Structural brain abnormalities and aggressive behaviour in schizophrenia: Mega-analysis of data from 2095 patients and 2861 healthy controls via the ENIGMA consortium

Background

Schizophrenia is associated with an increased risk of aggressive behaviour, which may partly be explained by illness-related changes in brain structure. However, previous studies have been limited by group-level analyses, small and selective samples of inpatients and long time lags between exposure and outcome.

Methods

This cross-sectional study pooled data from 20 sites participating in the international ENIGMA-Schizophrenia Working Group. Sites acquired T1-weighted and diffusion-weighted magnetic resonance imaging scans in a total of 2095 patients with schizophrenia and 2861 healthy controls. Measures of grey matter volume and white matter microstructural integrity were extracted from the scans using harmonised protocols. For each measure, normative modelling was used to calculate how much patients deviated (in z-scores) from healthy controls at the individual level. Ordinal regression models were used to estimate the associations of these deviations with concurrent aggressive behaviour (as odds ratios [ORs] with 99% confidence intervals [CIs]). Mediation analyses were performed for positive symptoms (i.e., delusions, hallucinations and disorganised thinking), impulse control and illness insight. Aggression and potential mediators were assessed with the Positive and Negative Syndrome Scale, Scale for the Assessment of Positive Symptoms or Brief Psychiatric Rating Scale.

Results

Aggressive behaviour was significantly associated with reductions in total cortical volume (OR [99% CI] = 0.88 [0.78, 0.98], p = .003) and global white matter integrity (OR [99% CI] = 0.72 [0.59, 0.88], p = 3.50 × 10-5) and additional reductions in dorsolateral prefrontal cortex volume (OR [99% CI] = 0.85 [0.74, 0.97], p =.002), inferior parietal lobule volume (OR [99% CI] = 0.76 [0.66, 0.87], p = 2.20 × 10-7) and internal capsule integrity (OR [99% CI] = 0.76 [0.63, 0.92], p = 2.90 × 10-4). Except for inferior parietal lobule volume, these associations were largely mediated by increased severity of positive symptoms and reduced impulse control.

Conclusions

This study provides evidence that the co-occurrence of positive symptoms, poor impulse control and aggressive behaviour in schizophrenia has a neurobiological basis, which may inform the development of therapeutic interventions.

Brain ageing in schizophrenia: evidence from 26 international cohorts via the ENIGMA Schizophrenia consortium

Schizophrenia (SZ) is associated with an increased risk of life-long cognitive impairments, age-related chronic disease, and premature mortality. We investigated evidence for advanced brain ageing in adult SZ patients, and whether this was associated with clinical characteristics in a prospective meta-analytic study conducted by the ENIGMA Schizophrenia Working Group. The study included data from 26 cohorts worldwide, with a total of 2803 SZ patients (mean age 34.2 years; range 18-72 years; 67% male) and 2598 healthy controls (mean age 33.8 years, range 18-73 years, 55% male). Brain-predicted age was individually estimated using a model trained on independent data based on 68 measures of cortical thickness and surface area, 7 subcortical volumes, lateral ventricular volumes and total intracranial volume, all derived from T1-weighted brain magnetic resonance imaging (MRI) scans. Deviations from a healthy brain ageing trajectory were assessed by the difference between brain-predicted age and chronological age (brain-predicted age difference [brain-PAD]). On average, SZ patients showed a higher brain-PAD of +3.55 years (95% CI: 2.91, 4.19; I2 = 57.53%) compared to controls, after adjusting for age, sex and site (Cohen's d = 0.48). Among SZ patients, brain-PAD was not associated with specific clinical characteristics (age of onset, duration of illness, symptom severity, or antipsychotic use and dose). This large-scale collaborative study suggests advanced structural brain ageing in SZ. Longitudinal studies of SZ and a range of mental and somatic health outcomes will help to further evaluate the clinical implications of increased brain-PAD and its ability to be influenced by interventions.

A comparative study of theory of mind in taxon-like clusters of psychometric schizotypes and individuals at genetic risk for schizophrenia

Introduction: Clinical and family studies suggest that alterations of theory of mind (ToM) represent a marker of genetic liability to schizophrenia. Findings regarding ToM in schizotypy are less consistent. The study aimed to explore whether this might be due to an insufficient account of the heterogeneity of schizotypy in prior research and/or the fact that in psychometric schizotypy ToM alterations could manifest as subtle peculiarities rather than overt errors of mentalising.Methods: Individuals without a family history of psychosis (n = 150) were assigned to low, positive, negative, and high mixed schizotypy classes based on a cluster analysis of 1322 subjects who completed the Schizotypal Personality Questionnaire. The classes were compared on their performance of faux pas tasks with 77 adult first-degree relatives of schizophrenia patients, who represent individuals at genetic risk for schizophrenia. Besides overt errors, subtle alterations in ToM were analysed using expert judgment.Results: The relatives tended to make overt errors and demonstrated specific features of intentional reasoning. None of the schizotypal classes showed similar trends.Conclusions: The results complement the literature on the subjective-objective disjunction in psychometric schizotypes and did not provide evidence that ToM anomalies are a marker of genetic liability to schizophrenia in this cohort.

Resting-state Functional Connectivity within Frontoparietal Network in Schizophrenia Patients and Healthy Individuals with Better and Worse Executive Functions

Introduction

Patients with schizophrenia spectrum disorders (SP) demonstrate heterogeneity in executive functions (EF) associated with the quality of outcome. However, neurobiological mechanisms of this heterogeneity are understudied.

Objectives

We aimed to identify features of resting-state functional connectivity (FC) within the frontoparietal network (FPN) that discriminate between SP and healthy individuals (HI) with better and worse EF.

Methods

Twenty-five SP (mean age 20.8±3.23, illness duration 1.3±2.1 years, all males) and twenty-six HI (mean age 25.17±3.46, all males) underwent EF assessment (4 verbal fluency tests and a modified Stroop task) as well as resting-state fMRI (3T).

Results

We used k-means clustering based on EF scores to divide all participants into groups with worse (15 SP, 6 HI) and better EF (10 SP, 20 HI). These groups differed in productivity of all verbal fluency tasks and performance time of the Stroop task. Differences between four subgroups (HI/SP with worse/better EF) were revealed in FC between the cingulate and lateral prefrontal cortex in the left hemisphere (ANCOVA, p-uncorrected<.005, p[FDR]<.05; Fig. 1). SP and HI within each group demonstrated a similar FC pattern. SP with poorer EF had increased FC, compared to HI with higher EF. HI with poorer EF demonstrated increased FC, compared to HI and SP with better EF.

Conclusions

FC within FPN may be one of the neurophysiological underpinnings of EF heterogeneity in SP as well as in HI. Further machine learning fMRI studies are needed to clarify whether FC within FPN is a prognostic marker in schizophrenia.

Disclosure

The study was supported by RFBR Grant 20-013-00748.

Religious End-World delusion: psychopathological types

Introduction

Diagnostics of End-World delusion with religious content (EWDRC) is relevant due to its insufficient exploration, difficulty in differential diagnostics and social danger of the delusional behavior.

Objectives

To develop a typology based on psychopathological and phenomenological features.

Methods

Sixty patients with EWDRC were examined. Psychopathological and statistical methods were applied.

Results

Study of EWDRC found heterogeneity of clinical appearances. Two different types were identified: apocalyptic and eschatological. The apocalyptic type (51 patients, 85%) was characterized by prevalence of End-World ideas in an acute sensual delusion. Due to heterogeneity of delusion’s dynamics two subtypes were identified: - Subtype 1 (31 patients, 61%) was characterized with long period of development (changes in the stages) of different delusion’s types: delusion of perception, importance, staging, and the antagonistic one. Psychotic symptoms were quickly reduced with antipsychotic therapy. - Subtype 2 (20 patients, 39%) was characterized with rapid development of delusion’s stages up to oneiro-catatonic states which were hardly jugulated. Eschatological type (9 patients, 15%) was characterized by the systematized interpretive delusion with individual interpretation of apocalyptic signs. These states evolved within mixed forms of schizophrenia.

