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Stoyanov D, Paunova R, Dichev J, Kandilarova S, Khorev V, Kurkin S. Functional magnetic resonance imaging study of group independent components underpinning item responses to paranoid-depressive scale. World J Clin Cases 2023; 11:8458-8474. [PMID: 38188204 PMCID: PMC10768520 DOI: 10.12998/wjcc.v11.i36.8458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/10/2023] [Accepted: 12/05/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Our study expand upon a large body of evidence in the field of neuropsychiatric imaging with cognitive, affective and behavioral tasks, adapted for the functional magnetic resonance imaging (MRI) (fMRI) experimental environment. There is sufficient evidence that common networks underpin activations in task-based fMRI across different mental disorders. AIM To investigate whether there exist specific neural circuits which underpin differential item responses to depressive, paranoid and neutral items (DN) in patients respectively with schizophrenia (SCZ) and major depressive disorder (MDD). METHODS 60 patients were recruited with SCZ and MDD. All patients have been scanned on 3T magnetic resonance tomography platform with functional MRI paradigm, comprised of block design, including blocks with items from diagnostic paranoid (DP), depression specific (DS) and DN from general interest scale. We performed a two-sample t-test between the two groups-SCZ patients and depressive patients. Our purpose was to observe different brain networks which were activated during a specific condition of the task, respectively DS, DP, DN. RESULTS Several significant results are demonstrated in the comparison between SCZ and depressive groups while performing this task. We identified one component that is task-related and independent of condition (shared between all three conditions), composed by regions within the temporal (right superior and middle temporal gyri), frontal (left middle and inferior frontal gyri) and limbic/salience system (right anterior insula). Another component is related to both diagnostic specific conditions (DS and DP) e.g. It is shared between DEP and SCZ, and includes frontal motor/language and parietal areas. One specific component is modulated preferentially by to the DP condition, and is related mainly to prefrontal regions, whereas other two components are significantly modulated with the DS condition and include clusters within the default mode network such as posterior cingulate and precuneus, several occipital areas, including lingual and fusiform gyrus, as well as parahippocampal gyrus. Finally, component 12 appeared to be unique for the neutral condition. In addition, there have been determined circuits across components, which are either common, or distinct in the preferential processing of the sub-scales of the task. CONCLUSION This study has delivers further evidence in support of the model of trans-disciplinary cross-validation in psychiatry.
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Affiliation(s)
- Drozdstoy Stoyanov
- Department of Psychiatry, Medical University Plovdiv, Plovdiv 4000, Bulgaria
| | - Rositsa Paunova
- Research Institute, Medical University, Plovdiv 4002, Bulgaria
| | - Julian Dichev
- Faculty of Medicine, Medical University, Plovdiv 4002, Bulgaria
| | - Sevdalina Kandilarova
- Department of Psychiatry and Medical Psychology, Medical University, Plovdiv 4002, Bulgaria
| | - Vladimir Khorev
- Baltic Center for Artificial Intelligence and Neurotechnology, Immanuel Kant Baltic Federal University, Kaliningrad 236041, Russia
| | - Semen Kurkin
- Baltic Center for Artificial Intelligence and Neurotechnology, Immanuel Kant Baltic Federal University, Kaliningrad 236041, Russia
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2
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Meng X, Iraji A, Fu Z, Kochunov P, Belger A, Ford JM, McEwen S, Mathalon DH, Mueller BA, Pearlson G, Potkin SG, Preda A, Turner J, van Erp TGM, Sui J, Calhoun VD. Multi-model order spatially constrained ICA reveals highly replicable group differences and consistent predictive results from resting data: A large N fMRI schizophrenia study. Neuroimage Clin 2023; 38:103434. [PMID: 37209635 PMCID: PMC10209454 DOI: 10.1016/j.nicl.2023.103434] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/22/2023]
Abstract
Brain functional networks identified from resting functional magnetic resonance imaging (fMRI) data have the potential to reveal biomarkers for brain disorders, but studies of complex mental illnesses such as schizophrenia (SZ) often yield mixed results across replication studies. This is likely due in part to the complexity of the disorder, the short data acquisition time, and the limited ability of the approaches for brain imaging data mining. Therefore, the use of analytic approaches which can both capture individual variability while offering comparability across analyses is highly preferred. Fully blind data-driven approaches such as independent component analysis (ICA) are hard to compare across studies, and approaches that use fixed atlas-based regions can have limited sensitivity to individual sensitivity. By contrast, spatially constrained ICA (scICA) provides a hybrid, fully automated solution that can incorporate spatial network priors while also adapting to new subjects. However, scICA has thus far only been used with a single spatial scale (ICA dimensionality, i.e., ICA model order). In this work, we present an approach using multi-objective optimization scICA with reference algorithm (MOO-ICAR) to extract subject-specific intrinsic connectivity networks (ICNs) from fMRI data at multiple spatial scales, which also enables us to study interactions across spatial scales. We evaluate this approach using a large N (N > 1,600) study of schizophrenia divided into separate validation and replication sets. A multi-scale ICN template was estimated and labeled, then used as input into scICA which was computed on an individual subject level. We then performed a subsequent analysis of multiscale functional network connectivity (msFNC) to evaluate the patient data, including group differences and classification. Results showed highly consistent group differences in msFNC in regions including cerebellum, thalamus, and motor/auditory networks. Importantly, multiple msFNC pairs linking different spatial scales were implicated. The classification model built on the msFNC features obtained up to 85% F1 score, 83% precision, and 88% recall, indicating the strength of the proposed framework in detecting group differences between schizophrenia and the control group. Finally, we evaluated the relationship of the identified patterns to positive symptoms and found consistent results across datasets. The results verified the robustness of our framework in evaluating brain functional connectivity of schizophrenia at multiple spatial scales, implicated consistent and replicable brain networks, and highlighted a promising approach for leveraging resting fMRI data for brain biomarker development.
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Affiliation(s)
- Xing Meng
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State, Georgia Tech, Emory University, Atlanta, GA, USA
| | - Armin Iraji
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State, Georgia Tech, Emory University, Atlanta, GA, USA
| | - Zening Fu
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State, Georgia Tech, Emory University, Atlanta, GA, USA
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Aysenil Belger
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Judy M Ford
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; San Francisco VA Medical Center, San Francisco, CA, USA
| | - Sara McEwen
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel H Mathalon
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; San Francisco VA Medical Center, San Francisco, CA, USA
| | - Bryon A Mueller
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Godfrey Pearlson
- Departments of Psychiatry and Neuroscience, Yale University, School of Medicine, New Haven, CT, USA
| | - Steven G Potkin
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - Adrian Preda
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - Jessica Turner
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State, Georgia Tech, Emory University, Atlanta, GA, USA; Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Theo G M van Erp
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - Jing Sui
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State, Georgia Tech, Emory University, Atlanta, GA, USA; Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Vince D Calhoun
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State, Georgia Tech, Emory University, Atlanta, GA, USA; Department of Psychology, Georgia State University, Atlanta, GA, USA.
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3
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Yeh TC, Huang CCY, Chung YA, Park SY, Im JJ, Lin YY, Ma CC, Tzeng NS, Chang HA. Resting-State EEG Connectivity at High-Frequency Bands and Attentional Performance Dysfunction in Stabilized Schizophrenia Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040737. [PMID: 37109695 PMCID: PMC10141517 DOI: 10.3390/medicina59040737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Attentional dysfunction has long been viewed as one of the fundamental underlying cognitive deficits in schizophrenia. There is an urgent need to understand its neural underpinning and develop effective treatments. In the process of attention, neural oscillation has a central role in filtering information and allocating resources to either stimulus-driven or goal-relevant objects. Here, we asked if resting-state EEG connectivity correlated with attentional performance in schizophrenia patients. Materials and Methods: Resting-state EEG recordings were obtained from 72 stabilized patients with schizophrenia. Lagged phase synchronization (LPS) was used to measure whole-brain source-based functional connectivity between 84 intra-cortical current sources determined by eLORETA (exact low-resolution brain electromagnetic tomography) for five frequencies. The Conners' Continuous Performance Test-II (CPT-II) was administered for evaluating attentional performance. Linear regression with a non-parametric permutation randomization procedure was used to examine the correlations between the whole-brain functional connectivity and the CPT-II measures. Results: Greater beta-band right hemispheric fusiform gyrus (FG)-lingual gyrus (LG) functional connectivity predicted higher CPT-II variability scores (r = 0.44, p < 0.05, corrected), accounting for 19.5% of variance in the CPT-II VAR score. Greater gamma-band right hemispheric functional connectivity between the cuneus (Cu) and transverse temporal gyrus (TTG) and between Cu and the superior temporal gyrus (STG) predicted higher CPT-II hit reaction time (HRT) scores (both r = 0.50, p < 0.05, corrected), accounting for 24.6% and 25.1% of variance in the CPT-II HRT score, respectively. Greater gamma-band right hemispheric Cu-TTG functional connectivity predicted higher CPT-II HRT standard error (HRTSE) scores (r = 0.54, p < 0.05, corrected), accounting for 28.7% of variance in the CPT-II HRTSE score. Conclusions: Our study indicated that increased right hemispheric resting-state EEG functional connectivity at high frequencies was correlated with poorer focused attention in schizophrenia patients. If replicated, novel approaches to modulate these networks may yield selective, potent interventions for improving attention deficits in schizophrenia.
