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Mwesiga EK, Nakasujja N, Ongeri L, Semeere A, Loewy R, Meffert S. A cross-sectional mixed methods protocol to describe correlates and explanations for a long duration of untreated psychosis among patients with first episode psychosis in Uganda. BMJ Open 2019; 9:e028029. [PMID: 31315866 PMCID: PMC6661643 DOI: 10.1136/bmjopen-2018-028029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/16/2019] [Accepted: 06/07/2019] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Among patients with psychotic disorders, the 'duration of untreated psychosis' (DUP) is a predictor of key outcomes such as symptom remission and quality of life. In sub-Saharan Africa, DUP is up to five times longer than in high-income countries, with many patients going without antipsychotic medication for 5 years or longer. One contributor to this high DUP may relate to cultural norms that drive use of alternative and complementary therapies (ACTs) as first-line treatment strategies, rather than biomedical care with antipsychotic medicine. We aim to1 determine the prevalence and factors associated with DUP and ACT use in Uganda, and2 Identify factors that drive patient and family choices to use ACT as a first-line treatment strategy. METHODS AND ANALYSIS We will leverage on an ongoing cohort study at the national psychiatric and teaching hospital in Uganda. The parent study is an observational cohort design following antipsychotic naïve adults with a first episode of psychosis without substance use, HIV/AIDS or syphilis. The embedded study will use a mixed methods design including quantitative assessment of parent study participants with the Nottingham Onset Schedule-DUP to determine the DUP. Qualitative assessment will focus on patient and caregiver perceptions and use of ACT and its impact on DUP among patients with psychosis using in-depth interviews. ETHICS AND DISSEMINATION The study has received ethical approval from the school of medicine research and ethics committee of the college of health sciences at Makerere University. It has also received institutional support to perform the study from the Infectious Diseases Institute and Butabika hospital. Besides publication of the work in reputable peer-reviewed journals, we hope that this work will lead to evidence-based discussions on the need for early interventions to reduce DUP in Uganda.
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Affiliation(s)
- Emmanuel Kiiza Mwesiga
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Linnet Ongeri
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Aggrey Semeere
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rachel Loewy
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Susan Meffert
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
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Dluhoš P, Schwarz D, Cahn W, van Haren N, Kahn R, Španiel F, Horáček J, Kašpárek T, Schnack H. Multi-center machine learning in imaging psychiatry: A meta-model approach. Neuroimage 2017; 155:10-24. [PMID: 28428048 DOI: 10.1016/j.neuroimage.2017.03.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/06/2017] [Accepted: 03/14/2017] [Indexed: 01/17/2023] Open
Abstract
One of the biggest problems in automated diagnosis of psychiatric disorders from medical images is the lack of sufficiently large samples for training. Sample size is especially important in the case of highly heterogeneous disorders such as schizophrenia, where machine learning models built on relatively low numbers of subjects may suffer from poor generalizability. Via multicenter studies and consortium initiatives researchers have tried to solve this problem by combining data sets from multiple sites. The necessary sharing of (raw) data is, however, often hindered by legal and ethical issues. Moreover, in the case of very large samples, the computational complexity might become too large. The solution to this problem could be distributed learning. In this paper we investigated the possibility to create a meta-model by combining support vector machines (SVM) classifiers trained on the local datasets, without the need for sharing medical images or any other personal data. Validation was done in a 4-center setup comprising of 480 first-episode schizophrenia patients and healthy controls in total. We built SVM models to separate patients from controls based on three different kinds of imaging features derived from structural MRI scans, and compared models built on the joint multicenter data to the meta-models. The results showed that the combined meta-model had high similarity to the model built on all data pooled together and comparable classification performance on all three imaging features. Both similarity and performance was superior to that of the local models. We conclude that combining models is thus a viable alternative that facilitates data sharing and creating bigger and more informative models.
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Affiliation(s)
- Petr Dluhoš
- Behavioural and Social Neuroscience Group, CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic; Department of Psychiatry, University Hospital Brno and Masaryk University, Brno, Czech Republic.