Conclusions

The analysis of EWDRC revealed the apocalyptic type’s acute course. Patients with the apocalyptic type have a premonition of upcoming End-World, and feel themselves engaged in it. The eschatological type is based on the systematized interpretive End-World delusion with “confirmations” found in everyday life. The results showed the high risk of the delusional behavior in patients with EWDRC which requires careful approach to the diagnostics and treatment of these conditions.

Disclosure

No significant relationships.

EEG Features in Adolescent Patients with Borderline and Narcissistic Personality Disorder

Introduction

Personality disorders (PD) in adolescence are widespread. It creates problems of social adaptation of patients and represents significant risk factors for auto-aggressive behavior, including suicidal one. The neurobiological basis and EEG markers of PD in adolescence have not been adequately studied.

Objectives

The aim of the study was to reveal the EEG features and their correlations with clinical parameters in male adolescents with borderline personality disorder (BPD) and narcissistic personality disorder (NPD), possibly mediating some aspects of their clinical traits.

Methods

28 BPD patients (301.83, by DSM-5) and 24 NPD patients (301.81, by DSM-5), as well as 24 healthy controls (HC) aged 16-25 years were enrolled in the study. HDRS-21 and HAM-A scales were used for quantitative assessment of patient’s conditions. Pre-treatment resting EEG was recorded, and EEG spectral analysis was carried out in 8 narrow frequency sub-bands. Descriptive statistics and correlation analysis of EEG and clinical data were performed.

Results

EEG spectral parameters in BPD group did not differ significantly from those of HC. NPD group shows the EEG signs of more activated brain cortex than in both BPD and norm groups caused by decreased functional state of the anterior cortical regions. The structure of correlations between EEG parameters and clinical scores also differed between BPD and NPD groups.

Conclusions

The data obtained suggests that these features of the brain activity may contribute to the disturbance of emotion regulation and of behavior control in adolescent patients with BPD and NPD, more pronounced in NPD group.

Disclosure

No significant relationships.

High-frequency rTMS in the treatment of depressive symptoms in schizophrenia: a neurophysiological profile of respondents and nonresponders

Introduction

Depressive symptoms in schizophrenia have a high prevalence – up to 20-60 %, at the different illness stages. Non-pharmacological treatment, namely rTMS, seems like a promising approach that lacks side-effects typical for antidepressants. RTMS is widely applied in the treatment of depression, however the studies within schizophrenia domain are still rather few

Objectives

The aim was to examine a potential of neurophysiological data for prediction of the effects of rTMS in the treatment of patients with schizophrenia with depressive symptoms

Methods

20 male patients with schizophrenia (F20.004, F20.014, F20.414, ICD–10) were examined at the stage of incomplete remission with predominance of prolonged (more than 6 months) treatment resistant depressive symptoms. An examination (clinical and neurophysiological (oddball ERP and EEG) fragments)) was repeated twice - before and after a course of 10 Hz rTMS (left DLPC, 2000 pulses per session, 15 sessions).

Results

Poor outcome was associated with initially higher coherence in alpha and lower - in beta1 EEG bands. The amplitudes of non-target N100 and mismatch negativity didn’t differ the groups of responders and nonresponders

Conclusions

The disturbances within brain networks of beta1 and alpha generators merit attention as potential neurophysiological markers with predictive value in rTMS treatment of patients with schizophrenia with depressive symptoms.

Disclosure

No significant relationships.

Religious Coping Strategies for Religious Patients with Schizophrenia and Schizoaffective Disorder

Introduction

Over last decades convincing evident data was accumulated about the positive correlation of religious involvement and better mental health in depression, substance abuse, suicide, stress-related disorders and dementia. The studies of the impact of religion on patients with schizophrenia and schizoaffective disorders are still insufficient and controversial.

Objectives

To investigate the impact of the religious coping strategies in patients with schizophrenia and shizoaffective disorder with focus on resolution and quality of remission in schizophrenia and schizoaffective disorder.

Methods

The pilot 1 year study covers 68 orthodox (group 1) and 55 unbeliever (group 2) outpatients with schizophrenia and schizoaffective disorder in remission on the maintenance therapy in FSBSI MHRC. The groups matched in age (18-60 y.o.), gender, treatment. The orthodox group received religious coping therapy. Number of relapses, remission quality (PANSS), quality of life (QLS), compliance (MARS) were measured 3 times (baseline visit, 6, 12 months). Statistical analysis (regression and correlation) was applied.

Results

Religious coping strategies proposed by Paragment K. (2013) were applied considering the peculiarities of value-semantic structures and selected religious values of the patients as important rehabilitation resource (Kopeyko et al, 2016). Group 1 demonstrated statistically significant better remission at 12-months point – better subjective well-being, social/functional outcomes, higher adherence to medication, less relapses, less psychotic symptoms.

Conclusions

Religion contributes to acquire adaptive functions as the meaning of life, sense of hope, spiritual comfort, supports the overcome the disease burden. Religious coping is an important tool for rehabilitation and preventing the relapses in patients with schizophrenic disorders.

Disclosure

No significant relationships.

Different trajectories of the first-episode psychosis remission in young adults

Introduction

Analysis of the first-episode psychosis remission, including post-psychotic affective and primary negative symptoms as well as personality changes, is necessary to personalize therapy and rehabilitation.

Objectives

We aimed to identify different trajectories of psychosis remission in young adults.

Methods

First-episode psychosis patients (n=56, mean age 19.8±2.5 years, all males) underwent psychopathological assessment at the stage of remission.

Results

Three trajectories of remission were identified. The thymopathic trajectory (33.93%, 19 patients) was characterized by the gradual increase of subclinical affective symptoms and resulted with a high-quality remission. In 63.61% cases in this group persistent depressed mood was present after a psychotic episode. Some patients (36.84%) became prone to depressive reactions. The pathocharacterological trajectory (39.28%, 22 patients) was characterised by personality changes with increase of existing traits or the development of traits previously not present. Types with an increase of schizoid (14.29%), histrionic (19.64%), and anxiety-hypochondriacal (5.36%) traits were identified. Patients in this group had high- as well as low-quality remission. The destructive trajectory (26.79%, 15 patients) was characterised by residual positive or single negative symptoms. Patients in this subgroup had low-quality remission with poor functioning and signs of treatment resistance.

Conclusions

Analysis of trajectories of the first-episode psychosis remission allowed us to choose the most effective strategy for personalized supportive treatment.

Disclosure

No significant relationships.

Psychopathological and clinical-typological aspects of youth chronic endogenous depression

Introduction

Youth ontogenesis contributes significantly to depressive disorders, causing pronounced atypia, a high level of comorbid pathology. A long-term depressive state lead can to persistent, adverse consequences.

Objectives

To study the clinical, psychopathological and psychometric features of youth chronic endogenous depression (UCED).

Methods

62 patients of the age 16-25 were examined clinically and psychopathologically; the patients were first hospitalized from 2017 to 2020 for a chronic depressive state with non-psychotic mental disorders (ICD-10: F31, F32, F33, F34, F21 keys) lasting more than two years. Psychometric assessment was done by HDRS, SOPS, and SANS.

Results

UCED are characterized by a pronounced atypia with a predominance of symptoms for negative affectivity with apathy, anhedonia, physical and mental asthenia, depressive devitalization. In contrast with non-chronic youth depressions, cognitive disorders, motor inhibition, a large proportion of comorbid pathology are presented in the chronic ones. Depending on the prevalence of additional psychopathological disorders, 2 types were distinguished: Type I – depression with a clear-cut affective psychopathological structure (54.8%, 34 patients); Type II - depression with the symptoms of other than affective registers (45.2%, 28 patients). Psychometric assessment on the HDRS scale, in the sub-scale “negative symptoms” of the SOPS scale, in the sub-scale “anhedonia-associality” of the SANS scale showed a greater severity of psychopathological symptoms in type II depression (p<0.05).