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Affiliation(s)
- Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
| | - Cathy Chia-Yu Huang
- Department of Life Sciences, National Central University, Taoyuan 320317, Taiwan
| | - Yong-An Chung
- Department of Nuclear Medicine, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Sonya Youngju Park
- Department of Nuclear Medicine, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Jooyeon Jamie Im
- Department of Psychology, Seoul National University, Seoul 08826, Republic of Korea
| | - Yen-Yue Lin
- Department of Life Sciences, National Central University, Taoyuan 320317, Taiwan
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 325208, Taiwan
| | - Chin-Chao Ma
- Department of Psychiatry, Tri-Service General Hospital Beitou Branch, National Defense Medical Center, Taipei 112003, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
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4
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Subcortical control of the default mode network: Role of the basal forebrain and implications for neuropsychiatric disorders. Brain Res Bull 2022; 185:129-139. [PMID: 35562013 PMCID: PMC9290753 DOI: 10.1016/j.brainresbull.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 01/03/2023]
Abstract
The precise interplay between large-scale functional neural systems throughout the brain is essential for performance of cognitive processes. In this review we focus on the default mode network (DMN), one such functional network that is active during periods of quiet wakefulness and believed to be involved in introspection and planning. Abnormalities in DMN functional connectivity and activation appear across many neuropsychiatric disorders, including schizophrenia. Recent evidence suggests subcortical regions including the basal forebrain are functionally and structurally important for regulation of DMN activity. Within the basal forebrain, subregions like the ventral pallidum may influence DMN activity and the nucleus basalis of Meynert can inhibit switching between brain networks. Interactions between DMN and other functional networks including the medial frontoparietal network (default), lateral frontoparietal network (control), midcingulo-insular network (salience), and dorsal frontoparietal network (attention) are also discussed in the context of neuropsychiatric disorders. Several subtypes of basal forebrain neurons have been identified including basal forebrain parvalbumin-containing or somatostatin-containing neurons which can regulate cortical gamma band oscillations and DMN-like behaviors, and basal forebrain cholinergic neurons which might gate access to sensory information during reinforcement learning. In this review, we explore this evidence, discuss the clinical implications on neuropsychiatric disorders, and compare neuroanatomy in the human vs rodent DMN. Finally, we address technological advancements which could help provide a more complete understanding of modulation of DMN function and describe newly identified BF therapeutic targets that could potentially help restore DMN-associated functional deficits in patients with a variety of neuropsychiatric disorders.
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5
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Wang X, Cheng B, Roberts N, Wang S, Luo Y, Tian F, Yue S. Shared and distinct brain fMRI response during performance of working memory tasks in adult patients with schizophrenia and major depressive disorder. Hum Brain Mapp 2021; 42:5458-5476. [PMID: 34431584 PMCID: PMC8519858 DOI: 10.1002/hbm.25618] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 02/05/2023] Open
Abstract
Working memory (WM) impairments are common features of psychiatric disorders. A systematic meta-analysis was performed to determine common and disorder-specific brain fMRI response during performance of WM tasks in patients with SZ and patients with MDD relative to healthy controls (HC). Thirty-four published fMRI studies of WM in patients with SZ and 18 published fMRI studies of WM in patients with MDD, including relevant HC, were included in the meta-analysis. In both SZ and MDD there was common stronger fMRI response in right medial prefrontal cortex (MPFC) and bilateral anterior cingulate cortex (ACC), which are part of the default mode network (DMN). The effects were of greater magnitude in SZ than MDD, especially in prefrontal-temporal-cingulate-striatal-cerebellar regions. In addition, a disorder-specific weaker fMRI response was observed in right middle frontal gyrus (MFG) in MDD, relative to HC. For both SZ and MDD a significant correlation was observed between the severity of clinical symptoms and lateralized fMRI response relative to HC. These findings indicate that there may be common and distinct anomalies in brain function underlying deficits in WM in SZ and MDD, which may serve as a potential functional neuroimaging-based diagnostic biomarker with value in supporting clinical diagnosis, measuring illness severity and assessing the efficacy of treatments for SZ and MDD at the brain level.
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Affiliation(s)
- Xiuli Wang
- Department of Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu, China
| | - Bochao Cheng
- Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Neil Roberts
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Song Wang
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Ya Luo
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Fangfang Tian
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Suping Yue
- Department of Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu, China
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6
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Stoyanov D, Kandilarova S, Aryutova K, Paunova R, Todeva-Radneva A, Latypova A, Kherif F. Multivariate Analysis of Structural and Functional Neuroimaging Can Inform Psychiatric Differential Diagnosis. Diagnostics (Basel) 2020; 11:E19. [PMID: 33374207 PMCID: PMC7823426 DOI: 10.3390/diagnostics11010019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023] Open
Abstract
Traditional psychiatric diagnosis has been overly reliant on either self-reported measures (introspection) or clinical rating scales (interviews). This produced the so-called explanatory gap with the bio-medical disciplines, such as neuroscience, which are supposed to deliver biological explanations of disease. In that context the neuro-biological and clinical assessment in psychiatry remained discrepant and incommensurable under conventional statistical frameworks. The emerging field of translational neuroimaging attempted to bridge the explanatory gap by means of simultaneous application of clinical assessment tools and functional magnetic resonance imaging, which also turned out to be problematic when analyzed with standard statistical methods. In order to overcome this problem our group designed a novel machine learning technique, multivariate linear method (MLM) which can capture convergent data from voxel-based morphometry, functional resting state and task-related neuroimaging and the relevant clinical measures. In this paper we report results from convergent cross-validation of biological signatures of disease in a sample of patients with schizophrenia as compared to depression. Our model provides evidence that the combination of the neuroimaging and clinical data in MLM analysis can inform the differential diagnosis in terms of incremental validity.
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Affiliation(s)
- Drozdstoy Stoyanov
- Department of Psychiatry and Medical Psychology and Research Institute at Medical University of Plovdiv, 4000 Plovdiv, Bulgaria; (S.K.); (K.A.); (R.P.); (A.T.-R.)
| | - Sevdalina Kandilarova
- Department of Psychiatry and Medical Psychology and Research Institute at Medical University of Plovdiv, 4000 Plovdiv, Bulgaria; (S.K.); (K.A.); (R.P.); (A.T.-R.)
| | - Katrin Aryutova
- Department of Psychiatry and Medical Psychology and Research Institute at Medical University of Plovdiv, 4000 Plovdiv, Bulgaria; (S.K.); (K.A.); (R.P.); (A.T.-R.)
| | - Rositsa Paunova
- Department of Psychiatry and Medical Psychology and Research Institute at Medical University of Plovdiv, 4000 Plovdiv, Bulgaria; (S.K.); (K.A.); (R.P.); (A.T.-R.)
| | - Anna Todeva-Radneva
- Department of Psychiatry and Medical Psychology and Research Institute at Medical University of Plovdiv, 4000 Plovdiv, Bulgaria; (S.K.); (K.A.); (R.P.); (A.T.-R.)
| | - Adeliya Latypova
- Centre for Research in Neuroscience—Department of Clinical Neurosciences, CHUV—UNIL, 1010 Lausanne, Switzerland; (A.L.); (F.K.)
| | - Ferath Kherif
- Centre for Research in Neuroscience—Department of Clinical Neurosciences, CHUV—UNIL, 1010 Lausanne, Switzerland; (A.L.); (F.K.)
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7
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Yamashita M, Shimokawa T, Takahashi S, Yamada S, Terada M, Ukai S, Tanemura R. Cognitive functions relating to aberrant interactions between task-positive and task-negative networks: Resting fMRI study of patients with schizophrenia. APPLIED NEUROPSYCHOLOGY. ADULT 2020; 29:1122-1130. [PMID: 33280403 DOI: 10.1080/23279095.2020.1852565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Brain functional connectivity in the resting-state represents intrinsic functional states and correlates with cognitive performance. In patients with schizophrenia, reports on the relationships between forms of functional disconnectivity in local areas and cognitive disability have used resting-state functional magnetic resonance imaging data. Meanwhile, cognitive deficits in relation to inter-network forms of functional connectivity on a large scale are not well understood. This study examines cognitive functions in relation to the number of resting-state inter-network forms of functional connectivity focusing on task-positive networks (fronto-parietal network [FPN] and cingulo-opercular network [CON]) and task-negative network (default mode network [DMN]). We compare patients with schizophrenia (SCH group) and healthy controls (HC group). We conducted a functional network analysis by applying graph theory and evaluated cognitive functions using the Brief Assessment of Cognition in Schizophrenia. The number of forms of functional connectivity between FPN and DMN and between CON and DMN were significantly higher in SCH group than in HC group, and those in SCH group were also weakly correlated with their attention scores. It is suggested that fewer than typical functional segregations between task-positive and task-negative networks in SCH group relate to inefficient distribution of cognitive resources and low attentional abilities.
