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Skouras S, Kleinert ML, Lee EHM, Hui CLM, Suen YN, Camchong J, Chong CSY, Chang WC, Chan SKW, Lo WTL, Lim KO, Chen EYH. Aberrant connectivity in the hippocampus, bilateral insula and temporal poles precedes treatment resistance in first-episode psychosis: a prospective resting-state functional magnetic resonance imaging study with connectivity concordance mapping. Brain Commun 2024; 6:fcae094. [PMID: 38707706 PMCID: PMC11069118 DOI: 10.1093/braincomms/fcae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 12/04/2023] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Functional connectivity resting-state functional magnetic resonance imaging has been proposed to predict antipsychotic treatment response in schizophrenia. However, only a few prospective studies have examined baseline resting-state functional magnetic resonance imaging data in drug-naïve first-episode schizophrenia patients with regard to subsequent treatment response. Data-driven approaches to conceptualize and measure functional connectivity patterns vary broadly, and model-free, voxel-wise, whole-brain analysis techniques are scarce. Here, we apply such a method, called connectivity concordance mapping to resting-state functional magnetic resonance imaging data acquired from an Asian sample (n = 60) with first-episode psychosis, prior to pharmaceutical treatment. Using a longitudinal design, 12 months after the resting-state functional magnetic resonance imaging, we measured and classified patients into two groups based on psychometric testing: treatment responsive and treatment resistant. Next, we compared the two groups' connectivity concordance maps that were derived from the resting-state functional magnetic resonance imaging data at baseline. We have identified consistently higher functional connectivity in the treatment-resistant group in a network including the left hippocampus, bilateral insula and temporal poles. These data-driven novel findings can help researchers to consider new regions of interest and facilitate biomarker development in order to identify treatment-resistant schizophrenia patients early, in advance of treatment and at the time of their first psychotic episode.
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Affiliation(s)
- Stavros Skouras
- Department of Fundamental Neurosciences, Faculty of Medicine, University of Geneva, CH-1211 Geneva, Switzerland
- Department of Neurology, Inselspital University Hospital Bern, CH3010 Bern, Switzerland
| | | | - Edwin H M Lee
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Christy L M Hui
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Jazmin Camchong
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454, USA
| | | | - Wing Chung Chang
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Sherry K W Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - William T L Lo
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong, China
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454, USA
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
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Geng Y, Zhang H, Dong Z, Zhang H. Effects of electroconvulsive therapy on functional brain networks in patients with schizophrenia. BMC Psychiatry 2024; 24:29. [PMID: 38191362 PMCID: PMC10773126 DOI: 10.1186/s12888-023-05408-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/27/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Schizophrenia is a kind of intractable brain disorder. Electroconvulsive therapy (ECT) has been used to rapidly improve the clinical symptoms of patients with schizophrenia, but the effect of ECT on topological attributes of brain functional network in patients with schizophrenia has not been clear. The purpose of this study was to investigate the brain functional network mechanism of ECT against schizophrenia. METHODS Thirty-one patients with schizophrenia and fifty healthy controls matching age, gender, and years of education were included. All participants underwent general data collection and magnetic resonance imaging scanning before ECT, and clinical symptoms were assessed using the Positive And Negative Syndrome Scale (PANSS). MRI and clinical symptoms were collected again after the first and eighth ECT application. The functional brain network was constructed on the basis of magnetic resonance imaging, and the global and node topological properties were analyzed. Repeated measure variance analysis was used to explore the changes of the topological attribute values and clinical symptom scores before and after ECT, and Bonferroni post hoc analysis was performed. The independent sample t-test was used to compare the differences in the topological attribute values between patients and healthy controls at three time points before and after ECT. Partial correlation analysis was performed for topological attribute values and clinical symptom scores of abnormal brain regions in the patient groups and their changes during ECT. A general linear regression model was used to predict the outcome after the final eighth ECT using the patient's response to the first ECT. RESULTS (1) One ECT can restore the gamma(γ), lamuda(λ), sigma(σ), nodal global efficiency (Ne) of right insular gyrus ventral agranular insula (INS_R_vIa) and nodal local efficiency (NLe) of bilateral fusiform gyrus medioventral area37 (FuG_A37mv). Eight ECT can also restore the NLe of cortex rostral lingual gyrus (MVOcC _R_rLinG). Eight ECT did not improve the Ne of right superior parietal lobule rostral area 7 (SPL_R_A7r) and NLe of left superior frontal gyrus medial area 6 (SFG_L_A6m). (2) Even after only the first use of ECT, total PANSS scores began to decrease (mean ΔPANSSECT1 was 11.7%; Range, 2%-32.8%), decreased significantly after the eighth application (mean ΔPANSSECT8 was 86.0%; Range,72.5% to 97.9%). Five patients met the response criteria after ECT1 (20% reduction in PANSS total score), and all patients met the response criteria after ECT8. (3) Linear regression analysis showed that ΔPANSSECT1 was a significant predictor of ΔPANSSECT8 (F=5.387, P=0.028), and ΔPANSSECT1 explained 15.7% of the variance of ΔPANSSECT8 (R2=0.157). CONCLUSIONS ECT was able to normalize γ, λ, σ, Ne of INS_R_vIa, NLe of bilateral FuG_A37mv in SZ patients after the first treatment, and NLe of MVOcC_R_rLinG after the eighth ECT. ECT significantly alleviates psychotic symptoms in patients with SZ, and its efficacy after eight sessions can be predicted by the patient's response to the first session of ECT.