Conclusions

The obtained data confirm the differences between UCED and non-chronic youth depressions and demonstrate the aggravating effect of symptoms of the non-affective spectrum on the severity of UCED and the level of negative affectivity.

Disclosure

No significant relationships.

Decreased Resting-state fMRI Local Coherence in Schizophrenia Patients with Poor Long-term Outcome

Introduction

Schizophrenia is heterogeneous in terms of symptoms and outcome, but neurobiology of this heterogeneity is not well-studied. Local correlation analysis of fMRI data provides a measure of local coherence, i.e., average correlation between BOLD-signal in a voxel and its neighbours. Local correlation is a promising approach, and it seems important to find links between local brain coherence and schizophrenia outcome.

Objectives

We aimed to compare brain local coherence between schizophrenia patients with varied long-term outcomes and healthy controls (HC).

Methods

Patients with chronic schizophrenia spectrum disorders (37 males, mean age 41.5±5.5) and HC (17 males, mean age 38±7.7) underwent resting-state fMRI (3T). Cluster analysis based on PANSS and PSP allowed us to allocate patients into two subgroups (N = 13/24). The second subgroup had significantly more marked negative and general psychopathology symptoms and worse functioning than the first subgroup. Local coherence in the brain was compared between clinical subgroups and HC (ANOVA, p<.001 voxelwise, p[FDR]<.05 clusterwise).

Results

Local coherence in the paracingulate gyri bilaterally ({-2; 58; 14}; 2712 mm³) differentiated the groups. Post hoc analysis revealed decreased local coherence in the subgroup with poorer outcome compared to HC, along with the absence of differences between the subgroup with better outcome and HC. There were no differences between clinical subgroups.

Conclusions

Hypoactivity of the cingulate cortex is related to negative symptoms (Bersani et al., 2014). Their severity, in turn, is strongly associated with outcome. Thus, local coherence in the cingulate cortex may be one of the factors which underlie outcome heterogeneity.

Disclosure

No significant relationships.

Depressions with religious experiences

Introduction

Despite a significant number of studies devoted to the relationship between depression and religiosity, the diagnosis of depression in religious patients is complicated due to the insufficiently studied psychopathology and the peculiarities of the patient’s experiences.

Objectives

To determine the specific features of psychopathology and phenomenology of depression, masked by a “religious facade”, for timely diagnostics and prevention of suicidal behavior.

Methods

One hundred and fifteen religious (orthodox) inpatients (41 male, 74 female) with depression (F31.3, F31.4, F 32.1., F 32.2, F 33.1, F 33.2 according to ICD-10) were examined. Psychopathological method, HAM-D, SIDAS and statistical analysis were applied.

Results

Five types of depression were specified, which differed in psychopathological structure and content of the religious experiences. Overvalued ideas of guilt and sinfulness were predominant in melancholic depressions, ideas of God-forsakenness and the loss of “living” faith - in apathetic. Depressions with overvalued doubts whether the right faith and confession has been chosen accompanied with anxiety, melancholy and apathy. It should be specially mentioned apathetic and melancholic depressions characterized by “spiritual hypochondria” with specific cenesto-hypochondrical symptomatology. Melancholic depressions characterized by high suicidal risk prevailed (65%) over the other depressions.

Conclusions

Depressions masked by a “religious facade” often are not recognized due to specifical content, which results in lack of timely diagnostics and creates a high risk of suicidal behavior.

Disclosure

No significant relationships.

The first psychotic episode with religious delusion in adolescence and young adults: premanifest stage

Introduction

The study of the premanifest stages of the first psychotic episode with religious delusion is relevant due to the lack of clarity in differentiating normal religiosity from pathological and, as a consequence, a relatively longer period of an untreated psychotic state, which negatively affects both the course of the disease and its outcomes. Another important factor is the high risk of antisocial, autoaggressive and suicidal behavior at different stages of the disease.

Objectives

The aim of the study is to identify the conditions for the formation of religious delusion in adolescence and young adults, to analyze the correlations between religiosity at the pre-manifest stage and the subsequent manifest psychotic episode with religious delusions of different content.

Methods

The 57 male patients at a young age (16-25 years) with a manifest psychotic episode (F20, F25 according to ICD-10) with religious delusion (delusion of sin (21,6 %), delusion of demonic possession (29,4 %), antagonistic and messianic delusion (39,2 %), oneiroid with religious content (9,8 %)) were studied with the clinical-psychopathological, psychometric (PAS) methods. The religiosity of patients in premorbid was assessed with the Duke University Religion Index (DUREL) questionnaire.

Results

Of greatest importance in the formation of psychotic episode with religious content is hereditary burden, premorbid personality structure, high scores on the PAS scale.

Conclusions

The presence or absence of religiosity in premorbid doesn’t matter to formation of psychotic episode with religious delusion.

Disclosure

No significant relationships.

Dynamics of immune markers in different variants of post-psychotic depression after first-episode psychosis in young adult age

Introduction

Research in recent decades focuses on understanding the role of the immune system in First-Episode Psychosis (FEP) at a young age. Our studies indicate that different stages of schizophrenia differ in the spectrum of inflammation markers. These indicators reflect the activity of the pathological process, using them as markers of the clinical state of patients at different stages of the disease.

Objectives

To assess the relationship of immune markers with the clinical features of remission in patients after FEP.

Methods

Fifty patients aged 15-25 years with post-psychotic depression (PD) after FEP (F20, F25) and 30 healthy men were included in the study. The follow-up period was two years. PD typological variants with positive affectivity (PA) (n=30) and negative affectivity (NA) (n=20) were distinguished. Leukocyte elastase (LE), a1-proteinase inhibitor (a1-PI) activity, and S-100B autoantibodies in plasma samples were measured.

Results

The increase of LE and a1-PI activity in plasma of both types of PD patients compared to controls was detected (p<0.01). There was the highest LE activity and S-100B autoantibodies in PD with NA (p<0.05). The different dynamics of immune markers in both groups were correlated to the clinical features of remission. PD with PA was associated with a decrease in inflammatory markers (p<0.05) and a favorable prognosis. PD patients with NA had a further increase in LE activity and S-100B autoantibodies (p<0.01), and an unfavorable prognosis.

Conclusions

The results confirm using the immune indicators as markers to assess the quality of remission after FEP in young adult age and the risk of recurrent psychotic attacks.

Disclosure

No significant relationships.

Increased spectral power of theta rhythm is not associated with decreased supragranular thickness in first-episode schizophrenia

Introduction

Schizophrenia is associated with disturbances in neurophysiological processes. However, the relation of EEG and ERP parameters to structural supragranular cortical abnormalities, observed in schizophrenia, remains unclear.

Objectives

The purpose was to characterize EEG and ERP disturbances and their relationship to changes occurring in supragranular cortical layers in subjects with schizophrenia.

Methods

43 first-episode schizophrenia (FES) male patients and 43 matched healthy controls (HC) underwent background EEG and standard two-tones oddball ERP recording and structural MRI at 3T Philips scanner. MRI images were processed via FreeSurfer and MATLAB to derive two markers specific to supragranular thickness change: gyral-sulcal thickness differences (GSTD) and gyral-sulcal intrinsic curvature differences on pial surface (GSCD) (github.com/kwagstyl/schizophrenia_gyral_sulcal).

Results

Theta rhythm spectral power was increased in FES while P300 amplitudes and latencies, N100 (to non-targets) amplitudes, alpha rhythm spectral power were not altered compared to HC. GSCD measures were increased in temporal, parietal and occipital cortices, whereas both GSTD and GSCD were increased in the right frontal cortex in FES. No correlations between altered EEG and supragranular thickness markers survived correction for multiple comparisons.