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Affiliation(s)
- Madoka Yamashita
- Department of Rehabilitation Science, Graduate School of Health Sciences, Life and Medical Sciences Area, Kobe University, Hyogo, Japan.,Center for Information and Neural Networks (CiNet), National Institute of Information and Communications Technology (NICT), Osaka University, Osaka, Japan.,Department of Rehabilitation, Asakayama General Hospital, Osaka, Japan
| | - Tetsuya Shimokawa
- Department of Rehabilitation Science, Graduate School of Health Sciences, Life and Medical Sciences Area, Kobe University, Hyogo, Japan.,Center for Information and Neural Networks (CiNet), National Institute of Information and Communications Technology (NICT), Osaka University, Osaka, Japan
| | - Shun Takahashi
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Shinichi Yamada
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | | | - Satoshi Ukai
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Rumi Tanemura
- Department of Rehabilitation Science, Graduate School of Health Sciences, Life and Medical Sciences Area, Kobe University, Hyogo, Japan
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8
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Perez SM, Boley A, Lodge DJ. Region specific knockdown of Parvalbumin or Somatostatin produces neuronal and behavioral deficits consistent with those observed in schizophrenia. Transl Psychiatry 2019; 9:264. [PMID: 31636253 PMCID: PMC6803626 DOI: 10.1038/s41398-019-0603-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/18/2019] [Accepted: 08/11/2019] [Indexed: 12/20/2022] Open
Abstract
The anterior hippocampus and prefrontal cortex are regions linked to symptoms of schizophrenia. The anterior hippocampus is believed to be a key regulator of the mesolimbic dopamine system and is thought to be the driving force contributing to positive symptoms, while the prefrontal cortex is involved in cognitive flexibility and negative symptoms. Aberrant activity in these regions is associated with decreases in GABAergic markers, indicative of an interneuron dysfunction. Specifically, selective decreases are observed in interneurons that contain parvalbumin (PV) or somatostatin (SST). Here, we used viral knockdown in rodents to recapitulate this finding and examine the region-specific roles of PV and SST on neuronal activity and behaviors associated with positive, negative and cognitive symptoms. We found that PV and SST had differential effects on neuronal activity and behavior when knocked down in the ventral hippocampus (vHipp) or medial prefrontal cortex (mPFC). Specifically, SST or PV knockdown in the vHipp increased pyramidal cell activity of the region and produced downstream effects on dopamine neuron activity in the ventral tegmental area (VTA). In contrast, mPFC knockdown did not affect the activity of VTA dopamine neuron activity; however, it did produce deficits in negative (social interaction) and cognitive (reversal learning) domains. Taken together, decreases in PV and/or SST were sufficient to produce schizophrenia-like deficits that were dependent on the region targeted.
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Affiliation(s)
- Stephanie M Perez
- UT Health San Antonio, Department of Pharmacology, Center for Biomedical Neuroscience, 7703 Floyd Curl Drive, MC 7764, San Antonio, TX, 78229, USA.
| | - Angela Boley
- UT Health San Antonio, Department of Pharmacology, Center for Biomedical Neuroscience, 7703 Floyd Curl Drive, MC 7764, San Antonio, TX, 78229, USA
| | - Daniel J Lodge
- UT Health San Antonio, Department of Pharmacology, Center for Biomedical Neuroscience, 7703 Floyd Curl Drive, MC 7764, San Antonio, TX, 78229, USA
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9
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Hugdahl K, Kazimierczak K, Beresniewicz J, Kompus K, Westerhausen R, Ersland L, Grüner R, Specht K. Dynamic up- and down-regulation of the default (DMN) and extrinsic (EMN) mode networks during alternating task-on and task-off periods. PLoS One 2019; 14:e0218358. [PMID: 31536496 PMCID: PMC6752853 DOI: 10.1371/journal.pone.0218358] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/02/2019] [Indexed: 12/21/2022] Open
Abstract
Using fMRI, Hugdahl et al. (2015) reported the existence of a general-domain cortical network during active task-processing which was non-specific to the cognitive task being processed. They labelled this network the extrinsic mode network (EMN). The EMN would be predicted to be negatively, or anti-correlated with the classic default mode network (DMN), typically observed during periods of rest, such that while the EMN should be down-regulated and the DMN up-regulated in the absence of demands for task-processing, the reverse should occur when demands change from resting to task-processing. This would require alternating periods of task-processing and resting and analyzing data continuously when demands change from active to passive periods and vice versa. We were particularly interested in how the networks interact in the critical transition points between conditions. For this purpose, we used an auditory task with multiple cognitive demands in a standard fMRI block-design. Task-present (ON) blocks were alternated with an equal number of task-absent, or rest (OFF) blocks to capture network dynamics across time and changing environmental demands. To achieve this, we specified the onset of each block, and used a finite-impulse response function (FIR) as basis function for estimation of the fMRI-BOLD response. During active (ON) blocks, the results showed an initial rapid onset of activity in the EMN network, which remained throughout the period, and faded away during the first scan of the OFF-block. During OFF blocks, activity in the DMN network showed an initial time-lag where neither the EMN nor the DMN was active, after which the DMN was up-regulated. Studying network dynamics in alternating passive and active periods may provide new insights into brain network interaction and regulation.
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Affiliation(s)
- Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- * E-mail:
| | | | - Justyna Beresniewicz
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Kristiina Kompus
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | | | - Lars Ersland
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Renate Grüner
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway
| | - Karsten Specht
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway
- Department of Education, UiT/The Arctic University of Norway, Tromsø, Norway
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10
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Extrinsic and default mode networks in psychiatric conditions: Relationship to excitatory-inhibitory transmitter balance and early trauma. Neurosci Biobehav Rev 2019; 99:90-100. [PMID: 30769024 DOI: 10.1016/j.neubiorev.2019.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/30/2019] [Accepted: 02/07/2019] [Indexed: 02/08/2023]
Abstract
Over the last three decades there has been an accumulation of Magnetic Resonance Imaging (MRI) studies reporting that aberrant functional networks may underlie cognitive deficits and other symptoms across a range of psychiatric diagnoses. The use of pharmacological MRI and 1H-Magnetic Resonance Spectroscopy (1H-MRS) has allowed researchers to investigate how changes in network dynamics are related to perturbed excitatory and inhibitory neurotransmission in individuals with psychiatric conditions. More recently, changes in functional network dynamics and excitatory/inhibitory (E/I) neurotransmission have been linked to early childhood trauma, a major antecedents for psychiatric illness in adulthood. Here we review studies investigating whether perturbed network dynamics seen across psychiatric conditions are related to changes in E/I neurotransmission, and whether such changes could be linked to childhood trauma. Whilst there is currently a paucity of studies relating early traumatic experiences to altered E/I balance and network function, the research discussed here lead towards a plausible mechanistic hypothesis, linking early traumatic experiences to cognitive dysfunction and symptoms mediated by E/I neurotransmitter imbalances.
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Alústiza I, Garcés MS, Solanes A, Goena J, Ortuño M, Molero P, Radua J, Ortuño F. Aberrant timing and oddball detection in Schizophrenia: findings from a signed differential mapping meta-analysis. Heliyon 2018; 4:e01004. [PMID: 30582035 PMCID: PMC6287083 DOI: 10.1016/j.heliyon.2018.e01004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/29/2018] [Accepted: 11/29/2018] [Indexed: 11/17/2022] Open
Abstract
Schizophrenia (SZ) is associated with deficits in both temporal and salience processing. The underlying neurological dysfunctions in both processes, which are interrelated and share neuroanatomical bases, remain poorly understood. The principal objective of this study was to elucidate whether there are any brain regions that show abnormal response during timing and oddball tasks in patients with SZ. To this end, we conducted a signed differential mapping (SDM) meta-analysis of functional magnetic resonance imaging (fMRI) studies assessing abnormal responses elicited by tasks based on the oddball paradigm in patients with SZ. We conducted a similar SDM meta-analysis of neuroimaging studies of timing tasks in SZ. Finally, we undertook a multimodal meta-analysis to detect the common findings of the two previous meta-analyses. We found that SZ patients showed hypoactivation in cortical and subcortical areas related to timing. The dysfunction observed during timing tasks partially coincided with deficiencies in change-detection functions (particularly in the case of preattentional processing in the mismatch negativity response). We hypothesize that a dysfunctional timing/change detection network underlies the cognitive impairment observed in SZ.
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Affiliation(s)
- Irene Alústiza
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
- Instituto de Investigación Sanitaria de Navarra (IDISNA), Navarra, Spain
- Corresponding author.
