Music Intervention Leads to Increased Insular Connectivity and Improved Clinical Symptoms in Schizophrenia

Therapeutic potential of gamma entrainment using sensory stimulation for cognitive symptoms associated with schizophrenia

Schizophrenia is a complex neuropsychiatric disorder with significant morbidity. Treatment options that address the spectrum of symptoms are limited, highlighting the need for innovative therapeutic approaches. Gamma Entrainment Using Sensory Stimulation (GENUS) is an emerging treatment for neuropsychiatric disorders that uses sensory stimulation to entrain impaired oscillatory network activity and restore brain function. Aberrant oscillatory activity often underlies the symptoms experienced by patients with schizophrenia. We propose that GENUS has therapeutic potential for schizophrenia. This paper reviews the current status of schizophrenia treatment and explores the use of sensory stimulation as an adjunctive treatment, specifically through gamma entrainment. Impaired gamma frequency entrainment is observed in patients, particularly in response to auditory and visual stimuli. Thus, sensory stimulation, such as music listening, may have therapeutic potential for individuals with schizophrenia. GENUS holds novel therapeutic potential to improve the lives of individuals with schizophrenia, but further research is required to determine the efficacy of GENUS, optimize its delivery and therapeutic window, and develop strategies for its implementation in specific patient populations.

Structural and functional brain alterations in subthreshold depression: A multimodal coordinate-based meta-analysis

Imaging studies of subthreshold depression (StD) have reported structural and functional abnormalities in a variety of spatially diverse brain regions. However, there is no consensus among different studies. In the present study, we applied a multimodal meta-analytic approach, the Activation Likelihood Estimation (ALE), to test the hypothesis that StD exhibits spatially convergent structural and functional brain abnormalities compared to healthy controls. A total of 31 articles with 25 experiments were included, collectively representing 1001 subjects with StD. We found consistent differences between StD and healthy controls mainly in the left insula across studies with various neuroimaging methods. Further exploratory analyses found structural atrophy and decreased functional activities in the right pallidum and thalamus in StD, and abnormal spontaneous activity converged to the middle frontal gyrus. Coordinate-based meta-analysis found spatially convergent structural and functional impairments in StD. These findings provide novel insights for understanding the neural underpinnings of subthreshold depression and enlighten the potential targets for its early screening and therapeutic interventions in the future.

Abnormal effective connectivity of reward network in first-episode schizophrenia with auditory verbal hallucinations

OBJECTIVE

Auditory verbal hallucinations (AVHs) in schizophrenia is proved to be associated with dysfunction of mesolimbic-cortical circuits, especially during abnormal salient and internal verbal resource monitoring processing procedures. However, the information flow among areas involved in coordinated interaction implicated the pathophysiology of AVHs remains unclear.

METHODS

We used spectral dynamic causal modeling (DCM) to quantify connections among eight critical hubs of reward network in 86 first-episode drug-naïve schizophrenia patients with AVHs (AVH), 93 patients without AVHs (NAVH), and 88 matched normal controls (NC) using resting-state functional magnetic resonance imaging. Group-level connection coefficients, between-group differences and correlation analysis between image measures and symptoms were performed.

RESULT

DCM revealed weaker effective connectivity (EC) from right ventral striatum (RVS) to ventral tegmental area (VTA) in AVH compared to NAVH. AVH showed stronger EC from left anterior insula (AI) to RVS, stronger EC from RVS to anterior cingulate cortex (ACC), and stronger EC from VTA to posterior cingulate cortex (PCC) compared to NC. The correlation analysis results were mostly visible in the negative correlation between EC from right AI to ACC and positive sub-score, P1 sub-score, and P3 sub-score of PNASS in group-level.

CONCLUSION

These findings suggest that neural causal interactions between the reward network associated with AVHs are disrupted, expanding the evidence for potential neurobiological mechanisms of AVHs. Particularly, dopamine-dependent salience attribution and top-down monitoring impairments and compensatory effects of enhanced excitatory afferents to ACC, which may provide evidence for a therapeutic target based on direct in vivo of AVHs in schizophrenia.

Can Music Therapy Help Adults with Schizophrenia Improve Their Cognitive Skills? A Scoping Review

Cognitive impairment associated with schizophrenia can lead to functional disability and poor quality of life. Established cognitive remediation programs have variable results for adults with schizophrenia, with some participants receiving little or no benefit. This scoping review investigates the efficacy of music therapy as cognitive remediation for adults with schizophrenia. Literature was identified using electronic databases, reference list searching and citation tracking. A total of 13 studies met the criteria for inclusion. Results demonstrated that music therapy improved attention, executive function, language, memory, and processing speed. However, more research is required to better understand and develop cognitively beneficial music therapy programs for adults with schizophrenia.

Treatment effects of adjunct group music therapy in inpatients with chronic schizophrenia: a systematic review

Introduction

Pharmacological treatment may be effective for treating positive symptoms of schizophrenia; no evidence of clinically significant effects on negative and cognitive symptoms, social and behavioral functioning. This review investigated treatment outcomes of multiple (at least four sessions in 4 weeks) group music therapy sessions adjunct to standard care in inpatients with chronic schizophrenia.

Methods

A systematic review search of five electronic medical and psychological databases conducted using keywords "music therapy" and "schizophrenia" up to December 2021. Screening was performed for published articles on any adjunct multiple group music therapy (four sessions in 4 weeks minimum) adjunct to "treatment as usual" for inpatients with "chronic" schizophrenia. All study outcomes were all included. Risk of bias of all studies was assessed.

