, Boyer L, Richieri R, Auquier P, Lançon C, Guedj E. Functional brain substrate of quality of life in patients with schizophrenia: A brain SPECT multidimensional analysis. Psychiatry Res Neuroimaging 2016; 249:67-75. [PMID: 27000309 DOI: 10.1016/j.pscychresns.2016.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 01/16/2016] [Accepted: 02/11/2016] [Indexed: 12/20/2022]
Abstract
The aim of this study was to investigate the functional brain substrate of quality of life (QoL) in patients with schizophrenia. Participants comprised 130 right-handed patients with schizophrenia who underwent whole-brain single photon emission computed tomography (SPECT) with (99m)Tc-labeled ethylcysteinate dimer ((99m)Tc-ECD) for exploring correlations of regional cerebral blood flow (rCBF) with the eight dimensions score of the Schizophrenia Quality of Life questionnaire (S-QoL 18). A significant positive correlation was found between the global index of the S-QoL 18 and rCBF in the right superior temporal sulcus and between psychological well-being dimension and rCBF in Brodmann area (BA)6, BA8, BA9, and BA10 and between self-esteem dimension and rCBF in striatum and between family relationship dimension and rCBF in BA1, BA2, BA3, BA4, BA8, BA22, BA40, BA42 and BA44 and between relationship with friends dimension and rCBF in BA44 and between physical well-being dimension and rCBF in parahippocampal gyrus, and finally between autonomy dimension and rCBF in cuneus and precuneus. A significant negative correlation was found between resilience dimension and rCBF in precuneus and between sentimental life dimension and rCBF in BA10. Our findings provide neural correlates of QoL. Brain regions involved in cognitions, emotional information processing and social cognition underlie the different QoL dimensions.
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Affiliation(s)
- Catherine Faget-Agius
- Aix-Marseille University, EA 3279, 13005 Marseille, France; Department of Psychiatry, Conception University Hospital, 13005 Marseille, France; EA 3279-Public Health, Chronic Diseases and Quality of Life, School of Medicine, Timone University, 13005 Marseille, France.
| | - Laurent Boyer
- Aix-Marseille University, EA 3279, 13005 Marseille, France; Department of Public Health, La Timone University Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France; EA 3279-Public Health, Chronic Diseases and Quality of Life, School of Medicine, Timone University, 13005 Marseille, France
| | - Raphaëlle Richieri
- Aix-Marseille University, EA 3279, 13005 Marseille, France; Department of Psychiatry, Conception University Hospital, 13005 Marseille, France; EA 3279-Public Health, Chronic Diseases and Quality of Life, School of Medicine, Timone University, 13005 Marseille, France
| | - Pascal Auquier
- Aix-Marseille University, EA 3279, 13005 Marseille, France; Department of Public Health, La Timone University Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France; EA 3279-Public Health, Chronic Diseases and Quality of Life, School of Medicine, Timone University, 13005 Marseille, France
| | - Christophe Lançon
- Aix-Marseille University, EA 3279, 13005 Marseille, France; Department of Psychiatry, Conception University Hospital, 13005 Marseille, France; EA 3279-Public Health, Chronic Diseases and Quality of Life, School of Medicine, Timone University, 13005 Marseille, France
| | - Eric Guedj
- Service Central de Biophysique et Médecine Nucléaire, La Timone University Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France; Centre Européen de Recherche en Imagerie Médicale (CERIMED), Aix-Marseille University, Marseille 13005, France
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25
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Huang X, Li HJ, Ye L, Zhang Y, Wei R, Zhong YL, Peng DC, Shao Y. Altered regional homogeneity in patients with unilateral acute open-globe injury: a resting-state functional MRI study. Neuropsychiatr Dis Treat 2016; 12:1901-6. [PMID: 27536111 PMCID: PMC4975161 DOI: 10.2147/ndt.s110541] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate the underlying regional homogeneity (ReHo) brain activity changes in patients with unilateral acute open-globe injury (OGI) and their relationship with their clinical features. PATIENTS AND METHODS In total, 18 patients with acute OGI (16 males and two females) and 18 healthy controls (HCs; 16 males and two females) closely matched in age, sex, and education status participated in the study. Each subject underwent a resting-state functional magnetic resonance imaging scan. The ReHo method was used to assess local features of spontaneous brain activity. Receiver-operating characteristic curve was used to distinguish OGIs from HCs. The nonparametric statistical analysis was used to explore the relationship between the observed mean ReHo values of the different brain areas and the behavioral performance. RESULTS Compared with HCs, acute OGI patients had significantly increased ReHo values in the right cerebellum posterior lobe/lingual gyrus, left superior temporal gyrus/inferior frontal gyrus, left inferior frontal gyrus, left posterior cingulate cortex/precuneus, and left precentral operculum. However, there was no relationship between the observed mean ReHo values of the different brain areas and the behavioral performance. CONCLUSION Acute OGI may cause dysfunction in many brain regions, which may reflect the underlying pathologic mechanisms of acute vision loss in OGI patients.