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Affiliation(s)
- Yibo Geng
- Department of Magnetic Resonance Imaging, The Second Affiliated Hospital, Xinxiang Medical University, Henan, China
- Mental Hospital, Xinxiang Key Laboratory of Multimodal Brain Imaging, Xinxiang Mental Image Engineering Technology Research Center, Xinxiang, 453002, China
| | - Hongxing Zhang
- Department of Psychology, Xinxiang Medical University, Xinxiang, 453003, China
| | - Zhao Dong
- Department of Magnetic Resonance Imaging, The Second Affiliated Hospital, Xinxiang Medical University, Henan, China
- Mental Hospital, Xinxiang Key Laboratory of Multimodal Brain Imaging, Xinxiang Mental Image Engineering Technology Research Center, Xinxiang, 453002, China
| | - Haisan Zhang
- Department of Magnetic Resonance Imaging, The Second Affiliated Hospital, Xinxiang Medical University, Henan, China.
- Mental Hospital, Xinxiang Key Laboratory of Multimodal Brain Imaging, Xinxiang Mental Image Engineering Technology Research Center, Xinxiang, 453002, China.
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Sun S, Xiao S, Guo Z, Gong J, Tang G, Huang L, Wang Y. Meta-analysis of cortical thickness reduction in adult schizophrenia. J Psychiatry Neurosci 2023; 48:E461-E470. [PMID: 38123240 PMCID: PMC10743639 DOI: 10.1503/jpn.230081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/17/2023] [Accepted: 09/11/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Numerous neuroimaging studies using surface-based morphometry analyses have reported altered cortical thickness among patients with schizophrenia, but the results have been inconsistent. We sought to provide a whole-brain meta-analysis, which may help enhance the spatial accuracy of identification. METHODS We conducted a meta-analysis of whole-brain studies that explored cortical thickness alteration among adult patients with schizophrenia, including first-episode patients with schizophrenia, and patients with chronic schizophrenia, compared with healthy controls by using the seed-based d mapping with permutation of subject images (SDM-PSI) software. RESULTS A systematic literature search identified 25 studies (33 data sets) of cortical thickness, including 2008 patients with schizophrenia and 2004 healthy controls. Overall, patients with schizophrenia showed decreased cortical thickness in the right inferior frontal gyrus (IFG) and bilateral insula extending to the superior temporal gyrus (STG). Subgroup meta-analysis reported that patients with chronic schizophrenia showed decreased cortical thickness in the right insula extending to the right IFG. There was no significant cortical thickness difference between first-episode patients with schizophrenia and healthy controls. LIMITATIONS The results of meta-regression analyses should be viewed cautiously since they were driven by a small number of studies or did not overlap with the between-group differences found in the primary analyses. CONCLUSION The meta-analysis suggested robust cortical thickness reduction in the IFG, insula and STG among adult patients with schizophrenia, particularly in those with chronic schizophrenia. The results provide useful insights to understanding the underlying pathophysiology of schizophrenia.