Results

1160 articles were screened, and 13 randomized controlled trials (RCTs) with a total of 1,114 inpatients were included. Ten RCTs reported open group sessions with active structured music making (ASMM) combining passive music listening (PML) and/or active singing, playing instruments, and improvisations while three other studies applied PML only. Four studies reported significant outcomes for both positive and negative symptoms. Ten of the thirteen studies recorded significant improvements in negative symptoms, behavioral and social functioning. Lasting significant effects were found in a longitudinal RCT with 272 samples evaluated unguided pre-recorded PML as a coping method lasting up to six months and similar results found in another two longitudinal RCTs. Secondary outcomes measured cognition, mood, social interest and function, self-care ability, interpersonal relationships, and QoL all showed significant outcomes. The significance level for pre-post intervention and between-group measures ranged from p < 0.001 to p < 0.05. No negative effects were reported in any studies.

Conclusion

Evidence from this review suggests rehabilitation with adjunctive regular PML or combined ASMM in group settings may provide therapeutic engagement, contributing to improvements in social interest and participation. PML is low-cost and non-invasive therapy. Enhancing overall QoL as one type of psychosocial therapy. More rigorous longitudinal studies with larger sample sizes are needed to investigate whether regular long-term individual PML and active group music therapy have the same significant treatment effects as coping and rehabilitation strategies.

Compressed sensorimotor-to-transmodal hierarchical organization in schizophrenia

BACKGROUND

Schizophrenia has been primarily conceptualized as a disorder of high-order cognitive functions with deficits in executive brain regions. Yet due to the increasing reports of early sensory processing deficit, recent models focus more on the developmental effects of impaired sensory process on high-order functions. The present study examined whether this pathological interaction relates to an overarching system-level imbalance, specifically a disruption in macroscale hierarchy affecting integration and segregation of unimodal and transmodal networks.

METHODS

We applied a novel combination of connectome gradient and stepwise connectivity analysis to resting-state fMRI to characterize the sensorimotor-to-transmodal cortical hierarchy organization (96 patients v. 122 controls).

RESULTS

We demonstrated compression of the cortical hierarchy organization in schizophrenia, with a prominent compression from the sensorimotor region and a less prominent compression from the frontal-parietal region, resulting in a diminished separation between sensory and fronto-parietal cognitive systems. Further analyses suggested reduced differentiation related to atypical functional connectome transition from unimodal to transmodal brain areas. Specifically, we found hypo-connectivity within unimodal regions and hyper-connectivity between unimodal regions and fronto-parietal and ventral attention regions along the classical sensation-to-cognition continuum (voxel-level corrected, p < 0.05).

CONCLUSIONS

The compression of cortical hierarchy organization represents a novel and integrative system-level substrate underlying the pathological interaction of early sensory and cognitive function in schizophrenia. This abnormal cortical hierarchy organization suggests cascading impairments from the disruption of the somatosensory-motor system and inefficient integration of bottom-up sensory information with attentional demands and executive control processes partially account for high-level cognitive deficits characteristic of schizophrenia.

Altered Functional Connectivity and Complexity in Major Depressive Disorder after Musical Stimulation

Major depressive disorder (MDD) is a common mental illness. This study used electroencephalography (EEG) to explore the effects of music therapy on brain networks in MDD patients and to elucidate changes in functional brain connectivity in subjects before and after musical stimulation. EEG signals were collected from eight MDD patients and eight healthy controls. The phase locking value was adopted to calculate the EEG correlation of different channels in different frequency bands. Correlation matrices and network topologies were studied to analyze changes in functional connectivity between brain regions. The results of the experimental analysis found that the connectivity of the delta and beta bands decreased, while the connectivity of the alpha band increased. Regarding the characteristics of the EEG functional network, the average clustering coefficient, characteristic path length and degree of each node in the delta band decreased significantly after musical stimulation, while the characteristic path length in the beta band increased significantly. Characterized by the average clustering coefficient and characteristic path length, the classification of depression and healthy controls reached 93.75% using a support vector machine.

Music and neuro-cognitive deficits in depression

Background

Cognitive deficits are one of the core features of major depressive disorder (MDD) that play crucial role in functional recovery. Studies have explored cognitive deficits in MDD, however, given inconsistent results, especially in mild-moderate MDD. Recently, studies have explored music as cognitive ability in various clinical conditions. In MDD, large focus has been on evaluating emotion deficits and just a handful on music cognition. With growing evidence on use of music based intervention to target cognitive deficits, it is imperative to explore nature of music cognitive ability in MDD.

Aim

To examine musical and neuro-cognitive deficits in patients with mild-moderate MDD.

Methods

Patients diagnosed with mild or moderate MDD (n = 19) and matched healthy controls (HC) (n = 18) were evaluated on selected tests from NIMHANS Neuropsychological test battery and Montreal battery for evaluation of amusia (MBEA).

Results

MDD group performed significantly lower than HC on working memory (p = 0.007), verbal learning (p = 0.02) and retention (p = 0.03). Three indices were computed for a comprehensive evaluation. Groups did not differ significantly in any of the indices- focused attention, executive function, learning and memory as well as on music cognition. Focused attention and memory index predicted music cognition in HC and the combined group (MDD + HC) (p < 0.01). Attention alone contributed to 62.1% of variance in music cognition. Similarly, music cognition significantly predicted focused attention (p < 0.01).

Conclusion

Individuals with mild-moderate MDD show significant deficits in working memory, verbal learning and memory, however, not in music cognition. There exists a significant relationship between music cognition and attention, which could be implicated in use of music interventions to ameliorate cognitive deficits. Limitations of study include small sample size and heterogeneity. Future studies on larger cohort examining musical emotion perception and neurocognition is imperative to have deeper understanding of this debilitating condition.