| | - María Sol Garcés
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Aleix Solanes
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
- FIDMAG Germanes Hospitalaries, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Saint Boi de Llobregat, Barcelona, Spain
| | - Javier Goena
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Marta Ortuño
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Patricio Molero
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
- Instituto de Investigación Sanitaria de Navarra (IDISNA), Navarra, Spain
| | - Joaquim Radua
- Early Psychosis: Interventions & Clinical-detection (EPIC) Laboratory, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
- FIDMAG Germanes Hospitalaries, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Saint Boi de Llobregat, Barcelona, Spain
| | - Felipe Ortuño
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
- Instituto de Investigación Sanitaria de Navarra (IDISNA), Navarra, Spain
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de Bézenac CE, Sluming V, Alhazmi F, Corcoran R. Agency performance modulates resting-state variation in prefrontal brain regions. Neuropsychologia 2018; 111:16-25. [DOI: 10.1016/j.neuropsychologia.2017.12.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 11/30/2017] [Accepted: 12/22/2017] [Indexed: 11/16/2022]
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Hahn B, Harvey AN, Gold JM, Ross TJ, Stein EA. Load-dependent hyperdeactivation of the default mode network in people with schizophrenia. Schizophr Res 2017; 185:190-196. [PMID: 28073606 PMCID: PMC6104387 DOI: 10.1016/j.schres.2017.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/28/2016] [Accepted: 01/01/2017] [Indexed: 02/01/2023]
Abstract
Schizophrenia is associated with impairment in a range of cognitive functions. Neuroimaging studies have reported lower, but also higher, task-induced activation accompanying impaired performance. Differences in task-load and the ability of people with schizophrenia (PSZ) to stay engaged in the cognitive operations probed appear to underlie such discrepancies. Similarly, task-induced deactivation of the default mode network (DMN) was weaker in PSZ relative to healthy control subjects (HCS) in most studies, but some reported greater deactivation. An inability to stay engaged in the cognitive operations could account for these discrepancies, too, as it would lead to more time off-task and consequently less deactivation of DMN functions. The present study employed a change detection paradigm with small to moderate set sizes (SSs) of 1, 2, and 4 items. Task training prior to fMRI scanning abolished the group difference in no-response trials. Task-positive regions of interest (ROIs) displayed greater activation with increasing SS in both groups. PSZ showed greater activation relative to HCS at SSs 1 and 2. DMN ROIs displayed greater deactivation with increasing SS in PSZ, but not in HCS, and PSZ tended to hyperdeactivate DMN regions at SS 4. No hypodeactivation was observed in PSZ. In conclusion, when minimizing differences in task-engagement, PSZ tend to over-recruit task-positive regions during low-load operations, and hyperdeactivate DMN functions at higher load, perhaps reflecting heightened non-specific vigilance or effort when dealing with cognitive challenges. This speaks against an inability to down-regulate task-independent thought processes as a primary mechanism underlying cognitive impairment in schizophrenia.
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Affiliation(s)
- Britta Hahn
- University of Maryland School of Medicine, Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore, MD 21228, USA.
| | - Alexander N Harvey
- University of Maryland School of Medicine, Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore, MD 21228, USA.
| | - James M Gold
- University of Maryland School of Medicine, Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore, MD 21228, USA.
| | - Thomas J Ross
- National Institute on Drug Abuse - Intramural Research Program, Neuroimaging Research Branch, 251 Bayview Blvd, Suite 200, Baltimore, MD 21224, USA.
| | - Elliot A Stein
- National Institute on Drug Abuse - Intramural Research Program, Neuroimaging Research Branch, 251 Bayview Blvd, Suite 200, Baltimore, MD 21224, USA.
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Hahn B, Harvey AN, Gold JM, Fischer BA, Keller WR, Ross TJ, Stein EA. Hyperdeactivation of the Default Mode Network in People With Schizophrenia When Focusing Attention in Space. Schizophr Bull 2016; 42:1158-66. [PMID: 26926831 PMCID: PMC4988736 DOI: 10.1093/schbul/sbw019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
When studying selective attention in people with schizophrenia (PSZ), a counterintuitive but replicated finding has been that PSZ display larger performance benefits than healthy control subjects (HCS) by cues that predicts the location of a target stimulus relative to non-predictive cues. Possible explanations are that PSZ hyperfocus attention in response to predictive cues, or that an inability to maintain a broad attentional window impairs performance when the cue is non-predictive. Over-recruitment of regions involved in top-down focusing of spatial attention in response to predictive cues would support the former possibility, and an inappropriate recruitment of these regions in response to non-predictive cues the latter. We probed regions of the dorsal attention network while PSZ (N = 20) and HCS (N = 20) performed a visuospatial attention task. A central cue either predicted at which of 4 peripheral locations a target signal would appear, or it gave no information about the target location. As observed previously, PSZ displayed a larger reaction time difference between predictive and non-predictive cue trials than HCS. Activity in frontoparietal and occipital regions was greater for predictive than non-predictive cues. This effect was almost identical between PSZ and HCS. There was no sign of over-recruitment when the cue was predictive, or of inappropriate recruitment when the cue was non-predictive. However, PSZ differed from HCS in their cue-dependent deactivation of the default mode network. Unexpectedly, PSZ displayed significantly greater deactivation than HCS in predictive cue trials, which may reflect a tendency to expend more processing resources when focusing attention in space.
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Affiliation(s)
- Britta Hahn
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD;
| | - Alexander N. Harvey
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - James M. Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Bernard A. Fischer
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - William R. Keller
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Thomas J. Ross
- Neuroimaging Research Branch, National Institute on Drug Abuse—Intramural Research Program, Baltimore, MD
| | - Elliot A. Stein
- Neuroimaging Research Branch, National Institute on Drug Abuse—Intramural Research Program, Baltimore, MD
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Haatveit B, Jensen J, Alnæs D, Kaufmann T, Brandt CL, Thoresen C, Andreassen OA, Melle I, Ueland T, Westlye LT. Reduced load-dependent default mode network deactivation across executive tasks in schizophrenia spectrum disorders. NEUROIMAGE-CLINICAL 2016; 12:389-96. [PMID: 27622135 PMCID: PMC5009228 DOI: 10.1016/j.nicl.2016.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 01/05/2023]
Abstract
Background Schizophrenia is associated with cognitive impairment and brain network dysconnectivity. Recent efforts have explored brain circuits underlying cognitive dysfunction in schizophrenia and documented altered activation of large-scale brain networks, including the task-positive network (TPN) and the task-negative default mode network (DMN) in response to cognitive demands. However, to what extent TPN and DMN dysfunction reflect overlapping mechanisms and are dependent on cognitive state remain to be determined. Methods In the current study, we investigated the recruitment of TPN and DMN using independent component analysis in patients with schizophrenia spectrum disorders (n = 29) and healthy controls (n = 21) during two different executive tasks probing planning/problem-solving and spatial working memory. Results We found reduced load-dependent DMN deactivation across tasks in patients compared to controls. Furthermore, we observed only moderate associations between the TPN and DMN activation across groups, implying that the two networks reflect partly independent mechanisms. Additionally, whereas TPN activation was associated with task performance in both tasks, no such associations were found for DMN. Conclusion These results support a general load-dependent DMN dysfunction in schizophrenia spectrum disorder across two demanding executive tasks that is not merely an epiphenomenon of cognitive dysfunction. SZ patients have reduced load-dependent DMN deactivation compared to controls. TPN activation is associated with task performance, whereas DMN deactivation is not. There are only moderate associations between the TPN and DMN activation.
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Affiliation(s)
- Beathe Haatveit
- Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway
| | - Jimmy Jensen
- Centre for Psychology, Kristianstad University, Elmetorpsvägen 15, 291 39 Kristianstad, Sweden
| | - Dag Alnæs
- Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway
| | - Tobias Kaufmann
- Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway
| | - Christine L Brandt
- Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway
| | - Christian Thoresen
- Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway
| | - Torill Ueland
- Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway; Department of Psychology, University of Oslo, P.O. Box 1094, Blindern, 0317 Oslo, Norway
| | - Lars T Westlye
- Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway; Department of Psychology, University of Oslo, P.O. Box 1094, Blindern, 0317 Oslo, Norway
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Phenomenology and neurobiology of self disorder in schizophrenia: Secondary factors. Schizophr Res 2015; 169:474-482. [PMID: 26603059 DOI: 10.1016/j.schres.2015.09.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 01/23/2023]
Abstract
Schizophrenia is a diverse and varying syndrome that defies most attempts at classification and pathogenetic explanation. This is the second of two articles offering a comprehensive model meant to integrate an understanding of schizophrenia-related forms of subjectivity, especially anomalous core-self experience (disturbed ipseity), with neurocognitive and neurodevelopmental findings. Previously we discussed the primary or foundational role of disturbed intermodal perceptional integration ("perceptual dys-integration"). Here we discuss phenomenological alterations that can be considered secondary in a pathogenetic sense--whether as consequential products downstream from a more originary disruption, or as defensive reactions involving quasi-intentional or even volitional compensations to the more primary disruptions. These include secondary forms of: 1, hyperreflexivity, 2, diminished self-presence (self-affection), and 3. disturbed "rip" or "hold" on the cognitive/perceptual field of awareness. We consider complementary relations between these secondary abnormal experiences while also considering their temporal relationships and pathogenetic intertwining with the more primary phenomenological alterations discussed previously, all in relation to the neurodevelopmental model. The secondary phenomena can be understood as highly variable factors involving overall orientations or attitudes toward experience; they have some affinities with experiences of meditation, introspectionism, and depersonalization defense. Also, they seem likely to become more pronounced during adolescence as a result of new cognitive capacities related to development of the prefrontal lobes, especially attention allocation, executive functions, abstraction, and meta-awareness. Heterogeneity in these secondary alterations might help explain much of the clinical diversity in schizophrenia, both between patients and within individual patients over time--without however losing sight of key underlying commonalities.