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Affiliation(s)
- Xin Huang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang; Department of Ophthalmology, The First People's Hospital of Jiujiang City, Jiujiang
| | - Hai-Jun Li
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Lei Ye
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang
| | - Ying Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang
| | - Rong Wei
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang
| | - Yu-Lin Zhong
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang
| | - De-Chang Peng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang
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26
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Spalletta G, Piras F, Piras F, Sancesario G, Iorio M, Fratangeli C, Cacciari C, Caltagirone C, Orfei MD. Neuroanatomical correlates of awareness of illness in patients with amnestic mild cognitive impairment who will or will not convert to Alzheimer's disease. Cortex 2015; 61:183-95. [PMID: 25481475 DOI: 10.1016/j.cortex.2014.10.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 07/07/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Awareness of cognitive deficits may be reduced in mild cognitive impairment (MCI). This may have a detrimental effect on illness course and may be a predictor of subsequent conversion to AD. Although neuropsychological correlates have been widely investigated, no evidence of a neuroanatomical basis of the phenomenon has been reported yet. This study was aimed at investigating the neuroanatomical correlates of deficit awareness in amnestic MCI to determine whether they constitute risk factors for conversion to AD. METHOD A sample of 36 first-diagnosis amnestic MCI patients were followed for five years. At the first diagnostic visit they were administered an extensive diagnostic and clinical procedure and the Memory Insight Questionnaire (MIQ), measuring a total index and four sub-indices, to investigate awareness of deficits in dementia; they also underwent a high resolution T1-weighted Magnetic Resonance Imaging (MRI) investigation. Grey matter brain volumes were analysed on a voxel-by-voxel basis using Statistical Parametric Mapping 8. Data of 10 converter patients (CONV) and those of 26 non converter patients (NOCONV) were analysed using multiple regression models. RESULTS At baseline, self-awareness of memory deficits was poorer in CONV compared to NOCONV. Furthermore, reduced awareness of cognitive deficits in CONV correlated with reduced grey matter volume of the anterior cingulate (memory deficit awareness), right pars triangularis of the inferior frontal cortex (memory deficit awareness) and cerebellar vermis (total awareness), whereas in NOCONV it correlated with reduced grey matter volume of left superior (total awareness) and middle (language deficit awareness) temporal areas. Further, at baseline self-awareness of memory deficits were poorer in CONV than in NOCONV. CONCLUSIONS Defective awareness of cognitive deficits is underpinned by different mechanisms in CONV and NOCONV amnestic MCI patients. Our data support the hypothesis that poor awareness of cognitive deficit is a predictor of subsequent conversion to AD.