Structural and Functional MRI Brain Changes in Patients with Schizophrenia Following Electroconvulsive Therapy: A Systematic Review

BACKGROUND

Schizophrenia (SZ) is a severe psychiatric disorder typically characterized by multidimensional psychotic syndromes. Electroconvulsive therapy (ECT) is a treatment option for medication-resistant patients with SZ or treating acute symptoms. Although the efficacy of ECT has been demonstrated in clinical use, its therapeutic mechanisms in the brain remain elusive.

OBJECTIVE

This study aimed to summarize brain changes on structural magnetic resonance imaging (sMRI) and functional MRI (fMRI) after ECT.

METHODS

According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was carried out. The PubMed and Medline databases were systematically searched using the following medical subject headings (MeSH): (electroconvulsive therapy OR ECT) AND (schizophrenia) AND (MRI OR fMRI OR DTI OR DWI).

RESULTS

This review yielded 12 MRI studies, including 4 with sMRI, 5 with fMRI and 3 with multimodal MRI. Increases in volumes of the hippocampus and its adjacent regions (parahippocampal gyrus and amygdala), as well as the insula and frontotemporal regions, were noted after ECT. fMRI studies found ECT-induced changes in different brain regions/networks, including the hippocampus, amygdala, default model network, salience network and other regions/networks that are thought to highly correlate with the pathophysiologic characteristics of SZ. The results of the correlation between brain changes and symptom remissions are inconsistent.

CONCLUSION

Our review provides evidence supporting ECT-induced brain changes on sMRI and fMRI in SZ and explores the relationship between these changes and symptom remission.

BMRMI Reduces Depressive Rumination Possibly through Improving Abnormal FC of Dorsal ACC

Rumination is a common symptom of major depressive disorder (MDD) and has been characterized as a vulnerability factor for the onset or recurrence of MDD. However, the neurobiological mechanisms underlying rumination and appropriate treatment strategies remain unclear. In the current study, we used resting-state functional magnetic resonance imaging to investigate the effects of body-mind relaxation meditation induction (BMRMI) intervention in MDD with rumination. To this aim, we have recruited 25 MDD and 24 healthy controls (HCs). Changes in functional connectivity (FC) of the anterior cingulate cortex (ACC) subregion and the scores of clinical measurements were examined using correlation analysis. At baseline, MDD showed stronger FC between the right dorsal ACC (dACC) and right superior frontal gyrus than did the HC group. Compared to baseline, the HC group showed a significantly enhanced FC between the right dACC and right superior frontal gyrus, and the MDD group demonstrated a significantly weaker FC between the left dACC and right middle frontal gyrus (MFG) after the intervention. Furthermore, the FC between the right dACC and right superior frontal gyrus was positively associated with rumination scores across all participants at baseline. The above results indicate that BMRMI may regulate self-referential processing and cognitive function through modulating FC of the dACC in MDD with rumination.

The Effect of Music Listening on EEG Functional Connectivity of Brain: A Short-Duration and Long-Duration Study

Music is considered a powerful brain stimulus, as listening to it can activate several brain networks. Music of different kinds and genres may have a different effect on the human brain. The goal of this study is to investigate the change in the brain’s functional connectivity (FC) when music is used as a stimulus. Secondly, the effect of listening to the subject’s favorite music is compared with listening to specifically formulated relaxing music with alpha binaural beats. Finally, the effect of the duration of music listening is studied. Subjects’ electroencephalographic (EEG) signals were captured as they listened to favorite and relaxing music. After preprocessing and artifact removal, the EEG recordings were decomposed into the delta, theta, alpha, and beta frequency bands, and the grand-averaged connectivity matrices were generated using Inter-Site Phase Clustering (ISPC) for each frequency band and each type of music. Furthermore, each lobe of the brain was analyzed separately to understand the effect of music on specific regions of the brain. EEG-FC among different channels was accessed by using graph theory and Network-based Statistics (NBS). To determine the significance of the changes in brain networks after listening to music, statistical analysis was conducted using Analysis of Variance (ANOVA) and t-test. The study of listening to music for a short duration verifies that either favorite or preferred music can affect the FC of the subject and induce a relaxation state. The short duration study also verifies a significant (ANOVA and t-test: p < 0.05) effectiveness of relaxing music over favorite music to induce relaxation and alertness in the subject. In the study of long duration, it is concluded that listening to relaxing music can increase functional connectivity and connections strength in the frontal lobe of the subject. A significant increase (ANOVA and t-test: p < 0.05) in FC in alpha and theta band and a significant decrease (ANOVA and t-test: p < 0.05) in FC in beta band in the frontal and parietal lobe of the brain verifies the hypothesis that the relaxing music can help the subject to achieve relaxation, activeness, and alertness.

Music Therapy vs. Music Listening for Negative Symptoms in Schizophrenia: Randomized, Controlled, Assessor- and Patient-Blinded Trial

Objective: To investigate the efficacy of music therapy for negative symptoms in patients with schizophrenia. Methods: Randomized, participant- and assessor-blinded, multicenter, controlled trial including patients diagnosed with schizophrenia according to ICD-10 with predominantly negative symptoms, between 18 and 65 years. Participants were randomized to 25 successive weekly individual sessions (excluding holidays, including cancellation by the participant) of either music therapy conducted by trained music therapists, or music listening together with a social care worker. The primary outcome was reduction in negative symptoms as measured by The Positive and negative Syndrome Scale (PANSS) negative subscale total score, assessed by a blinded rater, utilizing mixed-effects model analysis. Results: In total, 57 participants were randomized; 39 completed the study's initial 15 weeks, and 30 completed follow-up at 25 weeks. On the primary outcome of PANSS negative subscale, no significant difference was observed between groups with a coefficient of -0.24 (95% CI -1.76 to 1.27, P = 0.754) in the intention to treat analysis, and -0.98 (95% CI -5.06 to 3.09, P = 0.625) when only analyzing completers. Both interventions showed significant reduction from baseline to 25 weeks on PANSS negative subscale. On secondary outcomes, no between group differences were observed in The Brief Negative Symptom Scale, WHOQOL-Bref (Quality of Life), The Helping Alliance Questionnaire and The Global Assessment of Functioning in the intention to treat or completers populations utilizing Mixed Effects Models. Conclusion: No difference between groups randomized to music therapy vs. musical listening was observed resulting in no clear recommendation for which intervention to use as the first choice for treatment of patients diagnosed with schizophrenia and predominantly having negative symptoms. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02942459.