Conclusions

Presumably, theta rhythm has a widespread circuit of generators, including the cortical ones. However, we have not found correlations between EEG and supragranular markers in FES. Considering an absence of correlations between theta and hippocampal volumes (Lebedeva et al., 2020), a speculative interpretation is that the neurophysiological disturbances may be associated with a more complex patterns of more localized structural and functional impairments.

Disclosure

The work was supported by RFBR grant 20-013-00748.

Clinical evaluation of Major Depressive Disorder (MDD) and Borderline Personality Disorder(BPD) in youth adolescents

Introduction

According to international studies, at least 70% of BPD in adolescence are comorbid with MDD.

Objectives

To determine the clinical and psychopathological markers of MDD in BPD in adolescence.

Methods

Clinical psychopathological interview, SCID-II, Hamilton Depression Rating Scale (HDRS). Sample: N=73 male and female, age: 18-25 with MDD and BPD.

Results

MDD comorbid with BPD in adolescence is characterized by polymorphism of its’ psychopathological manifestations due to the structure of BPD and the input of the age factor. In the studied sample 31 (42,5%) with both MDD and BPD also revealed addictions; 24 patients (32,9%) - anxiety and obsessive-compulsive (OCD) disorders, 18 patients (24,7%) had overvalued ideas. The high contingency of MDD with autoaggressive actions confirmed their high suicidal risk (53 patients). Among them - 31 patients (58,5%) - had non-suicidal self-harm (NSSI), 7 patients – (13,2%) had suicidal attempt (SA), and 15 patients (28,3%) had NSSI and suicidal attempts (NSSI+SA). The highest incidence of NSSI and NSSI+SA was noted in MDD with addictive disorders: NSSI – N=20 (80,00%), NSSI+SA - N=5 (20,00%), SA – N=0. MDD with BPD and anxiety disorders: NSSI – N=9 (56,25%), NSSI+SA – N= 6 (37,50%), SA–N=1 (6,25%). MDD with BPD and overvalued ideas: NSSI – N=2 (16,67%), NSSI +SA – N= 4 (33,33%), SA N=6 (50,0%), (results p<0.01).

Conclusions

Psychopathological relations between BPD and MDD in youth are different due to additional comorbid conditions, like addictions, anxiety and OCD, overvalued ideas and have clinical implications in terms of suicidal and NSSI risks, individualized interventions and prognosis.

Disclosure

No significant relationships.

A meta-analysis of deep brain structural shape and asymmetry abnormalities in 2,833 individuals with schizophrenia compared with 3,929 healthy volunteers via the ENIGMA Consortium

Schizophrenia is associated with widespread alterations in subcortical brain structure. While analytic methods have enabled more detailed morphometric characterization, findings are often equivocal. In this meta-analysis, we employed the harmonized ENIGMA shape analysis protocols to collaboratively investigate subcortical brain structure shape differences between individuals with schizophrenia and healthy control participants. The study analyzed data from 2,833 individuals with schizophrenia and 3,929 healthy control participants contributed by 21 worldwide research groups participating in the ENIGMA Schizophrenia Working Group. Harmonized shape analysis protocols were applied to each site's data independently for bilateral hippocampus, amygdala, caudate, accumbens, putamen, pallidum, and thalamus obtained from T1-weighted structural MRI scans. Mass univariate meta-analyses revealed more-concave-than-convex shape differences in the hippocampus, amygdala, accumbens, and thalamus in individuals with schizophrenia compared with control participants, more-convex-than-concave shape differences in the putamen and pallidum, and both concave and convex shape differences in the caudate. Patterns of exaggerated asymmetry were observed across the hippocampus, amygdala, and thalamus in individuals with schizophrenia compared to control participants, while diminished asymmetry encompassed ventral striatum and ventral and dorsal thalamus. Our analyses also revealed that higher chlorpromazine dose equivalents and increased positive symptom levels were associated with patterns of contiguous convex shape differences across multiple subcortical structures. Findings from our shape meta-analysis suggest that common neurobiological mechanisms may contribute to gray matter reduction across multiple subcortical regions, thus enhancing our understanding of the nature of network disorganization in schizophrenia.

The varieties of delusional syndrome of possession in schizophrenia

Introduction

Delusional Syndrome of Possession in schizophrenia (DSPS) is insufficiently explored. Although it characterized by significant severity of clinical state and resistance to psychopharmacotherapy, and may be accompanied by high social risks.

Objectives

To carry out clinical and psychopathological differentiation of DSPS and to define its personalized diagnostic and prognostic criteria.

Methods

66 patients with DSPS were observed (F20.0, F20.01, F20.02 according to ICD-10) by psychopathological, psychometrical and statistical methods.

Results

Persistent delusional conviction of patient in invasion of certain «spiritual being» (demonic or divine) inside of the body and soul is the specific core of DSPS. The psychotic episode with DSPS has similar pattern with paranoid syndrome of Kandinsky–Clérambault. Although, the structure of the syndrome is varying, and characterized by predominance of hallucinatory or delusion symptoms. According to these varieties two different types of DSPS were identified, which were observed in continuous or paroxysmal course of disease. The forms of destructive delusional behavior were also different for both of these types.

Conclusions

Delusional Syndrome of Possession in schizophrenia (DSPS) is complex and diverse phenomenon, due to religious content of delusional disorders, which occurs in specific psychopathological structure of psychotic state. This fact may cause controversy both in psychiatric practice and in religious communities. So, the obtained data could be important for social and treatment predicting, as well as for pastoral counseling.

Disclosure

No significant relationships.

Gambling disorder (GD) in youth with borderline personality disorder: Understanding comorbidity

Introduction

Epidemiological data suggest that in youth the prevalence of co-occurring borderline personality disorder (BPD) is particularly high in people with gambling disorder (GD).

Objectives

The objective of this study was to investigate clinical presentations of GD in youth patients with BPD.

Methods

Clinical psychopathological interview, SCID-II, The Gambling Symptom Assessment Scale (G-SAS), Hamilton Depression Rating Scale (HDRS), Zung Anxiety Rating Scale (ZARS). Sample: N=65 male and female, age: 18-25 with GD and BPD.

Results

GD clinical presentation in BPD patients in youth have age and individual specific signs, like polymorphism and high conjugacy with comorbid mental disorders (including, but not limited to MDD, OCD, anxiety disorders, body dysmorphic disorder and etc.) Types of GD in BPD varied due to these comorbid syndrome: 1. Subjects with GD, BPD and MDD in youth demonstrated severity progression in anticipatory tension emotional distress (mental pain, shame, guilt) and lower level in pleasure on winning the bet (G-SAS:SD/Mean 35± 3). 2. Group with OCR and Anxiety Disorders showed different profile: urges to gamble and emotional distress dominated here (G-SAS SD/Mean 32.5± 1). 3. Individuals with no clear co-occurring clinical syndromes revealed combination low level control thoughts of gambling with much excitement and pleasure on winning the bet (G-SAS:SD/Mean 41.2± 2).

Conclusions

Our research provides further insight on GD structure in youth BPD patients with comorbid psychiatric syndromes

Disclosure

No significant relationships.

Classification of first-episode schizophrenia patients, individuals at ultra-high risk for psychosis, and healthy controls using structural mri, eeg, and machine learning

Introduction

Machine learning has increasingly been applied to classification of psychosis spectrum in neuroimaging research. However, a number of multimodal studies using MRI and electroencephalography (EEG) is quite limited.

Objectives

To assess the power of multimodal structural MRI (sMRI) and EEG data to provide pairwise discrimination between first-episode schizophrenia (FES) patients, individuals at ultra-high-risk of psychosis (UHR), and healthy controls (HC) using machine learning algorithms.

Methods

46 FES male patients, 39 UHR individuals, and 54 matched HC underwent sMRI (3T Philips scanner) and electroencephalography. T1-weighted images were processed via FreeSurfer to obtain cortical and subcortical measures. L2 regularized logistic regression was used to evaluate the efficacy of diagnostic prediction.