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17
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Hanlon FM, Shaff NA, Dodd AB, Ling JM, Bustillo JR, Abbott CC, Stromberg SF, Abrams S, Lin DS, Mayer AR. Hemodynamic response function abnormalities in schizophrenia during a multisensory detection task. Hum Brain Mapp 2015; 37:745-55. [PMID: 26598791 DOI: 10.1002/hbm.23063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/20/2015] [Accepted: 11/12/2015] [Indexed: 11/07/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) of the blood oxygen level dependent (BOLD) response has commonly been used to investigate the neuropathology underlying cognitive and sensory deficits in patients with schizophrenia (SP) by examining the positive phase of the BOLD response, assuming a fixed shape for the hemodynamic response function (HRF). However, the individual phases (positive and post-stimulus undershoot (PSU)) of the HRF may be differentially affected by a variety of underlying pathologies. The current experiment used a multisensory detection task with a rapid event-related fMRI paradigm to investigate both the positive and PSU phases of the HRF in SP and healthy controls (HC). Behavioral results indicated no significant group differences during task performance. Analyses that examined the shape of the HRF indicated two distinct group differences. First, SP exhibited a reduced and/or prolonged PSU following normal task-related positive BOLD activation in secondary auditory and visual sensory areas relative to HC. Second, SP did not show task-induced deactivation in the anterior node of the default-mode network (aDMN) relative to HC. In contrast, when performing traditional analyses that focus on the positive phase, there were no group differences. Interestingly, the magnitude of the PSU in secondary auditory and visual areas was positively associated with the magnitude of task-induced deactivation within the aDMN, suggesting a possible common neural mechanism underlying both of these abnormalities (failure in neural inhibition). Results are consistent with recent views that separate neural processes underlie the two phases of the HRF and that they are differentially affected in SP. Hum Brain Mapp 37:745-755, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Faith M Hanlon
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | - Nicholas A Shaff
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | - Josef M Ling
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | - Juan R Bustillo
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico.,Department of Neuroscience, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Christopher C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Shannon F Stromberg
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Swala Abrams
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Denise S Lin
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico.,Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico.,Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico.,Department of Psychology, University of New Mexico, Albuquerque, New Mexico
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Task-independent effects are potential confounders in longitudinal imaging studies of learning in schizophrenia. NEUROIMAGE-CLINICAL 2015; 10:159-71. [PMID: 26759790 PMCID: PMC4683460 DOI: 10.1016/j.nicl.2015.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 11/05/2015] [Accepted: 11/22/2015] [Indexed: 11/21/2022]
Abstract
Learning impairment is a core deficit in schizophrenia that impacts on real-world functioning and yet, elucidating its underlying neural basis remains a challenge. A key issue when interpreting learning-task experiments is that task-independent changes may confound interpretation of task-related signal changes in neuroimaging studies. The nature of these task-independent changes in schizophrenia is unknown. Therefore, we examined task-independent “time effects” in a group of participants with schizophrenia contrasted with healthy participants in a longitudinal fMRI learning-experiment designed to allow for examination of non-specific effects of time. Flanking the learning portions of the experiment with a task-of-no-interest allowed us to extract task-independent BOLD changes. Task-independent effects occurred in both groups, but were more robust in the schizophrenia group. There was a significant interaction effect between group and time in a distributed activity pattern that included inferior and superior temporal regions, frontal areas (left anterior insula and superior medial gyri), and parietal areas (posterior cingulate cortices and precuneus). This pattern showed task-independent linear decrease in BOLD amplitude over the two scanning sessions for the schizophrenia group, but showed either opposite effect or no activity changes for the control group. There was a trend towards a correlation between task-independent effects and the presence of more negative symptoms in the schizophrenia group. The strong interaction between group and time suggests that both the scanning experience as a whole and the transition between task-types evokes a different response in persons with schizophrenia and may confound interpretation of learning-related longitudinal imaging experiments if not explicitly considered. A robust method was used to identify task-independent fMRI BOLD changes in a multiday learning experiment in schizophrenia Task-independent effects were apparent in healthy control group and schizophrenia but differed in direction and magnitude In schizophrenia they were greater in magnitude and most prominent in areas of the salience and default mode networks Unless properly accounted for, these effects will compromise precise interpretation of fMRI learning data in schizophrenia.
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Greenwood PM, Espeseth T, Lin MK, Reinvang I, Parasuraman R. Longitudinal change in working memory as a function of APOE genotype in midlife and old age. Scand J Psychol 2015; 55:268-77. [PMID: 24853824 DOI: 10.1111/sjop.12123] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 02/17/2014] [Indexed: 01/17/2023]
Abstract
Previous investigations into whether the APOE-ε4 allele exerts cognitive effects at midlife have been inconclusive. We have advanced a "cognitive phenotype" hypothesis arguing that the ε4 allele of the apolipoprotein E gene (APOE) is associated with lower efficiency of neuronal plasticity thereby resulting in poorer cognitive performance independently of the pathology of Alzheimer's disease (Greenwood et al., ). This hypothesis is best tested at midlife, prior to the neuron loss associated with AD diagnosis. This hypothesis predicts that the ε4 allele would alter cognition regardless of age through plasticity mechanisms, but would not induce longitudinal decline in midlife. The alternative "prodrome" hypothesis predicts that the APOE-ε4 allele would be associated with longitudinal cognitive decline as early as midlife due to prodromal effects of AD. We tested these hypotheses with a working memory task in a large cross-sectional sample of cognitively screened APOE-ε4 carriers and non-carriers and also in a small longitudinal sample over 3 years. The sample was divided into middle-aged (mean age 50, range 40-59) and older (mean age 69, range 60-84) individuals. Cross-sectionally, we observed that older, but not middle-aged, APOE-ε4 carriers had lower accuracy than ε4 non-carriers, mainly under the hardest discrimination condition. Longitudinally, we observed increases in accuracy in middle-aged APOE-ε4 carriers, suggesting a cognitive phenotype that includes ability to benefit from experience. We observed a longitudinal decrease in older APOE-ε4 carriers, suggesting an AD prodrome.
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Brandt CL, Doan NT, Tønnesen S, Agartz I, Hugdahl K, Melle I, Andreassen OA, Westlye LT. Assessing brain structural associations with working-memory related brain patterns in schizophrenia and healthy controls using linked independent component analysis. Neuroimage Clin 2015; 9:253-63. [PMID: 26509112 PMCID: PMC4576364 DOI: 10.1016/j.nicl.2015.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/17/2015] [Accepted: 08/17/2015] [Indexed: 01/01/2023]
Abstract
Schizophrenia (SZ) is a psychotic disorder with significant cognitive dysfunction. Abnormal brain activation during cognitive processing has been reported, both in task-positive and task-negative networks. Further, structural cortical and subcortical brain abnormalities have been documented, but little is known about how task-related brain activation is associated with brain anatomy in SZ compared to healthy controls (HC). Utilizing linked independent component analysis (LICA), a data-driven multimodal analysis approach, we investigated structure-function associations in a large sample of SZ (n = 96) and HC (n = 142). We tested for associations between task-positive (fronto-parietal) and task-negative (default-mode) brain networks derived from fMRI activation during an n-back working memory task, and brain structural measures of surface area, cortical thickness, and gray matter volume, and to what extent these associations differed in SZ compared to HC. A significant association (p < .05, corrected for multiple comparisons) was found between a component reflecting the task-positive fronto-parietal network and another component reflecting cortical thickness in fronto-temporal brain regions in SZ, indicating increased activation with increased thickness. Other structure-function associations across, between and within groups were generally moderate and significant at a nominal p-level only, with more numerous and stronger associations in SZ compared to HC. These results indicate a complex pattern of moderate associations between brain activation during cognitive processing and brain morphometry, and extend previous findings of fronto-temporal brain abnormalities in SZ by suggesting a coupling between cortical thickness of these brain regions and working memory-related brain activation.
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Affiliation(s)
- Christine Lycke Brandt
- Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nhat Trung Doan
- Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Siren Tønnesen
- Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway ; Department of Psychiatric Research, Diakonhjemmet Hospital, Diakonhjemmet, Norway ; Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
| | - Kenneth Hugdahl
- Norwegian Centre for Mental Disorders Research, Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway ; Division of Psychiatry, Haukeland University Hospital, Haukeland, Norway ; Department of Radiology, Haukeland University Hospital, Haukeland, Norway ; KG Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars T Westlye
- Norwegian Centre for Mental Disorders Research, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway ; Department of Psychology, University of Oslo, Oslo, Norway
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Hugdahl K, Raichle ME, Mitra A, Specht K. On the existence of a generalized non-specific task-dependent network. Front Hum Neurosci 2015; 9:430. [PMID: 26300757 PMCID: PMC4526816 DOI: 10.3389/fnhum.2015.00430] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/13/2015] [Indexed: 02/03/2023] Open
Abstract
In this paper we suggest the existence of a generalized task-related cortical network that is up-regulated whenever the task to be performed requires the allocation of generalized non-specific cognitive resources, independent of the specifics of the task to be performed. We have labeled this general purpose network, the extrinsic mode network (EMN) as complementary to the default mode network (DMN), such that the EMN is down-regulated during periods of task-absence, when the DMN is up-regulated, and vice versa. We conceptualize the EMN as a cortical network for extrinsic neuronal activity, similar to the DMN as being a cortical network for intrinsic neuronal activity. The EMN has essentially a fronto-temporo-parietal spatial distribution, including the inferior and middle frontal gyri, inferior parietal lobule, supplementary motor area, inferior temporal gyrus. We hypothesize that this network is always active regardless of the cognitive task being performed. We further suggest that failure of network up- and down-regulation dynamics may provide neuronal underpinnings for cognitive impairments seen in many mental disorders, such as, e.g., schizophrenia. We start by describing a common observation in functional imaging, the close overlap in fronto-parietal activations in healthy individuals to tasks that denote very different cognitive processes. We now suggest that this is because the brain utilizes the EMN network as a generalized response to tasks that exceeds a cognitive demand threshold and/or requires the processing of novel information. We further discuss how the EMN is related to the DMN, and how a network for extrinsic activity is related to a network for intrinsic activity. Finally, we discuss whether the EMN and DMN networks interact in a common single brain system, rather than being two separate and independent brain systems.