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Affiliation(s)
- Shilin Sun
- From the Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China (Sun, Xiao, Guo, Tang, Huang, Wang); the Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China (Sun, Xiao, Guo, Gong, Tang, Huang, Wang); the Department of Radiology, Six Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (Gong)
| | - Shu Xiao
- From the Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China (Sun, Xiao, Guo, Tang, Huang, Wang); the Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China (Sun, Xiao, Guo, Gong, Tang, Huang, Wang); the Department of Radiology, Six Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (Gong)
| | - Zixuan Guo
- From the Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China (Sun, Xiao, Guo, Tang, Huang, Wang); the Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China (Sun, Xiao, Guo, Gong, Tang, Huang, Wang); the Department of Radiology, Six Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (Gong)
| | - Jiaying Gong
- From the Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China (Sun, Xiao, Guo, Tang, Huang, Wang); the Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China (Sun, Xiao, Guo, Gong, Tang, Huang, Wang); the Department of Radiology, Six Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (Gong)
| | - Guixian Tang
- From the Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China (Sun, Xiao, Guo, Tang, Huang, Wang); the Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China (Sun, Xiao, Guo, Gong, Tang, Huang, Wang); the Department of Radiology, Six Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (Gong)
| | - Li Huang
- From the Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China (Sun, Xiao, Guo, Tang, Huang, Wang); the Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China (Sun, Xiao, Guo, Gong, Tang, Huang, Wang); the Department of Radiology, Six Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (Gong)
| | - Ying Wang
- From the Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China (Sun, Xiao, Guo, Tang, Huang, Wang); the Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China (Sun, Xiao, Guo, Gong, Tang, Huang, Wang); the Department of Radiology, Six Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (Gong)
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Shin HR, Kim M, Park KI. Electroconvulsive therapy and seizure: a double-edged sword? ENCEPHALITIS 2023; 3:103-108. [PMID: 37621189 PMCID: PMC10598284 DOI: 10.47936/encephalitis.2023.00059] [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: 03/13/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 08/26/2023] Open
Abstract
Electroconvulsive therapy (ECT) is a widely used therapeutic option of drug-refractory psychiatric disorders. ECT treats psychiatric symptoms by inducing brief controlled seizures through electrical stimulation, but ECT does not generally cause prolonged seizures or epilepsy. However, several studies have reported cases of prolonged seizures after ECT. This review aimed to determine the mechanism of epileptogenesis with neurobiological changes after ECT. Contrary to epileptogenesis by ECT, several cases have reported that ECT was successfully applied for treatment of refractory status epilepticus. In addition, ECT might be applied to hyperkinetic movement and psychiatric symptoms of encephalitis. We also investigated the anticonvulsant mechanism of ECT and how it controls encephalitis symptoms.
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Affiliation(s)
- Hye-Rim Shin
- Department of Neurology, Dankook University Hospital, Cheonan, Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
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5
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Kawashima H, Yamasaki S, Kubota M, Hazama M, Fushimi Y, Miyata J, Murai T, Suwa T. Commonalities and differences in ECT-induced gray matter volume change between depression and schizophrenia. Neuroimage Clin 2023; 38:103429. [PMID: 37150022 PMCID: PMC10193002 DOI: 10.1016/j.nicl.2023.103429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is one of the most effective treatments for depression and schizophrenia, particularly in urgent or treatment-resistant cases. After ECT, regional gray matter volume (GMV) increases have been repeatedly reported both in depression and schizophrenia. However, the interpretation of these findings remains entangled because GMV changes do not necessarily correlate with treatment effects and may be influenced by the intervention itself. We hypothesized that the comparison of longitudinal magnetic resonance imaging data between the two diagnostic groups will provide clues to distinguish diagnosis-specific and transdiagnostic changes. METHOD Twenty-nine Japanese participants, including 18 inpatients with major depressive disorder and 11 with schizophrenia, underwent longitudinal voxel-based morphometry before and after ECT. We investigated GMV changes common to both diagnostic groups and those specific to each group. Moreover, we also evaluated potential associations between GMV changes and clinical improvement for each group. RESULTS In both diagnostic groups, GMV increased in widespread areas after ECT, sharing common regions including: anterior temporal cortex; medial frontal and anterior cingulate cortex; insula; and caudate nucleus. In addition, we found a schizophrenia-specific GMV increase in a region including the left pregenual anterior cingulate cortex, with volume increase significantly correlating with clinical improvement. CONCLUSIONS Transdiagnostic volume changes may represent the effects of the intervention itself and pathophysiological changes common to both groups. Conversely, diagnosis-specific volume changes are associated with treatment effects and may represent pathophysiology-specific impacts of ECT.