Frequency-specific alternations in the moment-to-moment BOLD signals variability in schizophrenia

Variability of neuronal activity is considered as the fundamental mechanism for the flexible and optimal brain function. Moreover, different frequency neuro signal is related to specific function. While little is currently known regarding changes in spontaneous BOLD variability of schizophrenia. The current study used resting-state fMRI data from 53 chronic schizophrenic subjects and 67 healthy subjects to investigate this issue. The data-driven method was used to measure the BOLD variability (MSSD: mean square successive difference) in two different frequency bands respectively (slow-5: 0.01-0.027 Hz; slow-4:0.027-0.073 Hz). Schizophrenic subjects exhibited decreased BOLD variability in thalamus region, sensorimotor and visual networks, and increased BOLD variability in salience network compared to matched healthy controls. Moreover, the interaction effects between frequency and group were observed in thalamus and right dorsolateral prefrontal cortex (DLPFC). These findings identified that altered BOLD variability is frequency dependent in schizophrenia. Importantly, the severity of patients' negative symptom was related to the increased BOLD variability of DLPFC within slow-4 frequency band, highlighting the evidence that abnormal BOLD variability of frontal cortex is likely to have effects on the pathophysiology of negative symptom in schizophrenia.

Altered asymmetries of diffusion and volumetry in basal ganglia of schizophrenia

Basal ganglia, which include the striatum and thalamus, have key roles in motivation, emotion, motor function, also contribute to higher-order cognitive function. Previous researches have documented structural and functional alterations in basal ganglia in schizophrenia. While few studies have assessed asymmetries of these characters in basal ganglia of schizophrenia. The current study investigated this issue by using diffusion tensor imaging, anatomic T1-weight image and resting-state functional data from 88 chronic schizophrenic subjects and 92 healthy controls. The structural characteristic, including fractional anisotropy, mean diffusivity (MD) and volume, were extracted and quantified from the subregions of basal ganglia, including caudate, putamen, pallidum and thalamus, through automated atlas-based method. The resting-state functional maps of these regions were also calculated through seed-based functional connectivity. Then, the laterality indexes of structural and functional features were calculated. Compared with healthy controls, schizophrenic subjects showed increased left laterality of volume in striatum and reduced left laterality of volume in thalamus. Furthermore, the difference of laterality of subregions in thalamus is compensatory in schizophrenic subjects. Importantly, the severity of patients' positive symptom was negative corelated with reduced left laterality of volume in thalamus. Our findings provide preliminary evidence demonstrating that the possibility of aberrant laterality in neural pathways and connectivity patterns related to the basal ganglia in schizophrenia.

The Use of Music in the Treatment and Management of Serious Mental Illness: A Global Scoping Review of the Literature

Mental and substance use disorders have been identified as the leading cause of global disability, and the global burden of mental illness is concentrated among those experiencing disability due to serious mental illness (SMI). Music has been studied as a support for SMIs for decades, with promising results; however, a lack of synthesized evidence has precluded increased uptake of and access to music-based approaches. The purpose of this scoping review was to identify the types and quantity of research at intersections of music and SMIs, document evidentiary gaps and opportunities, and generate recommendations for improving research and practice. Studies were included if they reported on music's utilization in treating or mitigating symptoms related to five SMIs: schizophrenia, bipolar disorder, generalized anxiety disorder, major depressive disorder, or post-traumatic stress disorder. Eight databases were searched; screening resulted in 349 included studies for data extraction. Schizophrenia was the most studied SMI, with bipolar disorder studied the least. Demographics, settings, and activity details were found to be inconsistently and insufficiently reported; however, listening to recorded music emerged as the most common musical activity, and activity details appeared to have been affected by the conditions under study. RCTs were the predominant study design, and 271 unique measures were utilized across 289 primary studies. Over two-thirds of primary studies (68.5%) reported positive results, with 2.8% reporting worse results than the comparator, and 12% producing indeterminate results. A key finding is that evidence synthesis is precluded by insufficient reporting, widely varied outcomes and measures, and intervention complexity; as a result, widespread changes are necessary to reduce heterogeneity (as feasible), increase replicability and transferability, and improve understandings of mechanisms and causal pathways. To that end, five detailed recommendations are offered to support the sharing and development of information across disciplines.

Altered Spatial Organization of Dynamic Functional Network Associates With Deficient Sensory and Perceptual Network in Schizophrenia

Schizophrenia is currently thought as a disorder with dysfunctional communication within and between sensory and cognitive processes. It has been hypothesized that these deficits mediate heterogeneous and comprehensive schizophrenia symptomatology. In this study, we investigated as to how the abnormal dynamic functional architecture of sensory and cognitive networks may contribute to these symptoms in schizophrenia. We calculated a sliding-window-based dynamic functional connectivity strength (FCS) and amplitude of low-frequency fluctuation (ALFF) maps. Then, using group-independent component analysis, we characterized spatial organization of dynamic functional network (sDFN) across various time windows. The spatial architectures of FCS/ALFF-sDFN were similar with traditional resting-state functional networks and cannot be accounted by length of the sliding window. Moreover, schizophrenic subjects demonstrated reduced dynamic functional connectivity (dFC) within sensory and perceptual sDFNs, as well as decreased connectivity between these sDFNs and high-order frontal sDFNs. The severity of patients' positive and total symptoms was related to these abnormal dFCs. Our findings revealed that the sDFN during rest might form the intrinsic functional architecture and functional changes associated with psychotic symptom deficit. Our results support the hypothesis that the dynamic functional network may influence the aberrant sensory and cognitive function in schizophrenia, further highlighting that targeting perceptual deficits could extend our understanding of the pathophysiology of schizophrenia.