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Affiliation(s)
| | | | | | | | | | | | | | - Carlo Caltagirone
- IRCCS Santa Lucia Foundation, Rome, Italy; Tor Vergata University, Rome, Italy
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Samudra N, Ivleva EI, Hubbard NA, Rypma B, Sweeney JA, Clementz BA, Keshavan MS, Pearlson GD, Tamminga CA. Alterations in hippocampal connectivity across the psychosis dimension. Psychiatry Res 2015; 233:148-57. [PMID: 26123450 PMCID: PMC4784701 DOI: 10.1016/j.pscychresns.2015.06.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/24/2015] [Accepted: 06/08/2015] [Indexed: 01/13/2023]
Abstract
Recent evidence demonstrates that hippocampal hyperactivity helps mediate psychosis. Using resting state functional magnetic resonance imaging (rsfMRI), we examined hippocampal connectivity alterations in individuals with psychosis (PS) versus healthy controls (HC). Because of its putative greater involvement in psychiatric disorders, we hypothesized that the anterior hippocampus network would show greater dysconnectivity in psychosis. We tested rsfMRI connectivity in 88 PS (including 21 with schizophrenia; 40 with schizoaffective disorder; 27 with psychotic bipolar I disorder) and 65 HC. Seed-based voxel-wise connectivity analyses were carried out using whole, anterior, and posterior hippocampal seeds. No significant differences in functional hippocampal connectivity were found across the three conventional diagnoses. PS were then contrasted with HC, showing strong reductions in anterior hippocampal connectivity to anterior neocortical regions, including medial frontal and anterior cingulate cortices, as well as superior temporal gyrus, precuneus, thalamus and cerebellum. Posterior hippocampal seeds also demonstrated decreased connectivity in PS, with fewer dysconnected regions and a posterior/cerebellar distribution. Whole hippocampal outcomes were consistent with anterior/posterior hippocampal connectivity changes. Connectivity alterations did not correlate with cognition, clinical symptoms, or medication effect variables. Our results suggest a psychosis network of decreased hippocampal connectivity with limbic and frontal contributions, independent of diagnostic categories.
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Affiliation(s)
- Niyatee Samudra
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | - Elena I Ivleva
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | | | - Bart Rypma
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States; Center for Brain Health, UT Dallas, Dallas, TX, United States
| | - John A Sweeney
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Brett A Clementz
- Department of Psychology, University of Georgia, Athens, GA, United States
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA, United States
| | - Godfrey D Pearlson
- Department of Psychiatry, Institute of Living/Hartford Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Carol A Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
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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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Squarcina L, Perlini C, Peruzzo D, Castellani U, Marinelli V, Bellani M, Rambaldelli G, Lasalvia A, Tosato S, De Santi K, Spagnolli F, Cerini R, Ruggeri M, Brambilla P. The use of dynamic susceptibility contrast (DSC) MRI to automatically classify patients with first episode psychosis. Schizophr Res 2015; 165:38-44. [PMID: 25888338 DOI: 10.1016/j.schres.2015.03.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 03/18/2015] [Accepted: 03/22/2015] [Indexed: 12/22/2022]
Abstract
Hemodynamic changes in the brain have been reported in major psychosis in respect to healthy controls, and could unveil the basis of structural brain modifications happening in patients. The study of first episode psychosis is of particular interest because the confounding role of chronicity and medication can be excluded. The aim of this work is to automatically discriminate first episode psychosis patients and normal controls on the basis of brain perfusion employing a support vector machine (SVM) classifier. 35 normal controls and 35 first episode psychosis underwent dynamic susceptibility contrast magnetic resonance imaging, and cerebral blood flow and volume, along with mean transit time were obtained. We investigated their behavior in the whole brain and in selected regions of interest, in particular the left and right frontal, parietal, temporal and occipital lobes, insula, caudate and cerebellum. The distribution of values of perfusion indexes were used as features in a support vector machine classifier. Mean values of blood flow and volume were slightly lower in patients, and the difference reached statistical significance in the right caudate, left and right frontal lobes, and in left cerebellum. Linear SVM reached an accuracy of 83% in the classification of patients and normal controls, with the highest accuracy associated with the right frontal lobe and left parietal lobe. In conclusion, we found evidence that brain perfusion could be used as a potential marker to classify patients with psychosis, who show reduced blood flow and volume in respect to normal controls.
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Affiliation(s)
- Letizia Squarcina
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy; InterUniversity Centre for Behavioural Neurosciences (ICBN), University of Verona, Verona, Italy
| | - Cinzia Perlini
- InterUniversity Centre for Behavioural Neurosciences (ICBN), University of Verona, Verona, Italy; Department of Public Health and Community Medicine, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Denis Peruzzo
- Department of Informatics, University of Verona, Verona, Italy; Scientific Institute IRCCS "E. Medea", Bosisio Parini (Lc), Italy
| | | | - Veronica Marinelli
- Department of Experimental & Clinical Medical Sciences (DISM), InterUniversity Center for Behavioral Neurosciences, University of Udine, Udine, Italy
| | - Marcella Bellani
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy; InterUniversity Centre for Behavioural Neurosciences (ICBN), University of Verona, Verona, Italy
| | - Gianluca Rambaldelli
- InterUniversity Centre for Behavioural Neurosciences (ICBN), University of Verona, Verona, Italy; Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Antonio Lasalvia
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy; Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Sarah Tosato
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Katia De Santi
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy
| | - Federica Spagnolli
- Department of Morphological and Biomedical Sciences, Section of Radiology, University of Verona, Italy
| | - Roberto Cerini
- Department of Morphological and Biomedical Sciences, Section of Radiology, University of Verona, Italy
| | - Mirella Ruggeri
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy; Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Psychiatric Clinic, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, TX, USA.