Results

The accuracies of pairwise discriminations were: 87% for FES vs HC (specificity 83%, sensitivity 91%); 77% for FES vs UHR (specificity 76%, sensitivity 79%); 75% for UHR vs HC (specificity 77%, sensitivity 73%).

Conclusions

Current findings suggest that the patterns of anatomical and functional variability have potential as biomarkers for discrimination between schizophrenia, UHR, and healthy subjects. Furthermore, results show that the selection and multimodality of feature types are important. Specifically, adding EEG data to morphometric measures improved accuracy rates in FES vs HC and FES vs UHR contrasts, whereas standalone EEG data provided higher accuracy compared with morphometric or multimodal data in UHR vs HC discrimination. Expectedly, predictive power for the UHR was smaller than for the FES due to its intermediate anatomical features, located between those observed in healthy controls and those found in patients. The work was supported by RFBR grant 20-013-00748

Functional connectivity between brain regions underlying executive control and language in schizophrenia patients with history of auditory verbal hallucination

Introduction

Schizophrenia patients with auditory verbal hallucinations (AVH) demonstrate impaired functional connectivity (FC) between brain regions, involved in executive functions and language. However, as most studies compare patients to healthy controls, the specificity of these findings either for schizophrenia in general or for AVH is unclear.

Objectives

We aimed to compare whole-brain resting-state FC of main language brain regions between schizophrenia patients with and without history of AVH and healthy controls.

Methods

Schizophrenia male patients with (n=31; mean age 29,8±11,6) or without history of AVH (n=16; 29±12,4) and 39 healthy male controls (30±8,9) underwent resting-state fMRI on 3T Philips scanner. No between-group differences in age, illness duration, and severity of clinical symptoms except AVH were revealed. Regions of interest (ROIs) were taken from the independent fMRI study with conventional language localizer and included left inferior frontal gyrus (l_IFG) and superior temporal gyri (STG) bilaterally. Whole-brain FC of each ROI was compared between groups (ANCOVA; p<.005 voxelwise; p(FDR)<.017 clusterwise, corrected for number of ROIs) with post hoc tests.

Results

Decreased FC between each STG (left and right) and anterior cingulate cortex (ACC) was revealed in all patients, compared to healthy controls. Patients with history of AVH, compared to other groups, showed decreased FC between l_IFG and ACC.

Conclusions

Disrupted fronto-temporal FC is non-specific for AVH and characterizes all schizophrenia patients. Patients with history of AVH have impaired FC between the l_IFG, underlying language production, and ACC, involved in differentiation between language production and comprehension. The study was supported by RFBR grant 18-013-01214.

Achievement of remission after first-episode psychosis in youth

Introduction

Dynamic assessment of remission achievement after first-episode psychosis (FEP) is necessary for early detection of post-psychotic depression, negative symptoms and changes in personality traits. The latter allows to decrease suicide risk and optimize treatment and social rehabilitation.

Objectives

We aimed to analyze achievement of remission after FEP in youth and to define prognostic criteria for psychosis outcome.

Methods

Fifty-six patients (16-25 y.o., mean age 19,8 ±2,5 y.o.) after FEP have been receiving follow-up outpatient visits for 3 years. PANSS was applied to assess psychotic symptoms. Depressive symptoms were assessed with HAMD-21.

Results

Remission achievement after FEP is a three-stage process. The stage of reduction and modification of psychotic symptoms is characterized by diminishing personality deterioration and decrease of leading positive symptoms. The second stage, stabilization, is defined through the presence of depressive symptoms with positive (HAMD-21 17,49 ± 7,49) and negative affectivity (HAMD-21 23,68 ± 9,24) with preponderance of emotional, volitional, and cognitive deficits as well as high suicide risk. The third stage, reintegration, is characterized by the combination of negative symptoms with preserved personality resources. There are three reintegration trajectories, with predominant affective or negative symptoms or personality deficits. Mean decrease of PANSS scores was 54,88 ± 6,17 during the overall remission. In the majority of cases (62,5%) the stage of reintegration was finished with the achievement of high-quality remission, coinciding with international remission criteria. The study was supported by RFBR grant 18-013-01214

Conclusions

Our approach to remission assessment allowed us to decrease suicide risk and to provide optimal treatment.

Disclosure

No significant relationships.

Functional connectivity between brain regions underlying executive control and language in schizophrenia patients with history of auditory verbal hallucinations

Introduction

Schizophrenia patients with auditory verbal hallucinations (AVH) demonstrate impaired functional connectivity (FC) between brain regions, involved in executive functions and language. However, as most studies compare patients to healthy controls, the specificity of these findings either for schizophrenia in general or for AVH is unclear.

Objectives

We aimed to compare whole-brain resting-state FC of main language brain regions between schizophrenia patients with and without history of AVH and healthy controls.

Methods

Schizophrenia male patients with (n=31; mean age 29,8±11,6) or without history of AVH (n=16; 29±12,4) and 39 healthy male controls (30±8,9) underwent resting-state fMRI on 3T Philips scanner. No between-group differences in age, illness duration, and severity of clinical symptoms except AVH were revealed. Regions of interest (ROIs) were taken from the independent fMRI study with conventional language localizer and included left inferior frontal gyrus (l_IFG) and superior temporal gyri (STG) bilaterally. Whole-brain FC of each ROI was compared between groups (ANCOVA; p<.005 voxelwise; p(FDR)<.017 clusterwise, corrected for number of ROIs) with post hoc tests.

Results

Decreased FC between each STG (left and right) and anterior cingulate cortex (ACC) was revealed in all patients, compared to healthy controls. Patients with history of AVH, compared to other groups, showed decreased FC between l_IFG and ACC.

Conclusions

Disrupted fronto-temporal FC is non-specific for AVH and characterizes all schizophrenia patients. Patients with history of AVH have impaired FC between the l_IFG, underlying language production, and ACC, involved in differentiation between language production and comprehension. The study was supported by RFBR grant 18-013-01214.

Conflict of interest

The study was supported by RFBR grant 18-013-01214.

A surface-based morphometry study of risk and resilience markers associated with supramarginal thickness in schizophrenia

Introduction

Conventional structural neuroimaging methods can identify changes in cortical thickness but cannot relate these changes to specific cortical layers due to a lack of sensitivity. However, several indirect measures sensitive to changes specifically occurring in supragranular cortical layers were developed recently (github.com/kwagstyl/schizophrenia_gyral_sulcal).

Objectives

The aim was to assess the ability of these novel measures to detect cortical layers thickness characteristics potentially associated with risk or resilience to developing schizophrenia.

Methods

43 first-episode schizophrenia (FES) male patients, 29 non-converted individuals at ultra-high risk of psychosis (ncUHR, mean follow-up period – 6.5 years), and 43 matched healthy controls (HC) underwent structural MRI at 3T Philips scanner. Images were processed via FreeSurfer and MATLAB to derive two markers specific to supragranular thickness change: gyral-sulcal thickness differences (GSTD) and gyral-sulcal intrinsic curvature differences on pial surface (GSCD).

Results

GSCD measures were increased in temporal, parietal and occipital cortices, whereas both GSTD and GSCD were increased in the right frontal cortex in FES compared to HC. No GSTD or GSCD were changed in ncUHR compared to HC, and GSCD was decreased in the frontal cortex compared to FES.

Conclusions

Our findings from the indirect measures indicate a potential predominance of supragranular thinning in FES and suggest that a supragranular thinning in the right frontal lobe might be associated with precipitating risk and/or illness effects of schizophrenia. At the same time, no clear supragranular markers directly associated with resilience or risk mechanisms were identified. The work was supported by RFBR grant 20-013-00748.

Religious delusions in adolescence and young adults: Features of psychopathology and clinic

Introduction

Religious delusions is a complex psychopathological phenomenon. The delusional disorders with religious content in young age, the need for an additional detailed study of the conditions of their formation, patterns of the course and outcome of the disease determine the relevance of this study.

Objectives

To identify the psychopathological features, the conditions of formation, the characteristics of the course of psychosis with religious delusions in young age.