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Affiliation(s)
- Hirotsugu Kawashima
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Shimpei Yamasaki
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Manabu Kubota
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaaki Hazama
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jun Miyata
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Taro Suwa
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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6
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Tuovinen N, Hofer A. Resting-state functional MRI in treatment-resistant schizophrenia. FRONTIERS IN NEUROIMAGING 2023; 2:1127508. [PMID: 37554635 PMCID: PMC10406237 DOI: 10.3389/fnimg.2023.1127508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/17/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Abnormalities in brain regions involved in the pathophysiology of schizophrenia (SCZ) may present insight into individual clinical symptoms. Specifically, functional connectivity irregularities may provide potential biomarkers for treatment response or treatment resistance, as such changes can occur before any structural changes are visible. We reviewed resting-state functional magnetic resonance imaging (rs-fMRI) findings from the last decade to provide an overview of the current knowledge on brain functional connectivity abnormalities and their associations to symptoms in treatment-resistant schizophrenia (TRS) and ultra-treatment-resistant schizophrenia (UTRS) and to look for support for the dysconnection hypothesis. METHODS PubMed database was searched for articles published in the last 10 years applying rs-fMRI in TRS patients, i.e., who had not responded to at least two adequate treatment trials with different antipsychotic drugs. RESULTS Eighteen articles were selected for this review involving 648 participants (TRS and control cohorts). The studies showed frontal hypoconnectivity before the initiation of treatment with CLZ or riluzole, an increase in frontal connectivity after riluzole treatment, fronto-temporal hypoconnectivity that may be specific for non-responders, widespread abnormal connectivity during mixed treatments, and ECT-induced effects on the limbic system. CONCLUSION Probably due to the heterogeneity in the patient cohorts concerning antipsychotic treatment and other clinical variables (e.g., treatment response, lifetime antipsychotic drug exposure, duration of illness, treatment adherence), widespread abnormalities in connectivity were noted. However, irregularities in frontal brain regions, especially in the prefrontal cortex, were noted which are consistent with previous SCZ literature and the dysconnectivity hypothesis. There were major limitations, as most studies did not differentiate between TRS and UTRS (i.e., CLZ-resistant schizophrenia) and investigated heterogeneous cohorts treated with mixed treatments (with or without CLZ). This is critical as in different subtypes of the disorder an interplay between dopaminergic and glutamatergic pathways involving frontal, striatal, and hippocampal brain regions in separate ways is likely. Better definitions of TRS and UTRS are necessary in future longitudinal studies to correctly differentiate brain regions underlying the pathophysiology of SCZ, which could serve as potential functional biomarkers for treatment resistance.
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Affiliation(s)
- Noora Tuovinen
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
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Yang M, Yang Y, Liu L, Kong D, Xu M, Huang X, Luo C, Zhao G, Zhang X, Huang Y, Tu Y, Li Z. Sex differences in factors influencing hospital-acquired pneumonia in schizophrenia patients receiving modified electroconvulsive therapy. Front Psychiatry 2023; 14:1127262. [PMID: 36865072 PMCID: PMC9971594 DOI: 10.3389/fpsyt.2023.1127262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Sex differences may be presented in the clinical features or symptoms of schizophrenia patients but also affect the occurrence of hospital-acquired pneumonia (HAP). Modified electroconvulsive therapy (mECT) is a common treatment method for schizophrenia, used in combination with antipsychotics. This retrospective research explores the sex difference in HAP affecting patients with schizophrenia who have received mECT treatment during hospitalization. METHODS We included schizophrenia inpatients treated with mECT and antipsychotics between January 2015 and April 2022. Blood-related and demographic data collected on admission were analyzed. Influencing factors of HAP in male and female groups were assessed separately. RESULTS A total of 951 schizophrenia patients treated with mECT were enrolled in the study, including 375 males and 576 females, of which 62 patients experienced HAP during hospitalization. The risk period of HAP in these patients was found to be the first day after each mECT treatment and the first three sessions of mECT treatment. Statistically significant differences in the incidence of HAP were identified in male vs. female groups, with an incidence in men about 2.3 times higher than that in women (P < 0.001). Lower total cholesterol (Z = -2.147, P = 0.032) and the use of anti-parkinsonian drugs (χ2 = 17.973, P < 0.001) were found to be independent risk factors of HAP in male patients, while lower lymphocyte count (Z = -2.408, P = 0.016), hypertension (χ2 = 9.096, P = 0.003), and use of sedative-hypnotic drugs (χ2 = 13.636, P < 0.001) were identified in female patients. CONCLUSION Influencing factors of HAP in schizophrenia patients treated with mECT have gender differences. The first day after each mECT treatment and the first three sessions of mECT treatment were identified to have the greatest risk for HAP development. Therefore, it would be imperative to monitor clinical management and medications during this period according to these gender differences.