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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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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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Boyer L, Testart J, Michel P, Richieri R, Faget-Agius C, Vanoye V, Auquier P, Lancon C, Guedj E. Neurophysiological correlates of metabolic syndrome and cognitive impairment in schizophrenia: a structural equation modeling approach. Psychoneuroendocrinology 2014; 50:95-105. [PMID: 25199983 DOI: 10.1016/j.psyneuen.2014.07.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/18/2014] [Accepted: 07/18/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We aimed to investigate the brain functional substrate underlying relationships between metabolic syndrome (MetS) and cognitive impairment in schizophrenia. METHODS In this cross-sectional study, we collected socio-demographic, clinical, anthropometric, blood, and cognition data and performed brain 99mTc-ECD-SPECT imaging of cerebral blood flow in patients with schizophrenia. Patients were grouped according to the absence or presence of MetS. Whole-brain perfusion SPECTs were compared at voxel level between these two groups, and voxel-wise interregional correlation was performed to compare functional connectivity (voxel level significance of p<0.005, uncorrected; p<0.05 for the cluster, uncorrected; using SPM8). A structural equation model (SEM) was applied to examine the relationships between brain perfusion, connectivity between brain areas, and cognition. RESULTS Of the 55 patients, 17 had MetS. They performed significantly worse than patients without MetS on tests of executive functions (processing speed p=0.005 for TMT-A; and reactive flexibility p=0.014 for TMT-B), attention (D2 attention task p=0.007), and memory (California Verbal Learning Test p=0.039). In comparison to patients without MetS, those with MetS exhibited significant hypoperfusion within the left orbital prefrontal cortex and greater functional connectivity from this left frontal cluster within the left insula and middle/superior frontal gyrus. SEM confirmed the effect on executive functions of brain hypoperfusion and of increased connectivity, suggesting possible compensatory networks in patients with MetS. CONCLUSION Our study identifies the brain functional impact of MetS on cognition, with orbital prefrontal impairment and possible compensatory networks.
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Affiliation(s)
- Laurent Boyer
- Aix-Marseille Univ, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005 Marseille, France.
| | - Julien Testart
- Department of Psychiatry, Sainte-Marguerite University Hospital, 13009 Marseille, France
| | - Pierre Michel
- Aix-Marseille Univ, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005 Marseille, France
| | - Raphaëlle Richieri
- Department of Psychiatry, Sainte-Marguerite University Hospital, 13009 Marseille, France
| | - Catherine Faget-Agius
- Department of Psychiatry, Sainte-Marguerite University Hospital, 13009 Marseille, France
| | - Violette Vanoye
- Department of Psychiatry, Sainte-Marguerite University Hospital, 13009 Marseille, France
| | - Pascal Auquier
- Aix-Marseille Univ, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005 Marseille, France
| | - Christophe Lancon
- Aix-Marseille Univ, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005 Marseille, France; Department of Psychiatry, Sainte-Marguerite University Hospital, 13009 Marseille, France
| | - Eric Guedj
- APHM, Hôpital de la Timone, Service Central de Biophysique et Médecine Nucléaire, 13005 Marseille, France; Aix-Marseille Univ, CERIMED 13005, Marseille, France; Aix-Marseille Univ, INT, 13005 Marseille, France
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Santra A, Kumar R. Brain perfusion single photon emission computed tomography in major psychiatric disorders: From basics to clinical practice. Indian J Nucl Med 2014; 29:210-21. [PMID: 25400359 PMCID: PMC4228583 DOI: 10.4103/0972-3919.142622] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Brain single photon emission computed tomography (SPECT) is a well-established and reliable method to assess brain function through measurement of regional cerebral blood flow (rCBF). It can be used to define a patient's pathophysiological status when neurological or psychiatric symptoms cannot be explained by anatomical neuroimaging findings. Though there is ample evidence validating brain SPECT as a technique to track human behavior and correlating psychiatric disorders with dysfunction of specific brain regions, only few psychiatrists have adopted brain SPECT in routine clinical practice. It can be utilized to evaluate the involvement of brain regions in a particular patient, to individualize treatment on basis of SPECT findings, to monitor the treatment response and modify treatment, if necessary. In this article, we have reviewed the available studies in this regard from existing literature and tried to present the evidence for establishing the clinical role of brain SPECT in major psychiatric illnesses.