Methods

95 patients (62 male and 33 female) with religious delusions (delusion of sin - 33,7%, delusion of demonic possession (40,0%), messianic and antagonistic delusion - 18,9%, oneiroid with religious content – 7,4 %) in psychotic episode (F20, F25 according to the ICD-10) at a young age (16-25 years) were included in the study and examined with clinical-psychopathological, clinical-follow-up and psychometric (PSP, SANS) methods. The average duration of follow-up was 7.4 ± 2.3 years.

Results

In a post-psychotic period it is possible to preserve or form religiosity, as well as a complete reduction of the religious worldview in patients who had been indifferent to religious issues before the first episode of the disease. Though, the formation of residual psychotic symptoms with religious content were noted with greater frequency. The delusions of demon obsession in a psychosis episode is unfavorable prognostic factor.

Conclusions

General psychopathological features of psychotic states with religious delusions, according to the specificity of young age, were identified. A role of the previous religiosity, including overvalued religious ideas, was clarified.

Disclosure

No significant relationships.

Delusional disorders with religious content

Introduction

Delusional Disorders with Religious Content (DDRC) require careful study concerning their prevalence, psychopathological heterogeneity and the risk of destructive behavior.

Objectives

To classify the clinical forms of DDRC

Methods

By clinical-psychopathological, follow-up and statistical approaches 2523 cases of patients with mental disorders who received inpatient care in a state clinic for year were analyzed; in 225 cases of total 2523 delusional disorders in schizophrenia (ICD-10: F20.0, F20.01, F20.02) were diagnosed.

Results

The comparative analysis of delusional disorders (225 cases, 100%) with religious (70 cases -31.1%) and non-religious content (155 cases - 69.9%) revealed prevalence of DDRC in non-believers (p <0.01). Delusional destructive behavior occurred in 47.1% of 70 cases in patients with DDRC (15% of total 225).

Delusional disorders 225 cases (100%)
	DDRC (70 cases, 31,1%)		Delusional disorders with non-religious content (155 cases - 69.9%)
	Believers	Non-believers	Believers	Non-believers
Total Cases	18 (8%)	52 (23,1%)	4 (1,8%)	151 (67,1%)
With Destructive behavior	10 (4,4%)	23 (10,2%)	0	61 (27,1%)
	33 (14,6 %)		61 (27,1%)

The predominant content of DDRC (among the Delusions of Possession, Sinfulness/guilt, Messianism, Manichaean and the End-world Delusions) was the Delusions of Possession - 36.8%. Psychopathological heterogeneity of DDRC was identified and specific types of DDRC were described.

Conclusions

DDRC is associated with the development of massive psychopathological symptoms and significant severity, and often accompanied by various forms of destractive behavior. This circumstance requires constant and careful management of these patients, collection of their religious history and asks for specific therapeutic approaches.

Disclosure

No significant relationships.

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The role of inflammation in pathogenesis of juvenile schizophrenia

Introduction

Inflammation is now known to be a key factor in the development of schizophrenia. In this regard, the study of the pathogenic role of inflammation in the early stages of schizophrenic process is of particular importance, making it possible to assess its activity and to predict the development of the disease.

Objectives

To compare the dynamics of inflammatory markers in blood of first-episode psychosis (FEP) patients and people at risk signs for schizophrenia in the course of the treatment. Juvenile depression (JD) with attenuated symptoms of schizophrenic spectrum (ASSS) was investigated as a risk group.

Methods

The patients aged 17-25 years (20 people, of which 10 FEP patients (F20) and 10 JD with ASSS ones (F32.1-2, F32.38, F32.8)) were examined at admission to the hospital and at discharge. The controls consisted of 10 healthy volunteers. Symptom severity was collected using PANSS, SOPS, SANS, HDRS. The inflammation markers (TNF-α, IL-6, IL-10, leukocyte elastase (LE), CRP, α1-proteinase inhibitor (α1-PI), anti-S100-beta antibodies) were determined in blood.

Results

An increase of inflammatory markers in both groups compared to controls was found (p<0,05). The highest values of IL-6, LE, CRP, α1-PI and anti-S100-beta antibodies in FEP patients were revealed (p=0,03). After the treatment, the positive trend of inflammatory markers in FEP patients (p<0,05), but not in JD with ASSS patients was detected (except LE activity, p<0,05).

Conclusions

The results confirm the pathogenic role of inflammation in the development of endogenous mental disorders. The inflammatory markers studied reflect the activity of the pathological process in the early stages of schizophrenia.

Disclosure

No significant relationships.

Clinical features of pathological pseudoreligiosity in patients with mental disorders

Introduction

The term pathological pseudoreligiosity (PPR) has been chosen for description of mental disorders with religious content (MDRC), accompanied with distortion of acceptance and assimilation of religious convictions, and with significant changes in patient’s religious behavior and way of life.

Objectives

To assess the entire spectrum of mental pathology with religious content and relate it to the depth of mental disorder.

Methods

857 patients (300 males, 557 females), with religious worldview and mental disorders were observed with psychopathological and follow-up methods.

Results

The pathological pseudoreligiosity was detected in 326 patients – 38%. Follow-up period estimated mean 9,5 years. Next mental disorders with religious content were identified and described. Specific PPR types were correlated with register of the depth of mental disorder (K. Schneider):

Types of PPR	Pts		The register of mental disorders
Toxic faith	6	1,8%	Personality disorders
Anorexia due to overvalued religious convictions	12	3,7%	Neurotic register
Depressive with congruent religious ideas of sinfulness, feeling of being abandoned by God	63	19,3%	Affective register
Depressive states with overvalued doubts of belief choice.	11	3,4%
Overvalued religious behavior	13	4%	Affective-delusional
Delusion of spiritual hypochondria	7	2,2%	Delusional
Eschatological delusion	21	6,4%
Anorexia in the form of delusional behavior with religious contents	11	3,4%	Hallucinatory-delusional
Apocalyptic delusion	32	9,8%
Religious delusion	138	42,3%
Religious standing, stiffening, mutism	4	1,2%	Catatonic
Fragmentary religious ideas	8	2,5%	Organic

Conclusions

Management and treatment of patients suffering from MDRC with pathological pseudoreligiosity requires a particular approach. The consideration must be given to religious content of mental disorders and to clinical specifics of these disorders.

Disclosure

No significant relationships.

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5-years follow-up of patients with the clinical high-risk state for psychosi

Introduction

The identification of the psychosis high-risk state in help-seeking patients with depressive symptoms offers the possibility of detection and intervention at the early stages of schizophrenia.

Objectives

Estimating the 5-year follow-up rate of the manifestation of psychosis and levels of functioning in patients with the clinical high-risk state and depressive symptoms.

Methods

81 inpatients (average age 19.6 years) with depressive symptoms and attenuated psychosis (60 patients with APS and 21 patients with BLIPS). Average duration of inpatient treatment was 56.3 days, antidepressant therapy (mean dosage equivalent to fluoxetine 43.1 mg/day) and antipsychotic therapy (mean dosage equivalent to chlorpromazine 408.9 mg/day) were conducted. All patients were followed up after discharge at least during 5 years (average follow-up 7.1 years). Levels of functioning were assessed on the PSP scale.

Results

The manifestation of psychosis was identified in 21.0% (17 patients) (on average in the third year of follow-up), complete symptomatic and functional remission was established in 11.1% (9 patients) (PSP 100-81), complete symptomatic and incomplete functional remission was established in 27.2% (22 patients) (PSP 80-61). Incomplete symptomatic and incomplete functional remission – in 24.7% (20 patients) (PSP 60-41) and 13.5% (11 patients) (PSP<40).

Conclusions

The combination of antidepressants and antipsychotics therapy in patients with the clinical high-risk state for psychosis reduced the risk of psychosis manifestation but did not significantly affect the level of outcome compared to other studies.

Disclosure

No significant relationships.