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Affiliation(s)
- Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of Bergen Bergen, Norway ; Division of Psychiatry, Haukeland University Hospital, Bergen Norway ; Department of Radiology, Haukeland University Hospital, Bergen Norway ; NORMENT Center of Excellence, University of Bergen Bergen, Norway
| | - Marcus E Raichle
- Department of Radiology, Washington University School of Medicine, St. Louis, MI USA
| | - Anish Mitra
- Department of Radiology, Washington University School of Medicine, St. Louis, MI USA
| | - Karsten Specht
- Department of Biological and Medical Psychology, University of Bergen Bergen, Norway ; Department of Clinical Engineering, Haukeland University Hospital, Bergen Norway
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Jukuri T, Kiviniemi V, Nikkinen J, Miettunen J, Mäki P, Mukkala S, Koivukangas J, Nordström T, Parkkisenniemi J, Moilanen I, Barnett JH, Jones PB, Murray GK, Veijola J. Central executive network in young people with familial risk for psychosis--the Oulu Brain and Mind Study. Schizophr Res 2015; 161:177-83. [PMID: 25468181 DOI: 10.1016/j.schres.2014.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The central executive network controls and manages high-level cognitive functions. Abnormal activation in the central executive network has been related to psychosis and schizophrenia but it is not established how this applies to people with familial risk for psychosis (FR). METHODS We conducted a resting-state functional MRI (R-fMRI) in 72 (29 males) young adults with a history of psychosis in one or both parents (FR) but without psychosis themselves, and 72 (29 males) similarly healthy control subjects without parental psychosis. Both groups in the Oulu Brain and Mind Study were drawn from the Northern Finland Birth Cohort 1986. Participants were 20-25years old. Parental psychosis was established using the Care Register for Health Care. R-fMRI data pre-processing was conducted using independent component analysis with 30 and 70 components. A dual regression technique was used to detect between-group differences in the central executive network with p<0.05 threshold corrected for multiple comparisons. RESULTS FR participants demonstrated statistically significantly lower activity compared to control subjects in the right inferior frontal gyrus, a key area of central executive network corresponding to Brodmann areas 44 and 45, known as Broca's area. The volume of the lower activation area with 30 components was 896mm(3) and with 70 components was 1151mm(3). CONCLUSION The activity of the central executive network differed in the right inferior frontal gyrus between FR and control groups. This suggests that abnormality of the right inferior frontal gyrus may be a central part of vulnerability for psychosis.
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Affiliation(s)
- Tuomas Jukuri
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Finland; Thule Doctoral Programme, University of Oulu, Finland.
| | - Vesa Kiviniemi
- Department of Diagnostic Radiology, Oulu University Hospital, Finland
| | - Juha Nikkinen
- Department of Oncology and Radiotherapy, Oulu University Hospital, Finland
| | - Jouko Miettunen
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Finland; Institute of Health Sciences, University of Oulu, Finland
| | - Pirjo Mäki
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Finland; Department of Psychiatry, Länsi-Pohja Healthcare District, Finland; Department of Psychiatry, the Middle Ostrobothnia Central Hospital, Kiuru, Finland; Mental Health Services, Joint Municipal Authority of Wellbeing in Raahe District, Finland; Mental Health Services, Basic Health Care District of Kallio, Finland; Visala Hospital, the Northern Ostrobothnia Hospital District, Finland
| | - Sari Mukkala
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Finland
| | - Jenni Koivukangas
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Finland; Thule Doctoral Programme, University of Oulu, Finland
| | - Tanja Nordström
- Thule Doctoral Programme, University of Oulu, Finland; Institute of Health Sciences, University of Oulu, Finland
| | - Juha Parkkisenniemi
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Finland
| | - Irma Moilanen
- Thule Doctoral Programme, University of Oulu, Finland; Clinic of Child Psychiatry, University of Oulu and Oulu University Hospital, Finland
| | - Jennifer H Barnett
- Department of Psychiatry, University of Cambridge, Cambridgeshire, UK; Cambridge Cognition, Cambridge, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridgeshire, UK
| | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridgeshire, UK
| | - Juha Veijola
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Finland; Thule Doctoral Programme, University of Oulu, Finland
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Hugdahl K, Craven AR, Nygård M, Løberg EM, Berle JØ, Johnsen E, Kroken R, Specht K, Andreassen OA, Ersland L. Glutamate as a mediating transmitter for auditory hallucinations in schizophrenia: a (1)H MRS study. Schizophr Res 2015; 161:252-60. [PMID: 25542859 DOI: 10.1016/j.schres.2014.11.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/07/2014] [Accepted: 11/15/2014] [Indexed: 01/16/2023]
Abstract
This is a (1)H MR spectroscopy (MRS) study of glutamate (Glu), measured as Glx, levels in temporal and frontal lobe regions in patients with schizophrenia compared with a healthy control group with the objective of revealing aspects of the underlying neurochemistry of auditory hallucinations. We further compared and correlated Glu(Glx) levels for the patients-only against frequency and severity of auditory hallucinations and the sum of Positive symptoms, and also for frequency and severity of emotional withdrawal, and sum of Negative symptoms. The sample included 23 patients with an ICD-10 and DSM-IV diagnosis of schizophrenia, and 26 healthy control subjects without any known psychiatric or neurological disorders. Symptom scores were obtained from the Positive and Negative Syndrome Scale (PANSS). (1)H MRS data were acquired on a 3T MR scanner from two temporal and two frontal voxels, using standard sequences and analysis parameters. The results showed that schizophrenia patients as a group had reduced Glu(Glx) levels in the voxels of interest compared to the healthy control subjects, while increased levels were found for patients with frequent and severe auditory hallucinations, relative to patients with less frequent and severe hallucination. We further found significant positive correlations between frequency and severity of auditory hallucinations, and for sum Positive symptoms, and Glu(Glx) levels in all regions, not seen when the analysis was done for negative symptoms. It is concluded that the results show for the first time that glutamate may be a mediating factor in auditory hallucinations in schizophrenia.
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Affiliation(s)
- Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Radiology, Haukeland University Hospital, Bergen, Norway; NORMENT Center of Excellence, University of Oslo and Oslo University Hospital, Norway.
| | - Alexander R Craven
- Department of Biological and Medical Psychology, University of Bergen, Norway
| | - Merethe Nygård
- Department of Biological and Medical Psychology, University of Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Norway
| | - Jan Øystein Berle
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Section of Psychiatry, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rune Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Karsten Specht
- Department of Biological and Medical Psychology, University of Bergen, Norway; Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Ole A Andreassen
- Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Norway; NORMENT Center of Excellence, University of Oslo and Oslo University Hospital, Norway
| | - Lars Ersland
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
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Løberg EM, Helle S, Nygård M, Berle JØ, Kroken RA, Johnsen E. The Cannabis Pathway to Non-Affective Psychosis may Reflect Less Neurobiological Vulnerability. Front Psychiatry 2014; 5:159. [PMID: 25477825 PMCID: PMC4235385 DOI: 10.3389/fpsyt.2014.00159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/24/2014] [Indexed: 12/19/2022] Open
Abstract
There is a high prevalence of cannabis use reported in non-affective psychosis. Early prospective longitudinal studies conclude that cannabis use is a risk factor for psychosis, and neurochemical studies on cannabis have suggested potential mechanisms for this effect. Recent advances in the field of neuroscience and genetics may have important implications for our understanding of this relationship. Importantly, we need to better understand the vulnerability × cannabis interaction to shed light on the mediators of cannabis as a risk factor for psychosis. Thus, the present study reviews recent literature on several variables relevant for understanding the relationship between cannabis and psychosis, including age of onset, cognition, brain functioning, family history, genetics, and neurological soft signs (NSS) in non-affective psychosis. Compared with non-using non-affective psychosis, the present review shows that there seem to be fewer stable cognitive deficits in patients with cannabis use and psychosis, in addition to fewer NSS and possibly more normalized brain functioning, indicating less neurobiological vulnerability for psychosis. There are, however, some familiar and genetic vulnerabilities present in the cannabis psychosis group, which may influence the cannabis pathway to psychosis by increasing sensitivity to cannabis. Furthermore, an earlier age of onset suggests a different pathway to psychosis in the cannabis-using patients. Two alternative vulnerability models are presented to integrate these seemingly paradoxical findings.
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Affiliation(s)
- Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Siri Helle
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Merethe Nygård
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Jan Øystein Berle
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rune A. Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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25
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Nekovarova T, Fajnerova I, Horacek J, Spaniel F. Bridging disparate symptoms of schizophrenia: a triple network dysfunction theory. Front Behav Neurosci 2014; 8:171. [PMID: 24910597 PMCID: PMC4038855 DOI: 10.3389/fnbeh.2014.00171] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 04/22/2014] [Indexed: 01/24/2023] Open
Abstract
Schizophrenia is a complex neuropsychiatric disorder with variable symptomatology, traditionally divided into positive and negative symptoms, and cognitive deficits. However, the etiology of this disorder has yet to be fully understood. Recent findings suggest that alteration of the basic sense of self-awareness may be an essential distortion of schizophrenia spectrum disorders. In addition, extensive research of social and mentalizing abilities has stressed the role of distortion of social skills in schizophrenia.This article aims to propose and support a concept of a triple brain network model of the dysfunctional switching between default mode and central executive network (CEN) related to the aberrant activity of the salience network. This model could represent a unitary mechanism of a wide array of symptom domains present in schizophrenia including the deficit of self (self-awareness and self-representation) and theory of mind (ToM) dysfunctions along with the traditional positive, negative and cognitive domains. We review previous studies which document the dysfunctions of self and ToM in schizophrenia together with neuroimaging data that support the triple brain network model as a common neuronal substrate of this dysfunction.