| | - Daniel Schwarz
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Wiepke Cahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Neeltje van Haren
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - René Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Filip Španiel
- National Institute of Mental Health, Klecany, Czech Republic
| | - Jiří Horáček
- National Institute of Mental Health, Klecany, Czech Republic
| | - Tomáš Kašpárek
- Behavioural and Social Neuroscience Group, CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic; Department of Psychiatry, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Hugo Schnack
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
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Park MH, Garrett A, Boucher S, Howe M, Sanders E, Kim E, Singh M, Chang K. Amygdalar volumetric correlates of social anxiety in offspring of parents with bipolar disorder. Psychiatry Res 2015; 234:252-8. [PMID: 26472294 DOI: 10.1016/j.pscychresns.2015.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 09/17/2015] [Accepted: 09/25/2015] [Indexed: 10/23/2022]
Abstract
The prevalence of social anxiety disorder is high in offspring of parents with bipolar disorder (BD) and anxiety may be a significant risk factor in these youth for developing BD. We compared social anxiety symptoms between BD offspring with mood symptoms (high-risk group for developing BD I or II: HR) and healthy controls (HC). We also explored the correlations between the amygdalar volumes and social anxiety symptoms in the HR group with high social anxiety scores (HRHSA) due to the potential involvement of the amygdala in the pathophysiology of both BD and social anxiety. Youth participating in the study included 29h and 17HC of comparable age and gender. To assess social anxiety symptoms, we used the Multidimensional Anxiety Scale for Children (MASC) social anxiety subscale. The HR group's MASC social anxiety score was significantly higher than that of the HC group. Among the 29h, 17 subjects (58.6%) showed high social anxiety and they were classified as the HRHSA group. No significant difference was observed in amygdalar volume between the HRHSA and HC groups. However, there were significant negative correlations between amydalar volumes and MASC social anxiety score in the HRHSA group. These findings have implications for the link between amygdalar structure and both anxiety and mood control. This link may serve to implicate high social anxiety as a risk marker for future BD development.
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Affiliation(s)
- Min-Hyeon Park
- Department of Psychiatry, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Amy Garrett
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Spencer Boucher
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Meghan Howe
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Erica Sanders
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Eunjoo Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Manpreet Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kiki Chang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
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Refining and integrating schizophrenia pathophysiology – Relevance of the allostatic load concept. Neurosci Biobehav Rev 2014; 45:183-201. [DOI: 10.1016/j.neubiorev.2014.06.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 04/02/2014] [Accepted: 06/09/2014] [Indexed: 12/20/2022]
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Cortical thinning in temporo-parietal junction (TPJ) in non-affective first-episode of psychosis patients with persistent negative symptoms. PLoS One 2014. [PMID: 24979583 DOI: 10.1371/journal.pone.0101372.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Negative symptoms represent an unmet therapeutic need in many patients with schizophrenia. In an extension to our previous voxel-based morphometry findings, we employed a more specific, vertex-based approach to explore cortical thinning in relation to persistent negative symptoms (PNS) in non-affective first-episode of psychosis (FEP) patients to advance our understanding of the pathophysiology of primary negative symptoms. METHODS This study included 62 non-affective FEP patients and 60 non-clinical controls; 16 patients were identified with PNS (i.e., at least 1 primary negative symptom at moderate or greater severity sustained for at least 6 consecutive months). Using cortical thickness analyses, we explored for differences between PNS and non-PNS patients as well as between each patient group and healthy controls; cut-off threshold was set at p<0.01, corrected for multiple comparisons. RESULTS A thinner cortex prominently in the right superior temporal gyrus extending into the temporo-parietal junction (TPJ), right parahippocampal gyrus, and left orbital frontal gyrus was identified in PNS patients vs. non-PNS patients. Compared with healthy controls, PNS patients showed a thinner cortex prominently in the right superior temporal gyrus, right parahippocampal gyrus, and right cingulate; non-PNS patients showed a thinner cortex prominently in the parahippocampal gyrus bi-laterally. CONCLUSION Cortical thinning in the early stages of non-affective psychosis is present in the frontal and temporo-parietal regions in patients with PNS. With these brain regions strongly related to social cognitive functioning, our finding suggests a potential link between primary negative symptoms and social cognitive deficits through common brain etiologies.