Multimodal magnetic resonance spectroscopy and surface-based morphometry study of individuals at ultra-high-risk for psychosis

Introduction

Studies examining gamma-aminobutyric acid (GABA) or glutamate in ultra-high risk for psychosis (UHR) have shown conflicting results, and a number of multimodal studies examining associations between metabolite and structural characteristics is very limited.

Objectives

We aimed to investigate potential associations between GABA and glutamate levels and cortical thickness in the frontal lobe in UHR individuals and healthy controls (HC).

Methods

20 male UHR individuals and 19 healthy controls (HC) underwent structural MRI and MR spectroscopy at 3T Philips scanner. T1-weighted images were processed via FreeSurfer 6.0 to quantify cortical thickness for selected frontal regions labeled according to Desikan atlas. MEGA-PRESS acquisitions were analyzed with jMRUi (ver. 5.1 Alpha), levels of GABA and glutamate were calculated as ratios to creatine + phosphocreatine.

Results

The study revealed: 1) GABA/Cr ratios reduction in the left frontal lobe (p=0.001) which was not attributable to antipsychotic medication; 2) cortical thickness reductions in the left pars orbitalis (p=0.005) (the anterior part of the inferior frontal gyrus) in the UHR individuals compared to HC. No significant correlations between GABA/Cr ratios and cortical thickness were identified in both groups.

Conclusions

The findings indicate that the UHR state is associated with altered GABA levels and cortical thickness reductions in the prefrontal cortex. The results also show that GABA levels are not directly related to cortical abnormalities, suggesting that altered metabolite levels may be associated with a complex system of structural and functional impairments, rather than directly correlating with structural changes in separate cortical regions. The work was supported by RFBR grant 19-29-10040.

Disclosure

No significant relationships.

An overlapping pattern of cerebral cortical thinning is associated with both positive symptoms and aggression in schizophrenia via the ENIGMA consortium

BACKGROUND

Positive symptoms are a useful predictor of aggression in schizophrenia. Although a similar pattern of abnormal brain structures related to both positive symptoms and aggression has been reported, this observation has not yet been confirmed in a single sample.

METHOD

To study the association between positive symptoms and aggression in schizophrenia on a neurobiological level, a prospective meta-analytic approach was employed to analyze harmonized structural neuroimaging data from 10 research centers worldwide. We analyzed brain MRI scans from 902 individuals with a primary diagnosis of schizophrenia and 952 healthy controls.

RESULTS

The result identified a widespread cortical thickness reduction in schizophrenia compared to their controls. Two separate meta-regression analyses revealed that a common pattern of reduced cortical gray matter thickness within the left lateral temporal lobe and right midcingulate cortex was significantly associated with both positive symptoms and aggression.

CONCLUSION

These findings suggested that positive symptoms such as formal thought disorder and auditory misperception, combined with cognitive impairments reflecting difficulties in deploying an adaptive control toward perceived threats, could escalate the likelihood of aggression in schizophrenia.

Increased power by harmonizing structural MRI site differences with the ComBat batch adjustment method in ENIGMA

A common limitation of neuroimaging studies is their small sample sizes. To overcome this hurdle, the Enhancing Neuro Imaging Genetics through Meta-Analysis (ENIGMA) Consortium combines neuroimaging data from many institutions worldwide. However, this introduces heterogeneity due to different scanning devices and sequences. ENIGMA projects commonly address this heterogeneity with random-effects meta-analysis or mixed-effects mega-analysis. Here we tested whether the batch adjustment method, ComBat, can further reduce site-related heterogeneity and thus increase statistical power. We conducted random-effects meta-analyses, mixed-effects mega-analyses and ComBat mega-analyses to compare cortical thickness, surface area and subcortical volumes between 2897 individuals with a diagnosis of schizophrenia and 3141 healthy controls from 33 sites. Specifically, we compared the imaging data between individuals with schizophrenia and healthy controls, covarying for age and sex. The use of ComBat substantially increased the statistical significance of the findings as compared to random-effects meta-analyses. The findings were more similar when comparing ComBat with mixed-effects mega-analysis, although ComBat still slightly increased the statistical significance. ComBat also showed increased statistical power when we repeated the analyses with fewer sites. Results were nearly identical when we applied the ComBat harmonization separately for cortical thickness, cortical surface area and subcortical volumes. Therefore, we recommend applying the ComBat function to attenuate potential effects of site in ENIGMA projects and other multi-site structural imaging work. We provide easy-to-use functions in R that work even if imaging data are partially missing in some brain regions, and they can be trained with one data set and then applied to another (a requirement for some analyses such as machine learning).

Cortical Brain Abnormalities in 4474 Individuals With Schizophrenia and 5098 Control Subjects via the Enhancing Neuro Imaging Genetics Through Meta Analysis (ENIGMA) Consortium

BACKGROUND

The profile of cortical neuroanatomical abnormalities in schizophrenia is not fully understood, despite hundreds of published structural brain imaging studies. This study presents the first meta-analysis of cortical thickness and surface area abnormalities in schizophrenia conducted by the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) Schizophrenia Working Group.

METHODS

The study included data from 4474 individuals with schizophrenia (mean age, 32.3 years; range, 11-78 years; 66% male) and 5098 healthy volunteers (mean age, 32.8 years; range, 10-87 years; 53% male) assessed with standardized methods at 39 centers worldwide.

RESULTS

Compared with healthy volunteers, individuals with schizophrenia have widespread thinner cortex (left/right hemisphere: Cohen's d = -0.530/-0.516) and smaller surface area (left/right hemisphere: Cohen's d = -0.251/-0.254), with the largest effect sizes for both in frontal and temporal lobe regions. Regional group differences in cortical thickness remained significant when statistically controlling for global cortical thickness, suggesting regional specificity. In contrast, effects for cortical surface area appear global. Case-control, negative, cortical thickness effect sizes were two to three times larger in individuals receiving antipsychotic medication relative to unmedicated individuals. Negative correlations between age and bilateral temporal pole thickness were stronger in individuals with schizophrenia than in healthy volunteers. Regional cortical thickness showed significant negative correlations with normalized medication dose, symptom severity, and duration of illness and positive correlations with age at onset.

CONCLUSIONS

The findings indicate that the ENIGMA meta-analysis approach can achieve robust findings in clinical neuroscience studies; also, medication effects should be taken into account in future genetic association studies of cortical thickness in schizophrenia.

Upper ministernotomy for mitral valve replacement via superior approach

This video tutorial demonstrates the surgical technique for mitral valve replacement through the roof of the left atrium via an upper inverted T-shaped ministernotomy, with central cannulation for cardiopulmonary bypass.

Executive Function Assessment in Young Hospitalized Schizophrenic Patients with the “CANTAB Schizophrenia Battery” (Russian Sample)

Introduction

Impairment of executive function is the fundamental feature of the cognitive dysfunction in schizophrenia has to be measured throughout the illness regularly. Computerized technologies for assessment of cognitive dysfunction are widely used. However, their applicability in hospitalized schizophrenic patients setting should be specially examined.

Objective

Executive function in schizophrenia.

Aims

To test the applicability of “CANTAB” neurocognitive battery for measurement of executive function in young hospitalized schizophrenic patients in Russian sample.

Methods

Fifteen inpatients diagnosed with schizophrenia according to ICD-10 (F 20.хх), 13 males and 2 females, aged 23.5(SD 3.2), disease duration is 5(SD 1.6) years and 16 healthy individuals, 7 males and 9 females, aged 21.3(SD 0.7). Spatial Working Memory (SWM) (Mnemonic Executive function), Stockings of Cambridge (OTS) (Planning Executive function), Intra/Extra-Dimensional Shift (IED) (Cognitive flexibility) were administered.