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Affiliation(s)
- Tereza Nekovarova
- Department of Neurophysiology of Memory, Institute of Physiology, Academy of Sciences of the Czech Republic Prague, Czech Republic ; Ecology and Ethology Research Group, Department of Zoology, Faculty of Science, Charles University in Prague Prague, Czech Republic
| | - Iveta Fajnerova
- Department of Neurophysiology of Memory, Institute of Physiology, Academy of Sciences of the Czech Republic Prague, Czech Republic ; Prague Psychiatric Center Prague, Czech Republic
| | - Jiri Horacek
- Prague Psychiatric Center Prague, Czech Republic
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26
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Xu J, Calhoun VD, Pearlson GD, Potenza MN. Opposite modulation of brain functional networks implicated at low vs. high demand of attention and working memory. PLoS One 2014; 9:e87078. [PMID: 24498021 PMCID: PMC3909055 DOI: 10.1371/journal.pone.0087078] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/16/2013] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Functional magnetic resonance imaging (fMRI) studies indicate that the brain organizes its activity into multiple functional networks (FNs) during either resting condition or task-performance. However, the functions of these FNs are not fully understood yet. METHODOLOGY/PRINCIPAL FINDINGS To investigate the operation of these FNs, spatial independent component analysis (sICA) was used to extract FNs from fMRI data acquired from healthy participants performing a visual task with two levels of attention and working memory load. The task-related modulations of extracted FNs were assessed. A group of FNs showed increased activity at low-load conditions and reduced activity at high-load conditions. These FNs together involve the left lateral frontoparietal cortex, insula, and ventromedial prefrontal cortex. A second group of FNs showed increased activity at high-load conditions and reduced activity at low-load conditions. These FNs together involve the intraparietal sulcus, frontal eye field, lateral frontoparietal cortex, insula, and dorsal anterior cingulate, bilaterally. Though the two groups of FNs showed opposite task-related modulations, they overlapped extensively at both the lateral and medial frontoparietal cortex and insula. Such an overlap of FNs would not likely be revealed using standard general-linear-model-based analyses. CONCLUSIONS By assessing task-related modulations, this study differentiated the functional roles of overlapping FNs. Several FNs including the left frontoparietal network are implicated in task conditions of low attentional load, while another set of FNs including the dorsal attentional network is implicated in task conditions involving high attentional demands.
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Affiliation(s)
- Jiansong Xu
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States
- * E-mail:
| | - Vince D. Calhoun
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States
- The Mind Research Network, Albuquerque, New Mexico, United States
- Department of ECE, The University of New Mexico, Albuquerque, New Mexico, United States
| | - Godfrey D. Pearlson
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Neurobiology, Yale University School of Medicine, New Haven, Connecticut, United States
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut, United States
| | - Marc N. Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Neurobiology, Yale University School of Medicine, New Haven, Connecticut, United States
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27
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Perrone-Bertolotti M, Rapin L, Lachaux JP, Baciu M, Lœvenbruck H. What is that little voice inside my head? Inner speech phenomenology, its role in cognitive performance, and its relation to self-monitoring. Behav Brain Res 2014; 261:220-39. [PMID: 24412278 DOI: 10.1016/j.bbr.2013.12.034] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 12/23/2013] [Accepted: 12/26/2013] [Indexed: 11/19/2022]
Abstract
The little voice inside our head, or inner speech, is a common everyday experience. It plays a central role in human consciousness at the interplay of language and thought. An impressive host of research works has been carried out on inner speech these last fifty years. Here we first describe the phenomenology of inner speech by examining five issues: common behavioural and cerebral correlates with overt speech, different types of inner speech (wilful verbal thought generation and verbal mind wandering), presence of inner speech in reading and in writing, inner signing and voice-hallucinations in deaf people. Secondly, we review the role of inner speech in cognitive performance (i.e., enhancement vs. perturbation). Finally, we consider agency in inner speech and how our inner voice is known to be self-generated and not produced by someone else.
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Affiliation(s)
- M Perrone-Bertolotti
- University Grenoble Alpes, LPNC, F-38040 Grenoble, France; CNRS, LPNC, UMR 5105, F-38040 Grenoble, France; INSERM U1028-CNRS UMR5292, Brain Dynamics and Cognition Team, Lyon Neuroscience Research Center, F-69500 Lyon-Bron, France; University Claude Bernard, Lyon 1, F-69000 Lyon, France; INSERM, U836, Grenoble Institut des Neurosciences, 38700 La Tronche, France.
| | - L Rapin
- Laboratoire de phonétique, Département de Linguistique, Université du Québec à Montréal, Canada
| | - J P Lachaux
- INSERM U1028-CNRS UMR5292, Brain Dynamics and Cognition Team, Lyon Neuroscience Research Center, F-69500 Lyon-Bron, France; University Claude Bernard, Lyon 1, F-69000 Lyon, France
| | - M Baciu
- University Grenoble Alpes, LPNC, F-38040 Grenoble, France; CNRS, LPNC, UMR 5105, F-38040 Grenoble, France
| | - H Lœvenbruck
- University Grenoble Alpes, LPNC, F-38040 Grenoble, France; CNRS, LPNC, UMR 5105, F-38040 Grenoble, France; GIPSA-lab, Département Parole et Cognition, UMR CNRS 5216, Université de Grenoble, Grenoble, France
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28
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Palaniyappan L, Simmonite M, White TP, Liddle EB, Liddle PF. Neural primacy of the salience processing system in schizophrenia. Neuron 2013; 79:814-28. [PMID: 23972602 PMCID: PMC3752973 DOI: 10.1016/j.neuron.2013.06.027] [Citation(s) in RCA: 230] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2013] [Indexed: 01/03/2023]
Abstract
For effective information processing, two large-scale distributed neural networks appear to be critical: a multimodal executive system anchored on the dorsolateral prefrontal cortex (DLPFC) and a salience system anchored on the anterior insula. Aberrant interaction among distributed networks is a feature of psychiatric disorders such as schizophrenia. We used whole-brain Granger causal modeling using resting fMRI and observed a significant failure of both the feedforward and reciprocal influence between the insula and the DLPFC in schizophrenia. Further, a significant failure of directed influence from bilateral visual cortices to the insula was also seen in patients. These findings provide compelling evidence for a breakdown of the salience-execution loop in the clinical expression of psychosis. In addition, this offers a parsimonious explanation for the often-observed “frontal inefficiency,” the failure to recruit prefrontal system when salient or novel information becomes available in patients with schizophrenia. A salience-executive loop emerges on fMRI whole-brain Granger causal analysis At rest, DLPFC has inhibitory Granger influence on the salience network In schizophrenia, the salience-executive interaction is diminished Visual cortex fails to influence the salience network in schizophrenia
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Affiliation(s)
- Lena Palaniyappan
- Centre for Translational Neuroimaging in Mental Health, Division of Psychiatry, University of Nottingham, Nottingham NG7 2TU, UK.
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Nygård M, Løberg EM, Craven AR, Ersland L, Berle JØ, Kroken RA, Johnsen E, Hugdahl K. Dichotic listening, executive functions and grey matter cortical volume in patients with schizophrenia and healthy controls. Scand J Psychol 2013; 54:443-50. [PMID: 24117463 DOI: 10.1111/sjop.12080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 08/01/2013] [Indexed: 12/19/2022]
Abstract
Schizophrenia is characterized by cognitive impairment, especially in relation to executive functions. Brain structural abnormalities are also often seen in schizophrenia although little is known of the relationship between cognitive impairment and structural brain changes. Our aim was therefore to investigate this relationship further using MRI and a dichotic listening (DL) task with simple speech sounds and with instructions to focus attention and report only from the left or right ear stimulus. When instructed to focus attention on the left ear syllable a cognitive conflict is induced requiring the allocation of executive resources to be resolved. Grey matter (GM) volume was measured with MRI from four volumes of interests (VOIs), left and right frontal and temporal cortex, respectively, and correlated with DL performance. The results showed significant differences between the groups in their ability to focus attention on and report the left ear stimulus, which was accompanied by reduced GM volume in the left frontal and right temporal lobe VOIs. There was also a significant positive correlation between left frontal GM volume and performance on the DL task, for the groups combined. The results did not support a conclusion that an impairment in cognitive function in schizophrenia was driven by an corresponding impairment in brain structure, since there were no significant correlations when the groups were analyzed separately. It is however concluded that patients with schizophrenia are impaired in executive functions and that they also show reduced GM volumes in left frontal and right temporal lobe areas, compared to healthy controls.