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Bodnar M, Hovington CL, Buchy L, Malla AK, Joober R, Lepage M. Cortical thinning in temporo-parietal junction (TPJ) in non-affective first-episode of psychosis patients with persistent negative symptoms. PLoS One 2014; 9:e101372. [PMID: 24979583 PMCID: PMC4076331 DOI: 10.1371/journal.pone.0101372] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 05/29/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Negative symptoms represent an unmet therapeutic need in many patients with schizophrenia. In an extension to our previous voxel-based morphometry findings, we employed a more specific, vertex-based approach to explore cortical thinning in relation to persistent negative symptoms (PNS) in non-affective first-episode of psychosis (FEP) patients to advance our understanding of the pathophysiology of primary negative symptoms. METHODS This study included 62 non-affective FEP patients and 60 non-clinical controls; 16 patients were identified with PNS (i.e., at least 1 primary negative symptom at moderate or greater severity sustained for at least 6 consecutive months). Using cortical thickness analyses, we explored for differences between PNS and non-PNS patients as well as between each patient group and healthy controls; cut-off threshold was set at p<0.01, corrected for multiple comparisons. RESULTS A thinner cortex prominently in the right superior temporal gyrus extending into the temporo-parietal junction (TPJ), right parahippocampal gyrus, and left orbital frontal gyrus was identified in PNS patients vs. non-PNS patients. Compared with healthy controls, PNS patients showed a thinner cortex prominently in the right superior temporal gyrus, right parahippocampal gyrus, and right cingulate; non-PNS patients showed a thinner cortex prominently in the parahippocampal gyrus bi-laterally. CONCLUSION Cortical thinning in the early stages of non-affective psychosis is present in the frontal and temporo-parietal regions in patients with PNS. With these brain regions strongly related to social cognitive functioning, our finding suggests a potential link between primary negative symptoms and social cognitive deficits through common brain etiologies.
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Affiliation(s)
- Michael Bodnar
- Prevention and Early Intervention Program for Psychoses (PEPP – Montreal), Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
| | - Cindy L. Hovington
- Department of Neurology & Neurosurgery, McGill University, Montreal, Canada
| | - Lisa Buchy
- Department of Neurology & Neurosurgery, McGill University, Montreal, Canada
| | - Ashok K. Malla
- Prevention and Early Intervention Program for Psychoses (PEPP – Montreal), Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychoses (PEPP – Montreal), Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychoses (PEPP – Montreal), Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
- Department of Neurology & Neurosurgery, McGill University, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- * E-mail:
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Jeppesen SS, Debes NM, Simonsen HJ, Rostrup E, Larsson H, Skov L. Study of medication-free children with Tourette syndrome do not show imaging abnormalities. Mov Disord 2014; 29:1212-6. [DOI: 10.1002/mds.25858] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 01/26/2014] [Accepted: 02/03/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Signe Søndergaard Jeppesen
- Department of Pediatric; Herlev University Hospital; Herlev Denmark
- Functional Imaging Unit, Diagnostic Department; Glostrup University Hospital; Glostrup Denmark
| | | | - Helle Juhl Simonsen
- Functional Imaging Unit, Diagnostic Department; Glostrup University Hospital; Glostrup Denmark
| | - Egill Rostrup
- Functional Imaging Unit, Diagnostic Department; Glostrup University Hospital; Glostrup Denmark
| | - H.B.W. Larsson
- Functional Imaging Unit, Diagnostic Department; Glostrup University Hospital; Glostrup Denmark
| | - Liselotte Skov
- Department of Pediatric; Herlev University Hospital; Herlev Denmark
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Remington G, Foussias G, Agid O, Fervaha G, Takeuchi H, Hahn M. The neurobiology of relapse in schizophrenia. Schizophr Res 2014; 152:381-90. [PMID: 24206930 DOI: 10.1016/j.schres.2013.10.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 10/06/2013] [Accepted: 10/08/2013] [Indexed: 12/30/2022]
Abstract
Dopamine's proposed role in psychosis proved a starting point in our understanding of the neurobiology of relapse, fitting given the central role positive symptoms play. This link is reflected in early work examining neurotransmitter metabolite and drug (e.g. amphetamine, methylphenidate) challenge studies as a means of better understanding relapse and predictors. Since, lines of investigation have expanded (e.g. electrophysiological, immunological, hormonal, stress), an important step forward if relapse per se is the question. Arguably, perturbations in dopamine represent the final common pathway in psychosis but it is evident that, like schizophrenia, relapse is heterogeneous and multidimensional. In understanding the neurobiology of relapse, greater gains are likely to be made if these distinctions are acknowledged; for example, efforts to identify trait markers might better be served by distinguishing primary (i.e. idiopathic) and secondary (e.g. substance abuse, medication nonadherence) forms of relapse. Similarly, it has been suggested that relapse is 'neurotoxic', yet individuals do very well on clozapine after multiple relapses and the designation of treatment resistance. An alternative explanation holds that schizophrenia is characterized by different trajectories, at least to some extent biologically and/or structurally distinguishable from the outset, with differential patterns of response and relapse. Just as with schizophrenia, it seems naïve to conceptualize the neurobiology of relapse as a singular process. We propose that it is shaped by the form of illness and in place from the outset, modified by constitutional factors like resilience, as well as treatment, and confounded by secondary forms of relapse.
