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Chen X, Fan X, Song X, Gardner M, Du F, Öngür D. White Matter Metabolite Relaxation and Diffusion Abnormalities in First-Episode Psychosis: A Longitudinal Study. Schizophr Bull 2022; 48:712-720. [PMID: 34999898 PMCID: PMC9077413 DOI: 10.1093/schbul/sbab149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Microstructural abnormalities in the white matter (WM) are implicated in the pathophysiology of psychosis. In vivo magnetic resonance spectroscopy (MRS) can probe the brain's intracellular microenvironment through the measurement of transverse relaxation and diffusion of neurometabolites and possibly provide cell-specific information. In our previous studies, we observed differential metabolite signal abnormalities in first episode and chronic stages of psychosis. In the present work, longitudinal data were presented for the first time on white matter cell-type specific abnormalities using a combination of diffusion tensor spectroscopy (DTS), T2 MRS, and diffusion tensor imaging (DTI) from a group of 25 first episode psychosis patients and nine matched controls scanned at baseline and one and two years of follow-up. We observed significantly reduced choline ADC in the year 1 of follow-up (0.194 µm2/ms) compared to baseline (0.229 µm2/ms), followed by a significant increase in NAA ADC in the year 2 follow-up (0.258 µm2/ms) from baseline (0.222 µm2/ms) and year 1 follow-up (0.217 µm2/ms). In contrast, NAA T2 relaxation, reflecting a related but different aspect of microenvironment from diffusion, was reduced at year 1 follow-up (257 ms) compared to baseline (278 ms). These abnormalities were observed in the absence of any abnormalities in water relaxation and diffusion at any timepoint. These findings indicate that abnormalities are seen in in glial-enriched (choline) signals in early stages of psychosis, followed by the subsequent emergence of neuronal-enriched (NAA) diffusion abnormalities, all in the absence of nonspecific water signal abnormalities.
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Affiliation(s)
- Xi Chen
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA,McLean Imaging Center, McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Xiaoying Fan
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA,McLean Imaging Center, McLean Hospital, Belmont, MA, USA
| | - Xiaopeng Song
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA,McLean Imaging Center, McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Margaret Gardner
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA,McLean Imaging Center, McLean Hospital, Belmont, MA, USA
| | - Fei Du
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA,McLean Imaging Center, McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Dost Öngür
- To whom correspondence should be addressed; Psychotic Disorders Division, McLean Hospital, AB3 South 342. 115 Mill St., Belmont, MA 02478, USA; tel: 617-855-2779, fax: 617-855-2895, e-mail:
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Merritt K, Perez-Iglesias R, Sendt KV, Goozee R, Jauhar S, Pepper F, Barker GJ, Glenthøj B, Arango C, Lewis S, Kahn R, Stone J, Howes O, Dazzan P, McGuire P, Egerton A. Remission from antipsychotic treatment in first episode psychosis related to longitudinal changes in brain glutamate. NPJ SCHIZOPHRENIA 2019; 5:12. [PMID: 31371817 PMCID: PMC6672005 DOI: 10.1038/s41537-019-0080-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/19/2019] [Indexed: 02/04/2023]
Abstract
Neuroimaging studies in schizophrenia have linked elevated glutamate metabolite levels to non-remission following antipsychotic treatment, and also indicate that antipsychotics can reduce glutamate metabolite levels. However, the relationship between symptomatic reduction and change in glutamate during initial antipsychotic treatment is unclear. Here we report proton magnetic resonance spectroscopy (1H-MRS) measurements of Glx and glutamate in the anterior cingulate cortex (ACC) and thalamus in patients with first episode psychosis (n = 23) at clinical presentation, and after 6 weeks and 9 months of treatment with antipsychotic medication. At 9 months, patients were classified into Remission (n = 12) and Non-Remission (n = 11) subgroups. Healthy volunteers (n = 15) were scanned at the same three time-points. In the thalamus, Glx varied over time according to remission status (P = 0.020). This reflected an increase in Glx between 6 weeks and 9 months in the Non-Remission subgroup that was not evident in the Remission subgroup (P = 0.031). In addition, the change in Glx in the thalamus over the 9 months of treatment was positively correlated with the change in the severity of Positive and Negative Syndrome Scale (PANSS) positive, total and general symptoms (P<0.05). There were no significant effects of group or time on glutamate metabolites in the ACC, and no differences between either patient subgroup and healthy volunteers. These data suggest that the nature of the response to antipsychotic medication may be related to the pattern of changes in glutamatergic metabolite levels over the course of treatment. Specifically, longitudinal reductions in thalamic Glx levels following antipsychotic treatment are associated with symptomatic improvement.
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Affiliation(s)
- Kate Merritt
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Rocio Perez-Iglesias
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.,CIBERSAM: Centro Investigación Biomédica en Red Salud Mental, Santander, Spain
| | - Kyra-Verena Sendt
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Rhianna Goozee
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Sameer Jauhar
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Fiona Pepper
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Gareth J Barker
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Birte Glenthøj
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, & Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Center Glostrup, University of Copenhagen, København, Denmark
| | - Celso Arango
- CIBERSAM: Centro Investigación Biomédica en Red Salud Mental, Santander, Spain
| | - Shôn Lewis
- Institute of Brain, Behaviour and Mental Health, Manchester Academic Health Sciences Centre and Manchester Mental Health and Social Care Trust, Manchester, M13 9PL, UK
| | - René Kahn
- Department of Psychiatry, Icahn School of Medicine, New York, USA
| | - James Stone
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
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