The Effect of Music and White Noise on Electroencephalographic (EEG) Functional Connectivity in Neonates in the Neonatal Intensive Care Unit

The purpose of this study is to investigate whether listening to music and white noise affects functional connectivity on scalp electroencephalography (EEG) in neonates in the neonatal intensive care unit.Nine neonates of ≥34 weeks' gestational age, who were already undergoing clinical continuous EEG monitoring in the neonatal intensive care unit, listened to lullaby-like music and white noise for 1 hour each separated by a 2-hour interval of no intervention. EEG segments during periods of music, white noise, and no intervention were band-pass filtered as delta (0.5-4 Hz), theta (4-8 Hz), lower alpha (8-10 Hz), upper alpha (10-13 Hz), beta (13-30 Hz), and gamma (30-45 Hz). Synchronization likelihood was used as a measure of connectivity between any 2 electrodes.In theta, lower alpha, and upper alpha frequency bands, the synchronization likelihood values yielded statistical significance with sound (music, white noise and no intervention) and with edge (between any 2 electrodes) factors. In theta, lower alpha, and upper alpha frequency bands, statistical significance was obtained between music and white noise (t = 3.12, 3.32, and 3.68, respectively; P < .017), and between white noise and no intervention (t = 4.51, 3.09, and 2.95, respectively, P < .017). However, there was no difference between music and no intervention.Although limited by a small sample size and the 1-time only auditory intervention, these preliminary results demonstrate the feasibility of EEG connectivity analyses even at bedside in neonates on continuous EEG monitoring in the neonatal intensive care unit. They also point to the possibility of detecting significant changes in functional connectivity related to the theta and alpha bands using auditory interventions.

The effectiveness of adjunct music therapy for patients with schizophrenia: A meta-analysis

To evaluate the efficacy of adjunct music therapy on patients with schizophrenia, we conducted a meta-analysis of currently available randomized controlled trials and controlled clinical trials. Eight electronic databases (CNKI, PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science, Psychology and behavioural Sciences Collection, and Medline) were systematically searched from inception to January 2020. Standard mean difference (SMD) with 95% confidence interval (CI) values were used to evaluate the effects of music therapy. Finally, we selected eighteen studies comprising 1,212 participants comparing with control conditions. The meta-analysis demonstrated that adjunct music therapy significantly improved total symptoms (SMD = -0.48, 95%CI: -0.74 to -0.22), negative symptoms (SMD=-0.56, 95%CI: -0.72 to -0.40), depression symptoms (SMD = -0.35, 95% CI: -0.54 to -0.17), and quality of life (SMD = 0.35, 95%CI: 0.07 to 0.62) in people with schizophrenia compared with the control group. In addition, the meta-analysis indicated no publication bias for total symptoms, negative symptoms, and positive symptoms. The sensitivity analysis showed that the result was reliable. But the quality of evidence is still low, more well-designed studies with larger sample size and high quality are needed to confirm the efficiency of adjunct music therapy in treating schizophrenia.

The Effects of Music Intervention on Pallidum-DMN Circuit of Schizophrenia

Music intervention has been applied to improve symptoms of schizophrenic subjects as a complementary treatment in medicine. Although the psychiatric symptoms, especially for motivation and emotion, could be increased in schizophrenia, the underlying neural mechanisms remain poorly understood. We employed a longitudinal study to measure the alteration of striatum functional networks in schizophrenic subjects undergoing Mozart music listening using resting-state functional magnetic resonance imaging (fMRI). Forty-five schizophrenic inpatients were recruited and randomly assigned to two groups. Under the standard care with antipsychotic medication, one group received music intervention for 1 month and the other group is set as control. Both schizophrenic groups were compared to healthy subjects. Resting-state fMRI was acquired from schizophrenic subjects at baseline and after one-month music intervention and from healthy subjects at baseline. Striatum network was assessed through seed-based static and dynamic functional connectivity (FC) analyses. After music intervention, increased static FC was observed between pallidum and ventral hippocampus in schizophrenic subjects. Increased dynamic FCs were also found between pallidus and subregions of default mode network (DMN), including cerebellum crus and posterior cingulate cortex. Moreover, static pallidus-hippocampus FC increment was positively correlated with the improvement of negative symptoms in schizophrenic subjects. Together, these findings provided evidence that music intervention might have an effect on the FC of the striatum-DMN circuit and might be related to the remission of symptoms of schizophrenia.