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Affiliation(s)
- Amburanjan Santra
- Department of Nuclear Medicine, Brain imaging Centre, Dakshi Diagnostics, Lucknow, Uttar Pradesh, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Gong X, Lu W, Kendrick KM, Pu W, Wang C, Jin L, Lu G, Liu Z, Liu H, Feng J. A brain-wide association study of DISC1 genetic variants reveals a relationship with the structure and functional connectivity of the precuneus in schizophrenia. Hum Brain Mapp 2014; 35:5414-30. [PMID: 24909300 DOI: 10.1002/hbm.22560] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 04/07/2014] [Accepted: 05/13/2014] [Indexed: 01/05/2023] Open
Abstract
The Disrupted in Schizophrenia Gene 1 (DISC1) plays a role in both neural signaling and development and is associated with schizophrenia, although its links to altered brain structure and function in this disorder are not fully established. Here we have used structural and functional MRI to investigate links with six DISC1 single nucleotide polymorphisms (SNPs). We employed a brain-wide association analysis (BWAS) together with a Jacknife internal validation approach in 46 schizophrenia patients and 24 matched healthy control subjects. Results from structural MRI showed significant associations between all six DISC1 variants and gray matter volume in the precuneus, post-central gyrus and middle cingulate gyrus. Associations with specific SNPs were found for rs2738880 in the left precuneus and right post-central gyrus, and rs1535530 in the right precuneus and middle cingulate gyrus. Using regions showing structural associations as seeds a resting-state functional connectivity analysis revealed significant associations between all 6 SNPS and connectivity between the right precuneus and inferior frontal gyrus. The connection between the right precuneus and inferior frontal gyrus was also specifically associated with rs821617. Importantly schizophrenia patients showed positive correlations between the six DISC-1 SNPs associated gray matter volume in the left precuneus and right post-central gyrus and negative symptom severity. No correlations with illness duration were found. Our results provide the first evidence suggesting a key role for structural and functional connectivity associations between DISC1 polymorphisms and the precuneus in schizophrenia.
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Affiliation(s)
- Xiaohong Gong
- Centre for Computational Systems Biology, School of Mathematical Sciences, Fudan University, Shanghai, 200433, China; State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, 200433, China
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Sapara A, ffytche DH, Birchwood M, Cooke MA, Fannon D, Williams SC, Kuipers E, Kumari V. Preservation and compensation: the functional neuroanatomy of insight and working memory in schizophrenia. Schizophr Res 2014; 152:201-9. [PMID: 24332795 PMCID: PMC3906535 DOI: 10.1016/j.schres.2013.11.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 11/12/2013] [Accepted: 11/18/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND Poor insight in schizophrenia has been theorised to reflect a cognitive deficit that is secondary to brain abnormalities, localized in the brain regions that are implicated in higher order cognitive functions, including working memory (WM). This study investigated WM-related neural substrates of preserved and poor insight in schizophrenia. METHOD Forty stable schizophrenia outpatients, 20 with preserved and 20 with poor insight (usable data obtained from 18 preserved and 14 poor insight patients), and 20 healthy participants underwent functional magnetic resonance imaging (fMRI) during a parametric 'n-back' task. The three groups were preselected to match on age, education and predicted IQ, and the two patient groups to have distinct insight levels. Performance and fMRI data were analysed to determine how groups of patients with preserved and poor insight differed from each other, and from healthy participants. RESULTS Poor insight patients showed lower performance accuracy, relative to healthy participants (p=0.01) and preserved insight patients (p=0.08); the two patient groups were comparable on symptoms and medication. Preserved insight patients, relative to poor insight patients, showed greater activity most consistently in the precuneus and cerebellum (both bilateral) during WM; they also showed greater activity than healthy participants in the inferior-superior frontal gyrus and cerebellum (bilateral). Group differences in brain activity did not co-vary significantly with performance accuracy. CONCLUSIONS The precuneus and cerebellum function contribute to preserved insight in schizophrenia. Preserved insight as well as normal-range WM capacity in schizophrenia sub-groups may be achieved via compensatory neural activity in the frontal cortex and cerebellum.