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Affiliation(s)
- Mi Yang
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China.,The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.,School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yan Yang
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Liju Liu
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Di Kong
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Min Xu
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Xincheng Huang
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Cheng Luo
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Guocheng Zhao
- Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yan Huang
- Department of Psychiatry, Chongqing Mental Health Center, Chongqing, China
| | - Yunzhong Tu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Zezhi Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
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8
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Wang S, Wen H, Qiu S, Xie P, Qiu J, He H. Driving brain state transitions in major depressive disorder through external stimulation. Hum Brain Mapp 2022; 43:5326-5339. [PMID: 35808927 PMCID: PMC9812249 DOI: 10.1002/hbm.26006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/27/2022] [Accepted: 06/22/2022] [Indexed: 01/15/2023] Open
Abstract
Major depressive disorder (MDD) as a dysfunction of neural circuits and brain networks has been established in modern neuroimaging sciences. However, the brain state transitions between MDD and health through external stimulation remain unclear, which limits translation to clinical contexts and demonstrable clinical utility. We propose a framework of the large-scale whole-brain network model for MDD linking the underlying anatomical connectivity with functional dynamics obtained from diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI). Then, we further explored the optimal brain regions to promote the transition of brain states between MDD and health through external stimulation of the model. Based on the whole-brain model successfully fitting the brain state space in MDD and the health, we demonstrated that the transition from MDD to health is achieved by the excitatory activation of the limbic system and from health to MDD by the inhibitory stimulation of the reward circuit. Our finding provides novel biophysical evidence for the neural mechanism of MDD and its recovery and allows the discovery of new stimulation targets for MDD recovery.
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Affiliation(s)
- Shengpei Wang
- Research Centre for Brain‐inspired Intelligence and National Laboratory of Pattern Recognition, Institute of AutomationChinese Academy of SciencesBeijingChina
| | - Hongwei Wen
- Key Laboratory of Cognition and Personality (Ministry of Education)ChongqingChina,School of PsychologySouthwest UniversityChongqingChina
| | - Shuang Qiu
- Research Centre for Brain‐inspired Intelligence and National Laboratory of Pattern Recognition, Institute of AutomationChinese Academy of SciencesBeijingChina
| | - Peng Xie
- Institute of NeuroscienceChongqing Medical UniversityChongqingChina,Chongqing Key Laboratory of NeurobiologyChongqingChina,Department of Neurologythe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Jiang Qiu
- Key Laboratory of Cognition and Personality (Ministry of Education)ChongqingChina,School of PsychologySouthwest UniversityChongqingChina
| | - Huiguang He
- Research Centre for Brain‐inspired Intelligence and National Laboratory of Pattern Recognition, Institute of AutomationChinese Academy of SciencesBeijingChina,University of Chinese Academy of SciencesBeijingChina,Center for Excellence in Brain Science and Intelligence TechnologyChinese Academy of SciencesBeijingChina
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9
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Wada M, Noda Y, Iwata Y, Tsugawa S, Yoshida K, Tani H, Hirano Y, Koike S, Sasabayashi D, Katayama H, Plitman E, Ohi K, Ueno F, Caravaggio F, Koizumi T, Gerretsen P, Suzuki T, Uchida H, Müller DJ, Mimura M, Remington G, Grace AA, Graff-Guerrero A, Nakajima S. Dopaminergic dysfunction and excitatory/inhibitory imbalance in treatment-resistant schizophrenia and novel neuromodulatory treatment. Mol Psychiatry 2022; 27:2950-2967. [PMID: 35444257 DOI: 10.1038/s41380-022-01572-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/31/2022] [Accepted: 04/07/2022] [Indexed: 12/13/2022]
Abstract