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Affiliation(s)
- Gary Remington
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada.
| | - George Foussias
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ofer Agid
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Gagan Fervaha
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Hiroyoshi Takeuchi
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Margaret Hahn
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
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Nagashima T, Inoue M, Kitamura S, Kiuchi K, Kosaka J, Okada K, Kishimoto N, Taoka T, Kichikawa K, Kishimoto T. Brain structural changes and neuropsychological impairments in male polydipsic schizophrenia. BMC Psychiatry 2012; 12. [PMID: 23181904 PMCID: PMC3532364 DOI: 10.1186/1471-244x-12-210] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Polydipsia frequently occurs in schizophrenia patients. The excessive water loading in polydipsia occasionally induces a hyponatremic state and leads to water intoxication. Whether polydipsia in schizophrenic patients correlates with neuropsychological impairments or structural brain changes is not clear and remains controversial. METHODS Eight polydipsic schizophrenia patients, eight nonpolydipsic schizophrenia patients, and eight healthy controls were recruited. All subjects underwent magnetic resonance imaging (MRI) and neuropsychological testing. Structural abnormalities were analyzed using a voxel-based morphometry (VBM) approach, and patients' neuropsychological function was assessed using the Brief Assessment of Cognition in Schizophrenia, Japanese version (BACS-J). RESULTS No significant differences were found between the two patient groups with respect to the clinical characteristics. Compared with healthy controls, polydipsic patients showed widespread brain volume reduction and neuropsychological impairment. Furthermore, the left insula was significantly reduced in polydipsic patients compared with nonpolydipsic patients. These nonpolydipsic patients performed intermediate to the other two groups in the neuropsychological function test. CONCLUSIONS It is possible that polydipsia or the secondary hyponatremia might induce left insula volume reduction. Furthermore, this structural brain change may indirectly induce more severe neuropsychological impairments in polydipsic patients. Thus, we suggest that insula abnormalities might contribute to the pathophysiology of polydipsic patients.
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Affiliation(s)
- Tomohisa Nagashima
- Department of Psychiatry, Nara Medical University, Kashihara, Nara, Japan.
| | - Makoto Inoue
- Department of Psychiatry, Nara Medical University, Kashihara, Nara, Japan,National Hospital Organization Yamato Mental Medical Center, Yamatokoriyama, Nara, Japan
| | - Soichiro Kitamura
- Department of Psychiatry, Nara Medical University, Kashihara, Nara, Japan
| | - Kuniaki Kiuchi
- Department of Psychiatry, Nara Medical University, Kashihara, Nara, Japan
| | - Jun Kosaka
- Department of Psychiatry, Nara Medical University, Kashihara, Nara, Japan,Sakai City Mental Health Center, Sakai, Osaka, Japan
| | - Koji Okada
- Department of Psychiatry, Nara Medical University, Kashihara, Nara, Japan
| | - Naoko Kishimoto
- Department of Psychiatry, Nara Medical University, Kashihara, Nara, Japan
| | - Toshiaki Taoka
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
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Abstract
Structural brain measures are employed as endophenotypes in the search for schizophrenia susceptibility genes. We analyzed two independent structural imaging datasets with voxel-based morphometry and with source-based morphometry, a multivariate, independent components analysis, to determine the stability and heritability of regional gray matter concentration abnormalities in schizophrenia. The samples comprised 209 and 102 patients with schizophrenia and 208 and 96 healthy volunteers, respectively. The second sample additionally included non-ill siblings of participants with and without schizophrenia. A standard voxel-based analysis showed reproducible regional gray matter deficits in the affected participants compared with unrelated, unaffected controls in both datasets: patients showed significant gray matter concentration deficits in cortical frontal, temporal, and insular lobes. Source-based morphometry (SBM) was applied to the gray matter images of the entire sample to determine the effects of diagnosis on networks of covarying structures. The SBM analysis extracted 24 significant sets of covarying regions (components). Four of these components showed significantly lower gray matter concentrations in patients (p < .05). We determined the familiality of the observed SBM components based on 66 sibling pairs (25 discordant for schizophrenia). Two components, one including the medial frontal, insular, inferior frontal, and temporal lobes, and the other including the posterior occipital lobe, showed significant familiality (p < .05). We conclude that structural brain deficits in schizophrenia are replicable, and that SBM can extract unique familial and likely heritable components. SBM provides a useful data reduction technique that can provide measures that may serve as endophenotypes for schizophrenia.
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