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Affiliation(s)
- Adegboyega Sapara
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Dominic H. ffytche
- Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, London, UK,Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
| | - Max Birchwood
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Michael A. Cooke
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Dominic Fannon
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Steven C.R. Williams
- Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Veena Kumari
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.
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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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Hirjak D, Breyer T, Thomann PA, Fuchs T. Disturbance of intentionality: a phenomenological study of body-affecting first-rank symptoms in schizophrenia. PLoS One 2013; 8:e73662. [PMID: 24019932 PMCID: PMC3760919 DOI: 10.1371/journal.pone.0073662] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 07/19/2013] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES In 1950, Kurt Schneider proposed that a considerable number of schizophrenia patients develop first-rank symptoms (FRS). In such cases, patients report made experiences, replaced control of will, thought insertion, broadcast or withdrawal and delusional perception, respectively. Although a number of recent studies tend to explain FRS in terms of neurobiological and neuropsychological processes, the origin of these symptoms still remains unknown. In this paper, we explore the subjective experience of patients with the following two FRS: (1) "made" impulses and (2) "made" volitional acts. METHOD The method applied for the study of two FRS consists first in the overview of psychiatric and philosophical literature and second in the further investigation of subjective experience in patients with FRS. Psychopathological and phenomenological aspects of FRS are discussed by means of patient cases. RESULTS We discovered a profound transformation of intentionality and agency in schizophrenia patients with body-affecting FRS. This concept offers an insight into the interrelatedness between particular FRS. CONCLUSION We propose that the subjective experience of schizophrenia patients with body-affecting FRS is rooted in the disturbance of intentionality and diminished sense of agency. This theoretical account of body-affecting FRS will open up new directions in both phenomenological and neurobiological psychiatric research.
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Affiliation(s)
- Dusan Hirjak
- Section Phenomenological Psychopathology and Psychotherapy, Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- Structural Neuroimaging Group, Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Thiemo Breyer
- Section Phenomenological Psychopathology and Psychotherapy, Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Philipp Arthur Thomann
- Structural Neuroimaging Group, Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Thomas Fuchs
- Section Phenomenological Psychopathology and Psychotherapy, Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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Metacognition: towards a new approach to quality of life. Qual Life Res 2013; 23:467-75. [DOI: 10.1007/s11136-013-0485-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
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Dumas R, Baumstarck K, Michel P, Lançon C, Auquier P, Boyer L. Systematic review reveals heterogeneity in the use of the Scale to Assess Unawareness of Mental Disorder (SUMD). Curr Psychiatry Rep 2013; 15:361. [PMID: 23636985 DOI: 10.1007/s11920-013-0361-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Scale to Assess Unawareness of Mental Disorder (SUMD) is one of the most widely used instruments to measure insight into mental disorders. The aim of this study was to review all studies using the SUMD in the last 20 years. We performed an electronic search of MEDLINE using PubMed to identify all relevant studies published from 1993 to 2012. The following data were extracted from each article: characteristics of the SUMD (version, rating scale, scoring, and item/dimension used), methodological aspects (country, language, subject inclusion criteria, and sample size), and statistical methods to analyse insight. Of the 133 articles screened, 100 studies were included in the review. Fifty-two studies were published over the past five years. The SUMD was rarely used in its entirety, and the use of selected items or subscales was heterogeneous across studies. The studies also varied in terms of response modalities and in the use of 3- or 5-point Likert scales. The calculation of insight scores was highly variable and included the following: treating items as categorical or continuous variables, separate analysis of individual items, items expressed in terms of the sum total or the mean scores, and a range of score values used to define insight. This paper provides a systematic review of studies using the SUMD and reveals important differences in the versions used, the methods of calculation, and the interpretation of scores across studies. The use of a modified SUMD may compromise the psychometric properties of the scale, lead to erroneous conclusions, and prevents comparison of results across studies. Our review underlines the need for the standardised use of the SUMD.
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Affiliation(s)
- Rémy Dumas
- EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, 13005, Marseille, France.