Reconfiguration of Dynamic Functional Connectivity in Sensory and Perceptual System in Schizophrenia

Schizophrenia is thought as a self-disorder with dysfunctional brain connectivity. This self-disorder is often attributed to high-order cognitive impairment. Yet due to the frequent report of sensorial and perceptual deficits, it has been hypothesized that self-disorder in schizophrenia is dysfunctional communication between sensory and cognitive processes. To further verify this assumption, the present study comprehensively examined dynamic reconfigurations of resting-state functional connectivity (rsFC) in schizophrenia at voxel level, region level, and network levels (102 patients vs. 124 controls). We found patients who show consistently increased rsFC variability in sensory and perceptual system, including visual network, sensorimotor network, attention network, and thalamus at all the three levels. However, decreased variability in high-order networks, such as default mode network and frontal-parietal network were only consistently observed at region and network levels. Taken together, these findings highlighted the rudimentary role of elevated instability of information communication in sensory and perceptual system and attenuated whole-brain integration of high-order network in schizophrenia, which provided novel neural evidence to support the hypothesis of disrupted perceptual and cognitive function in schizophrenia. The foci of effects also highlighted that targeting perceptual deficits can be regarded as the key to enhance our understanding of pathophysiology in schizophrenia and promote new treatment intervention.

Bacomics: a comprehensive cross area originating in the studies of various brain-apparatus conversations

The brain is the most important organ of the human body, and the conversations between the brain and an apparatus can not only reveal a normally functioning or a dysfunctional brain but also can modulate the brain. Here, the apparatus may be a nonbiological instrument, such as a computer, and the consequent brain-computer interface is now a very popular research area with various applications. The apparatus may also be a biological organ or system, such as the gut and muscle, and their efficient conversations with the brain are vital for a healthy life. Are there any common bases that bind these different scenarios? Here, we propose a new comprehensive cross area: Bacomics, which comes from brain-apparatus conversations (BAC) + omics. We take Bacomics to cover at least three situations: (1) The brain is normal, but the conversation channel is disabled, as in amyotrophic lateral sclerosis. The task is to reconstruct or open up new channels to reactivate the brain function. (2) The brain is in disorder, such as in Parkinson's disease, and the work is to utilize existing or open up new channels to intervene, repair and modulate the brain by medications or stimulation. (3) Both the brain and channels are in order, and the goal is to enhance coordinated development between the brain and apparatus. In this paper, we elaborate the connotation of BAC into three aspects according to the information flow: the issue of output to the outside (BAC-1), the issue of input to the brain (BAC-2) and the issue of unity of brain and apparatus (BAC-3). More importantly, there are no less than five principles that may be taken as the cornerstones of Bacomics, such as feedforward and feedback control, brain plasticity, harmony, the unity of opposites and systems principles. Clearly, Bacomics integrates these seemingly disparate domains, but more importantly, opens a much wider door for the research and development of the brain, and the principles further provide the general framework in which to realize or optimize these various conversations.

Different role of the supplementary motor area and the insula between musicians and non-musicians in a controlled musical creativity task

The ability to compose creative musical ideas depends on the cooperation of brain mechanisms involved in multiple processes, including controlled creative cognition, which is a type of creativity that has so far been poorly researched. Therefore, the objective of this study was to examine the brain evoked activations by using fMRI, in both musicians and non-musicians, during a general task of controlled musical creativity and its relationship with general creativity. Results revealed that during a rhythmic improvisation task, musicians show greater activation of the motor supplementary area, the anterior cingulate cortex, the dorsolateral prefrontal cortex, and the insula, along with greater deactivation of the default mode network in comparison with non-musicians. For the group of musicians, we also found a positive correlation between the time improvising and the activation of the supplementary motor area, whilst in the non-musicians group improvisation time correlated with the activation of the insula. The results found for the musicians support the notion that the supplementary motor area plays a role in the representation and execution of musical behaviour, while the results in non-musicians reveal the role of the insula in the processing of novel musical information.

Music in premature infants enhances high-level cognitive brain networks

Preterm babies are cared for in neonatal intensive care units (NICU), which are busy places with a lot of mechanical noise increasingly recognized to disrupt normal brain development. NICUs therefore invest in developmental care procedures, with music for example, but neurobiological evidence for these interventions is missing. We present results from a clinical trial to study the effects of a music intervention on preterm infants’ brain development. Based on resting-state fMRI, we provide evidence that music enhanced connectivity in a brain circuitry involving the salience network with regions implicated in sensory and higher-order cognitive functions, previously found to be altered in preterm infants. To our knowledge, this study is unique in observing an impact of music on brain development in preterm newborns.

Neonatal intensive care units are willing to apply environmental enrichment via music for preterm newborns. However, no evidence of an effect of music on preterm brain development has been reported to date. Using resting-state fMRI, we characterized a circuitry of interest consisting of three network modules interconnected by the salience network that displays reduced network coupling in preterm compared with full-term newborns. Interestingly, preterm infants exposed to music in the neonatal intensive care units have significantly increased coupling between brain networks previously shown to be decreased in premature infants: the salience network with the superior frontal, auditory, and sensorimotor networks, and the salience network with the thalamus and precuneus networks. Therefore, music exposure leads to functional brain architectures that are more similar to those of full-term newborns, providing evidence for a beneficial effect of music on the preterm brain.

Increased Insular Connectivity and Enhanced Empathic Ability Associated with Dance/Music Training

Dance and music are expressive art forms. Previous behavioural studies have reported that dancers/musicians show a better sensorimotor ability and emotional representation of others. However, the neural mechanism behind this phenomenon is not completely understood. Recently, intensive researches have identified that the insula is highly enrolled in the empathic process. Thus, to expand the knowledge of insular function associated with empathy under the dance/music training background, we mapped the insular network and its associated brain regions in 21 dancers, 20 musicians, and 24 healthy controls using resting-state functional connectivity (FC) analysis. Whole brain voxel-based analysis was performed using seeds from the posterior insula (PI), the ventral anterior insula (vAI), and the dorsal anterior insula (dAI). The training effects of dance and music on insular subnetworks were then evaluated using one-way analysis of variance ANOVA. Increased insular FC with those seeds was found in dancers/musicians, including PI and anterior cingulated cortex (ACC), vAI and middle temporal gyrus (MTG) and middle cingulated cortex (MCC), and dAI and ACC and MTG. In addition, significant associations were found between discrepant insular FC patterns and empathy scores in dancers and musicians. These results indicated that dance/music training might enhance insular subnetwork function, which would facilitate integration of intero/exteroceptive information and result in better affective sensitivity. Those changes might finally facilitate the subjects' empathic ability.