Antipsychotic drugs are the mainstay in the treatment of schizophrenia. However, one-third of patients do not show adequate improvement in positive symptoms with non-clozapine antipsychotics. Additionally, approximately half of them show poor response to clozapine, electroconvulsive therapy, or other augmentation strategies. However, the development of novel treatment for these conditions is difficult due to the complex and heterogenous pathophysiology of treatment-resistant schizophrenia (TRS). Therefore, this review provides key findings, potential treatments, and a roadmap for future research in this area. First, we review the neurobiological pathophysiology of TRS, particularly the dopaminergic, glutamatergic, and GABAergic pathways. Next, the limitations of existing and promising treatments are presented. Specifically, this article focuses on the therapeutic potential of neuromodulation, including electroconvulsive therapy, repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and deep brain stimulation. Finally, we propose multivariate analyses that integrate various perspectives of the pathogenesis, such as dopaminergic dysfunction and excitatory/inhibitory imbalance, thereby elucidating the heterogeneity of TRS that could not be obtained by conventional statistics. These analyses can in turn lead to a precision medicine approach with closed-loop neuromodulation targeting the detected pathophysiology of TRS.
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Affiliation(s)
- Masataka Wada
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Yusuke Iwata
- Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Sakiko Tsugawa
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan.,Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Hideaki Tani
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Yoji Hirano
- Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan.,Neural Dynamics Laboratory, Research Service, VA Boston Healthcare System, and Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Shinsuke Koike
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Haruyuki Katayama
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Eric Plitman
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Fumihiko Ueno
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Fernando Caravaggio
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Teruki Koizumi
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan.,Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Philip Gerretsen
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Takefumi Suzuki
- Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Daniel J Müller
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Gary Remington
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anthony A Grace
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ariel Graff-Guerrero
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan. .,Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
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10
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Lang X, Wang D, Chen D, Xiu M, Zhou H, Wang L, Cao B, Zhang X. Association Between Hippocampal Subfields and Clinical Symptoms of First-Episode and Drug Naive Schizophrenia Patients During 12 Weeks of Risperidone Treatment. Neurotherapeutics 2022; 19:399-407. [PMID: 35099766 PMCID: PMC9130442 DOI: 10.1007/s13311-021-01174-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 01/03/2023] Open
Abstract
Small hippocampal size may be implicated in the pathogenesis and psychopathology of schizophrenia (SCZ). However, does the volume of hippocampal subfields in SCZ patients affect response to antipsychotic treatment? In this study, we used risperidone to treat first-episode drug naïve (FEDN) SCZ patients for 12 weeks, and then explored the relationship between baseline hippocampal subfield volumes, as well as any changes in these hippocampal subfield volumes during treatment, and improvement in their psychopathological symptoms. By adopting a state-of the-art automated algorithm, the hippocampal subfields were segmented in 43 FEDN SCZ inpatients at baseline and after 12 weeks of risperidone monotherapy, as well as in 30 matched healthy controls. We adopted the Positive and Negative Syndrome Scale (PANSS) to assess psychopathological symptoms in patients at baseline and at post-treatment. Before treatment, SCZ patients had no significant differences in total or subfield hippocampal volumes compared with healthy volunteers. However, we found a significant correlation between a smaller left CA1 at baseline and a lower PANSS total score and general psychopathology sub-score at post-treatment (both p < 0.05). Furthermore, the left CA1 at baseline was significantly smaller in responders, who had >50% improvement in PANSS total score, than in non-responders (p < 0.05). Our results suggest that smaller left CA1 volume may be a predicator for improvement in psychotic symptoms of FEDN SCZ patients.
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Affiliation(s)
- Xiaoe Lang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.
| | - Dongmei Wang
- Institute of Psychology, Key Laboratory of Mental Health, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dachun Chen
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Meihong Xiu
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Huixia Zhou
- Institute of Psychology, Key Laboratory of Mental Health, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- Institute of Psychology, Key Laboratory of Mental Health, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Bo Cao
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada.
| | - Xiangyang Zhang
- Institute of Psychology, Key Laboratory of Mental Health, Chinese Academy of Sciences, Beijing, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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