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Boyer L, Cermolacce M, Dassa D, Fernandez J, Boucekine M, Richieri R, Vaillant F, Dumas R, Auquier P, Lancon C. Neurocognition, insight and medication nonadherence in schizophrenia: a structural equation modeling approach. PLoS One 2012; 7:e47655. [PMID: 23144705 PMCID: PMC3483287 DOI: 10.1371/journal.pone.0047655] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 09/14/2012] [Indexed: 01/29/2023] Open
Abstract
Objective The aim of this study was to examine the complex relationships among neurocognition, insight and nonadherence in patients with schizophrenia. Methods Design: Cross-sectional study. Inclusion criteria: Diagnosis of schizophrenia according to the DSM-IV-TR criteria. Data collection: Neurocognition was assessed using a global approach that addressed memory, attention, and executive functions; insight was analyzed using the multidimensional ‘Scale to assess Unawareness of Mental Disorder;’ and nonadherence was measured using the multidimensional ‘Medication Adherence Rating Scale.’ Analysis: Structural equation modeling (SEM) was applied to examine the non-straightforward relationships among the following latent variables: neurocognition, ‘awareness of positive symptoms’ and ‘negative symptoms’, ‘awareness of mental disorder’ and nonadherence. Results One hundred and sixty-nine patients were enrolled. The final testing model showed good fit, with normed χ2 = 1.67, RMSEA = 0.063, CFI = 0.94, and SRMR = 0.092. The SEM revealed significant associations between (1) neurocognition and ‘awareness of symptoms,’ (2) ‘awareness of symptoms’ and ‘awareness of mental disorder’ and (3) ‘awareness of mental disorder’ and nonadherence, mainly in the ‘attitude toward taking medication’ dimension. In contrast, there were no significant links between neurocognition and nonadherence, neurocognition and ‘awareness of mental disorder,’ and ‘awareness of symptoms’ and nonadherence. Conclusions Our findings support the hypothesis that neurocognition influences ‘awareness of symptoms,’ which must be integrated into a higher level of insight (i.e., the ‘awareness of mental disorder’) to have an impact on nonadherence. These findings have important implications for the development of effective strategies to enhance medication adherence.
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Affiliation(s)
- Laurent Boyer
- Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Marseille, France.
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Dumas R, Richieri R, Guedj E, Auquier P, Lancon C, Boyer L. Improvement of health-related quality of life in depression after transcranial magnetic stimulation in a naturalistic trial is associated with decreased perfusion in precuneus. Health Qual Life Outcomes 2012; 10:87. [PMID: 22838740 PMCID: PMC3492154 DOI: 10.1186/1477-7525-10-87] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 07/16/2012] [Indexed: 12/05/2022] Open
Abstract
Background Assessing Health-related Quality of life (HRQoL) is necessary to evaluate care and treatments provided to patients with major depressive disorder (MDD), in addition to the traditional assessment of clinical outcomes. However, HRQoL remains under-utilized to assess the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in research or in a routine clinical setting. The primary objective of this exploratory study on MDD was to investigate the impact of low-frequency rTMS on HRQoL using the SF-36 questionnaire. A secondary objective was to study the functional neural substrate underlying HRQoL changes using neuroimaging. Methods Fifteen right-handed patients who met DSM-IV criteria for MDD participated in the study. HRQoL was assessed using the SF-36, and regional cerebral blood (rCBF) flow using 99mTc-ECD-SPECT. Voxel based correlation was searched between concomitant changes in rCBF and in HRQoL after rTMS. Results Role-Physical Problems dimension showed a statistical significant improvement of 73.2% (p = 0.001) and an effect size (Cohen’s d) of 0.43, indicating moderate effect. Five SF-36 dimension scores and the two composite scores showed effect sizes ranged from 0.28 to 0.43. Improvement of Mental Composite Score (MCS)-SF-36 after rTMS was correlated with a concomitant decrease of precuneus perfusion (p < 0.001). Post-hoc analyses confirmed that decreased perfusion in precuneus was correlated with improvement of HRQoL, especially for MCS (r = −0.71; p < 0.001), Mental Health (r = −0.81; p < 0.001) and Social Functioning (r = −0.57; p = 0.026) dimensions. Conclusions This study suggests low-frequency rTMS can improve HRQoL, through its role-physical problems dimension, in patients with MDD. This improvement is associated with a decreased perfusion of the precuneus, a brain area involved in self-focus and self-processing, arguing for a neural substrate to the impact of rTMS on HRQoL.
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Affiliation(s)
- Rémy Dumas
- Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille 13009, France.
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