Evaluation of functional connectivity in subdivisions of the thalamus in schizophrenia

BACKGROUND

Previous studies in schizophrenia revealed abnormalities in the cortico-cerebellar-thalamo-cortical circuit (CCTCC) pathway, suggesting the necessity for defining thalamic subdivisions in understanding alterations of brain connectivity.AimsTo parcellate the thalamus into several subdivisions using a data-driven method, and to evaluate the role of each subdivision in the alterations of CCTCC functional connectivity in patients with schizophrenia.

METHOD

There were 54 patients with schizophrenia and 42 healthy controls included in this study. First, the thalamic structural and functional connections computed, based on diffusion magnetic resonance imaging (MRI, white matter tractography) and resting-state functional MRI, were clustered to parcellate thalamus. Next, functional connectivity of each thalamus subdivision was investigated, and the alterations in thalamic functional connectivity for patients with schizophrenia were inspected.

RESULTS

Based on the data-driven parcellation method, six thalamic subdivisions were defined. Loss of connectivity was observed between several thalamic subdivisions (superior-anterior, ventromedial and dorsolateral part of the thalamus) and the sensorimotor system, anterior cingulate cortex and cerebellum in patients with schizophrenia. A gradual pattern of dysconnectivity was observed across the thalamic subdivisions. Additionally, the altered connectivity negatively correlated with symptom scores and duration of illness in individuals with schizophrenia.

CONCLUSIONS

The findings of the study revealed a wide range of thalamic functional dysconnectivity in the CCTCC pathway, increasing our understanding of the relationship between the CCTCC pathway and symptoms associated with schizophrenia, and further indicating a potential alteration pattern in the thalamic nuclei in people with schizophrenia.Declaration of interestNone.

Low-rank network signatures in the triple network separate schizophrenia and major depressive disorder

Brain imaging studies have revealed that functional and structural brain connectivity in the so-called triple network (i.e., default mode network (DMN), salience network (SN) and central executive network (CEN)) are consistently altered in schizophrenia. However, similar changes have also been found in patients with major depressive disorder, prompting the question of specific triple network signatures for the two disorders. In this study, we proposed Supervised Convex Nonnegative Matrix Factorization (SCNMF) to extract distributed multi-modal brain patterns. These patterns distinguish schizophrenia and major depressive disorder in a latent low-dimensional space of the triple brain network. Specifically, 21 patients of schizophrenia and 25 patients of major depressive disorder were assessed by T1-weighted, diffusion-weighted, and resting-state functional MRIs. Individual structural and functional connectivity networks, based on pre-defined regions of the triple network were constructed, respectively. Afterwards, SCNMF was employed to extract the discriminative patterns. Experiments indicate that SCNMF allows extracting the low-rank discriminative patterns between the two disorders, achieving a classification accuracy of 82.6% based on the extracted functional and structural abnormalities with support vector machine. Experimental results show the specific brain patterns for schizophrenia and major depressive disorder that are multi-modal, complex, and distributed in the triple network. Parts of the prefrontal cortex including superior frontal gyri showed variation between patients with schizophrenia and major depression due to structural properties. In terms of functional properties, the middle cingulate cortex, inferior parietal lobule, and cingulate cortex were the most discriminative regions.

Reduction in gray matter of cerebellum in schizophrenia and its influence on static and dynamic connectivity

Pathophysiological and atrophic changes in the cerebellum have been well-documented in schizophrenia. Reduction of gray matter (GM) in the cerebellum was confirmed across cognitive and motor cerebellar modules in schizophrenia. Such abnormalities in the cerebellum could potentially have widespread effects on both sensorimotor and cognitive symptoms. In this study, we investigated how reduction change in the cerebellum affects the static and the dynamic functional connectivity (FC) between the cerebellum and cortical/subcortical networks in schizophrenia. Reduction of GM in the cerebellum was confirmed across the cognitive and motor cerebellar modules in schizophrenic subjects. Results from this study demonstrates that the extent of reduction of GM within cerebellum correlated with increased static FCs between the cerebellum and the cortical/subcortical networks, including frontoparietal network (FPN), and thalamus in patients with schizophrenia. Decreased GM in the cerebellum was also associated with a declined dynamic FC between the cerebellum and the FPN in schizophrenic subjects. The severity of patients' positive symptom was related to these structural-functional coupling score of cerebellum. These findings identified potential cerebellar driven functional changes associated with positive symptom deficits. A post hoc analysis exploring the effect of changed FC within cerebellum, confirmed that a significant positive relationship, between dynamic FCs of cerebellum-thalamus and intracerebellum existed in patients, but not in controls. The reduction of GM within the cerebellum might be associated with modulation of cerebellum-thalamus, and contributes to the dysfunctional cerebellar-cortical communication in schizophrenia. Our results provide a new insight into the role of cerebellum in understanding the pathophysiological of schizophrenia.