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Affiliation(s)
- Merethe Nygård
- Department of Biological and Medical Psychology, University of Bergen, Norway
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Moran LV, Tagamets MA, Sampath H, O’Donnell A, Stein EA, Kochunov P, Hong LE. Disruption of anterior insula modulation of large-scale brain networks in schizophrenia. Biol Psychiatry 2013; 74:467-74. [PMID: 23623456 PMCID: PMC3735654 DOI: 10.1016/j.biopsych.2013.02.029] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/27/2013] [Accepted: 02/28/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Systems level modeling of functional magnetic resonance imaging data has demonstrated dysfunction of several large-scale brain networks in schizophrenia. Anomalies across multiple functional networks associated with schizophrenia could be due to diffuse pathology across multiple networks or, alternatively, dysfunction at converging control(s) common to these networks. The right anterior insula has been shown to modulate activity in the central executive and default mode networks in healthy individuals. We tested the hypothesis that right anterior insula modulation of central executive and default mode networks is disrupted in schizophrenia and associated with cognitive deficits. METHODS In 44 patients with schizophrenia and 44 healthy control subjects, we used seed-based resting state functional connectivity functional magnetic resonance imaging analysis to examine connectivity between right insular subregions and central executive/default mode network regions. We also performed two directed connectivity analyses of resting state data: Granger analysis and confirmatory structural equation modeling. Between-group differences in path coefficients were used to evaluate anterior insula modulation of central executive and default mode networks. Cognitive performance was assessed with the rapid visual information processing task, a test of sustained attention. RESULTS With multiple connectivity techniques, we found compelling, corroborative evidence of disruption of right anterior insula modulation of central executive and default mode networks in patients with schizophrenia. The strength of right anterior insula modulation of these networks predicted cognitive performance. CONCLUSIONS Individuals with schizophrenia have impaired right anterior insula modulation of large-scale brain networks. The right anterior insula might be an emergent pathophysiological gateway in schizophrenia.
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Affiliation(s)
- Lauren V. Moran
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21228
,Correspondence to, Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore, MD 21228. Tel: 410 402 6827. Fax: 410 402 6023.
| | - Malle A. Tagamets
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21228
| | - Hemalatha Sampath
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21228
| | - Alan O’Donnell
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21228
| | - Elliot A. Stein
- Neuroimaging Research Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health, Baltimore, Maryland
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21228
| | - L. Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21228
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Johnsen E, Hugdahl K, Fusar-Poli P, Kroken RA, Kompus K. Neuropsychopharmacology of auditory hallucinations: insights from pharmacological functional MRI and perspectives for future research. Expert Rev Neurother 2013; 13:23-36. [PMID: 23253389 DOI: 10.1586/ern.12.147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Experiencing auditory verbal hallucinations is a prominent symptom in schizophrenia that also occurs in subjects at enhanced risk for psychosis and in the general population. Drug treatment of auditory hallucinations is challenging, because the current understanding is limited with respect to the neural mechanisms involved, as well as how CNS drugs, such as antipsychotics, influence the subjective experience and neurophysiology of hallucinations. In this article, the authors review studies of the effect of antipsychotic medication on brain activation as measured with functional MRI in patients with auditory verbal hallucinations. First, the authors examine the neural correlates of ongoing auditory hallucinations. Then, the authors critically discuss studies addressing the antipsychotic effect on the neural correlates of complex cognitive tasks. Current evidence suggests that blood oxygen level-dependant effects of antipsychotic drugs reflect specific, regional effects but studies on the neuropharmacology of auditory hallucinations are scarce. Future directions for pharmacological neuroimaging of auditory hallucinations are discussed.
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Affiliation(s)
- Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
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Broderick G, Craddock TJA. Systems biology of complex symptom profiles: capturing interactivity across behavior, brain and immune regulation. Brain Behav Immun 2013; 29:1-8. [PMID: 23022717 PMCID: PMC3554865 DOI: 10.1016/j.bbi.2012.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 09/13/2012] [Accepted: 09/14/2012] [Indexed: 12/15/2022] Open
Abstract
As our thinking about the basic principles of biology and medicine continue to evolve, the importance of context and regulatory interaction is becoming increasingly obvious. Biochemical and physiological components do not exist in isolation but instead are part of a tightly integrated network of interacting elements that ensure robustness and support the emergence of complex behavior. This integration permeates all levels of biology from gene regulation, to immune cell signaling, to coordinated patterns of neuronal activity and the resulting psychosocial interaction. Systems biology is an emerging branch of science that sits as a translational catalyst at the interface of the life and computational sciences. While there is no universally accepted definition of systems biology, we attempt to provide an overview of some the basic unifying concepts and current efforts in the field as they apply to illnesses where brain and subsequent behavior are a chief component, for example autism, schizophrenia, depression, and others. Methods in this field currently constitute a broad mosaic that stretches across multiple scales of biology and physiological compartments. While this work by no means constitutes an exhaustive list of all these methods, this work highlights the principal sub-disciplines presently driving the field as well as future directions of progress.
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Affiliation(s)
- Gordon Broderick
- Department of Medicine, University of Alberta, Edmonton, Canada.
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Tunbridge EM, Farrell SM, Harrison PJ, Mackay CE. Catechol-O-methyltransferase (COMT) influences the connectivity of the prefrontal cortex at rest. Neuroimage 2012; 68:49-54. [PMID: 23228511 PMCID: PMC3566589 DOI: 10.1016/j.neuroimage.2012.11.059] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 11/21/2012] [Accepted: 11/30/2012] [Indexed: 11/26/2022] Open
Abstract
Catechol-O-methyltransferase (COMT) modulates dopamine in the prefrontal cortex (PFC) and influences PFC dopamine-dependent cognitive task performance. A human COMT polymorphism (Val158Met) alters enzyme activity and is associated with both the activation and functional connectivity of the PFC during task performance, particularly working memory. Here, we used functional magnetic resonance imaging and a data-driven, independent components analysis (ICA) approach to compare resting state functional connectivity within the executive control network (ECN) between young, male COMT Val158 (n = 27) and Met158 (n = 28) homozygotes. COMT genotype effects on grey matter were assessed using voxel-based morphometry. COMT genotype significantly modulated functional connectivity within the ECN, which included the head of the caudate, and anterior cingulate and frontal cortical regions. Val158 homozygotes showed greater functional connectivity between a cluster within the left ventrolateral PFC and the rest of the ECN (using a threshold of Z > 2.3 and a family-wise error cluster significance level of p < 0.05). This difference occurred in the absence of any alterations in grey matter. Our data show that COMT Val158Met affects the functional connectivity of the PFC at rest, complementing its prominent role in the activation and functional connectivity of this region during cognitive task performance. The results suggest that genotype-related differences in prefrontal dopaminergic tone result in neuroadaptive changes in basal functional connectivity, potentially including subtle COMT genotype-dependent differences in the relative coupling of task-positive and task-negative regions, which could in turn contribute to its effects on brain activation, connectivity, and behaviour.
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The role of default network deactivation in cognition and disease. Trends Cogn Sci 2012; 16:584-92. [PMID: 23142417 DOI: 10.1016/j.tics.2012.10.008] [Citation(s) in RCA: 653] [Impact Index Per Article: 54.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/16/2012] [Accepted: 10/16/2012] [Indexed: 12/17/2022]
Abstract
A considerable body of evidence has accumulated over recent years on the functions of the default-mode network (DMN)--a set of brain regions whose activity is high when the mind is not engaged in specific behavioral tasks and low during focused attention on the external environment. In this review, we focus on DMN suppression and its functional role in health and disease, summarizing evidence that spans several disciplines, including cognitive neuroscience, pharmacological neuroimaging, clinical neuroscience, and theoretical neuroscience. Collectively, this research highlights the functional relevance of DMN suppression for goal-directed cognition, possibly by reducing goal-irrelevant functions supported by the DMN (e.g., mind-wandering), and illustrates the functional significance of DMN suppression deficits in severe mental illness.
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Løberg EM, Nygård M, Berle JØ, Johnsen E, Kroken RA, Jørgensen HA, Hugdahl K. An fMRI Study of Neuronal Activation in Schizophrenia Patients with and without Previous Cannabis Use. Front Psychiatry 2012; 3:94. [PMID: 23115554 PMCID: PMC3483569 DOI: 10.3389/fpsyt.2012.00094] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 10/09/2012] [Indexed: 01/26/2023] Open
Abstract
Previous studies have mostly shown positive effects of cannabis use on cognition in patients with schizophrenia, which could reflect lower neurocognitive vulnerability. There are however no studies comparing whether such cognitive differences have neuronal correlates. Thus, the aim of the present study was to compare whether patients with previous cannabis use differ in brain activation from patients who has never used cannabis. The patients groups were compared on the ability to up-regulate an effort mode network during a cognitive task and down-regulate activation in the same network during a task-absent condition. Task-present and task-absent brain activation was measured by functional magnetic resonance neuroimaging (fMRI). Twenty-six patients with a DSM-IV and ICD-10 diagnosis of schizophrenia were grouped into a previous cannabis user group and a no-cannabis group. An auditory dichotic listening task with instructions of attention focus on either the right or left ear stimulus was used to tap verbal processing, attention, and cognitive control, calculated as an aggregate score. When comparing the two groups, there were remaining activations in the task-present condition for the cannabis group, not seen in the no-cannabis group, while there was remaining activation in the task-absent condition for the no-cannabis group, not seen in the cannabis group. Thus, the patients with previous cannabis use showed increased activation in an effort mode network and decreased activation in the default mode network as compared to the no-cannabis group. It is concluded that the present study show some differences in brain activation to a cognitively challenging task between previous cannabis and no-cannabis schizophrenia patients.
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Affiliation(s)
- Else-Marie Løberg
- Department of Biological and Medical Psychology, University of Bergen Bergen, Norway ; Division of Psychiatry, Haukeland University Hospital Bergen, Norway
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