Aberrant Prefrontal-Thalamic-Cerebellar Circuit in Schizophrenia and Depression: Evidence From a Possible Causal Connectivity

Neuroimaging studies have suggested the presence of abnormalities in the prefrontal-thalamic-cerebellar circuit in schizophrenia (SCH) and depression (DEP). However, the common and distinct structural and causal connectivity abnormalities in this circuit between the two disorders are still unclear. In the current study, structural and resting-state functional magnetic resonance imaging (fMRI) data were acquired from 20 patients with SCH, 20 depressive patients and 20 healthy controls (HC). Voxel-based morphometry analysis was first used to assess gray matter volume (GMV). Granger causality analysis, seeded at regions with altered GMVs, was subsequently conducted. To discover the differences between the groups, ANCOVA and post hoc tests were performed. Then, the relationships between the structural changes, causal connectivity and clinical variables were investigated. Finally, a leave-one-out resampling method was implemented to test the consistency. Statistical analyses showed the GMV and causal connectivity changes in the prefrontal-thalamic-cerebellar circuit. Compared with HC, both SCH and DEP exhibited decreased GMV in middle frontal gyrus (MFG), and a lower GMV in MFG and medial prefrontal cortex (MPFC) in SCH than DEP. Compared with HC, both patient groups showed increased causal flow from the right cerebellum to the MPFC (common causal connectivity abnormalities). And distinct causal connectivity abnormalities (increased causal connectivity from the left thalamus to the MPFC in SCH than HC and DEP, and increased causal connectivity from the right cerebellum to the left thalamus in DEP than HC and SCH). In addition, the structural deficits in the MPFC and its causal connectivity from the cerebellum were associated with the negative symptom severity in SCH. This study found common/distinct structural deficits and aberrant causal connectivity patterns in the prefrontal-thalamic-cerebellar circuit in SCH and DEP, which may provide a potential direction for understanding the convergent and divergent psychiatric pathological mechanisms between SCH and DEP. Furthermore, concomitant structural and causal connectivity deficits in the MPFC may jointly contribute to the negative symptoms of SCH.

Brain Connectivity Networks and the Aesthetic Experience of Music

Listening to music is above all a human experience, which becomes an aesthetic experience when an individual immerses himself/herself in the music, dedicating attention to perceptual-cognitive-affective interpretation and evaluation. The study of these processes where the individual perceives, understands, enjoys and evaluates a set of auditory stimuli has mainly been focused on the effect of music on specific brain structures, as measured with neurophysiology and neuroimaging techniques. The very recent application of network science algorithms to brain research allows an insight into the functional connectivity between brain regions. These studies in network neuroscience have identified distinct circuits that function during goal-directed tasks and resting states. We review recent neuroimaging findings which indicate that music listening is traceable in terms of network connectivity and activations of target regions in the brain, in particular between the auditory cortex, the reward brain system and brain regions active during mind wandering.

The Effects of Music Intervention on Functional Connectivity Strength of the Brain in Schizophrenia

Schizophrenia is often associated with behavior abnormality in the cognitive and affective domain. Music intervention is used as a complementary treatment for improving symptoms in patients with schizophrenia. However, the neurophysiological correlates of these remissions remain poorly understood. Here, we investigated the effects of music intervention in neural circuits through functional magnetic resonance imaging (fMRI) study in schizophrenic subjects. Under the standard care, patients were randomly assigned to music and non-music interventions (MTSZ, UMTSZ) for 1 month. Resting-state fMRI were acquired over three time points (baseline, 1 month, and 6 months later) in patients and analyzed using functional connectivity strength (FCS) and seed-based functional connection (FC) approaches. At baseline, compared with healthy controls, decreased FCS in the right middle temporal gyrus (MTG) was observed in patients. However, after music intervention, the functional circuitry of the right MTG, which was related with the function of emotion and sensorimotor, was improved in MTSZ. Furthermore, the FC increments were significantly correlated with the improvement of symptoms, while vanishing 6 months later. Together, these findings provided evidence that music intervention might positively modulate the functional connectivity of MTG in patients with schizophrenia; such changes might be associated with the observed therapeutic effects of music intervention on neurocognitive function. This trial is registered with ChiCTR-OPC-14005339.

Mobile Software as a Medical Device (SaMD) for the Treatment of Epilepsy: Development of Digital Therapeutics Comprising Behavioral and Music-Based Interventions for Neurological Disorders

Digital health technologies for people with epilepsy (PWE) include internet-based resources and mobile apps for seizure management. Since non-pharmacological interventions, such as listening to specific Mozart's compositions, cognitive therapy, psychosocial and educational interventions were shown to reduce epileptic seizures, these modalities can be integrated into mobile software and delivered by mobile medical apps as digital therapeutics. Herein, we describe: (1) a survey study among PWE about preferences to use mobile software for seizure control, (2) a rationale for developing digital therapies for epilepsy, (3) creation of proof-of-concept mobile software intended for use as an adjunct digital therapeutic to reduce seizures, and (4) broader applications of digital therapeutics for the treatment of epilepsy and other chronic disorders. A questionnaire was used to survey PWE with respect to preferred features in a mobile app for seizure control. Results from the survey suggested that over 90% of responders would be interested in using a mobile app to manage their seizures, while 75% were interested in listening to specific music that can reduce seizures. To define digital therapeutic for the treatment of epilepsy, we designed and created a proof-of-concept mobile software providing digital content intended to reduce seizures. The rationale for all components of such digital therapeutic is described. The resulting web-based app delivered a combination of epilepsy self-care, behavioral interventions, medication reminders and the antiseizure music, such as the Mozart's sonata K.448. To improve long-term patient engagement, integration of mobile medical app with music and multimedia streaming via smartphones, tablets and computers is also discussed. This work aims toward development and regulatory clearance of software as medical device (SaMD) for seizure control, yielding the adjunct digital therapeutic for epilepsy, and subsequently a drug-device combination product together with specific antiseizure medications. Mobile medical apps, music, therapeutic video games and their combinations with prescription medications present new opportunities to integrate pharmacological and non-pharmacological interventions for PWE, as well as those living with other chronic disorders, including depression and pain.