Results

The majority of patients and controls easily understood the test instructions. Both groups did not have any difficulties with the touchpad. The “CANTAB” demonstrated sensitivity to the impairments of executive function. As a group, patients with schizophrenia performed significantly worse than controls on almost all tests: SWM–Between errors (P = 0.028), Total errors (P = 0.019), Strategy (P = 0.03), Mean time to last response (P = 0.001); OTS–Mean choices to correct (P = 0.044), Problems solved on first choice (P = 0.009), Probability of error given correct (P = 0.021); IED–Total errors (P = 0.015), Total trials (P = 0.002).

Conclusion

The “CANTAB” is an applicable instrument for assessment of the executive function in young hospitalized schizophrenic patients. It can be used both for experimental and clinical needs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Arginine vasopressin 1a receptor RS3 promoter microsatellites in schizophrenia: a study of the effect of the "risk" allele on clinical symptoms and facial affect recognition

We studied AVPR1A RS3 polymorphism in schizophrenic patients and controls. AVPR1A RS3 was not associated with schizophrenia. The allele 327bp implicated in autism and social behavior was associated with negative symptoms and tended to be linked to patient facial affect recognition suggesting its impact on schizophrenia social phenotypes.

Common variant at 16p11.2 conferring risk of psychosis

Epidemiological and genetic data support the notion that schizophrenia and bipolar disorder share genetic risk factors. In our previous genome-wide association study, meta-analysis and follow-up (totaling as many as 18 206 cases and 42 536 controls), we identified four loci showing genome-wide significant association with schizophrenia. Here we consider a mixed schizophrenia and bipolar disorder (psychosis) phenotype (addition of 7469 bipolar disorder cases, 1535 schizophrenia cases, 333 other psychosis cases, 808 unaffected family members and 46 160 controls). Combined analysis reveals a novel variant at 16p11.2 showing genome-wide significant association (rs4583255[T]; odds ratio=1.08; P=6.6 × 10(-11)). The new variant is located within a 593-kb region that substantially increases risk of psychosis when duplicated. In line with the association of the duplication with reduced body mass index (BMI), rs4583255[T] is also associated with lower BMI (P=0.0039 in the public GIANT consortium data set; P=0.00047 in 22 651 additional Icelanders).

Common variants at VRK2 and TCF4 conferring risk of schizophrenia

Common sequence variants have recently joined rare structural polymorphisms as genetic factors with strong evidence for association with schizophrenia. Here we extend our previous genome-wide association study and meta-analysis (totalling 7 946 cases and 19 036 controls) by examining an expanded set of variants using an enlarged follow-up sample (up to 10 260 cases and 23 500 controls). In addition to previously reported alleles in the major histocompatibility complex region, near neurogranin (NRGN) and in an intron of transcription factor 4 (TCF4), we find two novel variants showing genome-wide significant association: rs2312147[C], upstream of vaccinia-related kinase 2 (VRK2) [odds ratio (OR) = 1.09, P = 1.9 × 10(-9)] and rs4309482[A], between coiled-coiled domain containing 68 (CCDC68) and TCF4, about 400 kb from the previously described risk allele, but not accounted for by its association (OR = 1.09, P = 7.8 × 10(-9)).

The 844ins68 polymorphism of the cystathionine beta-synthase gene is associated with schizophrenia

A subtle genetic defect in homocysteine metabolism is thought to play an etiologic role in schizophrenia. Cystathionine-beta-synthase (CBS) is a key enzyme related to homocysteine levels. The aim of the present study was to search for association between the 844ins68 polymorphism of the CBS gene and schizophrenia in a large Russian sample using case-control and family-based designs. The sample comprised 1135 patients, 626 controls and 172 families. There was a trend for association between the 844ins68 polymorphism and schizophrenia in the case-control study, with higher frequency of the insertion in the control group. The FBAT revealed a statistically significant difference in transmission of alleles from parents to the affected proband, with preferential transmission of the variant without insertion. When the sample of patients was stratified by sex and forms of schizophrenia, the significantly lower frequency of insertion was observed in the group of female patients with chronic schizophrenia (n=180) as compared to psychiatrically well women. The insertion variant has been reported earlier to be related to decreased levels of homocysteine and thus thought to play a protective role. In conclusion, our study revealed a possible relation of the CBS 844ins68 polymorphism to schizophrenia.

Common variants conferring risk of schizophrenia

Schizophrenia is a complex disorder, caused by both genetic and environmental factors and their interactions. Research on pathogenesis has traditionally focused on neurotransmitter systems in the brain, particularly those involving dopamine. Schizophrenia has been considered a separate disease for over a century, but in the absence of clear biological markers, diagnosis has historically been based on signs and symptoms. A fundamental message emerging from genome-wide association studies of copy number variations (CNVs) associated with the disease is that its genetic basis does not necessarily conform to classical nosological disease boundaries. Certain CNVs confer not only high relative risk of schizophrenia but also of other psychiatric disorders. The structural variations associated with schizophrenia can involve several genes and the phenotypic syndromes, or the 'genomic disorders', have not yet been characterized. Single nucleotide polymorphism (SNP)-based genome-wide association studies with the potential to implicate individual genes in complex diseases may reveal underlying biological pathways. Here we combined SNP data from several large genome-wide scans and followed up the most significant association signals. We found significant association with several markers spanning the major histocompatibility complex (MHC) region on chromosome 6p21.3-22.1, a marker located upstream of the neurogranin gene (NRGN) on 11q24.2 and a marker in intron four of transcription factor 4 (TCF4) on 18q21.2. Our findings implicating the MHC region are consistent with an immune component to schizophrenia risk, whereas the association with NRGN and TCF4 points to perturbation of pathways involved in brain development, memory and cognition.

Association study of three polymorphisms in the dopamine D2 receptor gene and schizophrenia in the Russian population

Polymorphisms in the dopamine D2 receptor gene (DRD2) have repeatedly been associated with schizophrenia. Recently, the C957T polymorphism (rs6277), which alters mRNA stability and dopamine-induced upregulation of DRD2 expression in cell cultures and DRD2 mRNA translation in vitro, was tested for an association with the disease. Frequency of the C allele, corresponding to a normal wild-type level of expression, was higher in patients compared to controls, and that of the T allele was lower. To replicate and extend previous findings, we conducted an association study of the C957T polymorphism and two additional SNPs (C939T and TaqIA) in 311 patients with a DSM-IV diagnosis of schizophrenia and 364 mentally healthy people from the Russian population as controls. The results of our study confirmed the association between the C957T polymorphism and schizophrenia. Consistent with previous findings, frequency of the C allele and the CC genotype were higher in patients compared to the control group (p=0.002). Meta-analysis of total 5 samples also suggests significant allelic association. The distribution of C939T genotypes in the case sample was significantly different from that of the controls: in the case sample, the TT genotype frequency was higher compared to the combined frequency of CT and CC genotypes (p=0.002). Though no association was found between the TaqIA polymorphism and schizophrenia, a haplotype-wise analysis revealed a lower frequency of the T-C (C957T-TaqIA) haplotype in patients (p=0.02). In conclusion, our findings provide additional evidence for an association between the C957T polymorphism and schizophrenia.

Association study of COMT gene Val158Met polymorphism with auditory P300 and performance on neurocognitive tests in patients with schizophrenia and their relatives

A number of studies have reported an association between catechol-O-methyltransferase (COMT) gene Val158Met polymorphism and neuropsychological traits in patients with schizophrenia, their relatives and healthy controls, with the Met allele carriers performing better on neurocognitive tasks than those with the Val allele. But the association was not confirmed in all studies. The present paper was aimed at further investigation of the COMT gene relationship with some neurocognitive traits, assessing mainly working and verbal memory, and to P300 event-related potentials (auditory oddball). A total sample of 319 individuals, including schizophrenic patients, their relatives and controls, was studied. No significant differences in performance of neurocognitive tasks were found by Val158Met genotypes. An association was observed between the Met/Met genotype and higher amplitude in centro-parietal area in relatives. Factors that could explain the non-replication of previous studies on the COMT gene polymorphism and neurocognitive traits are discussed. We suggest here that (1) Val158Met polymorphism rather exerts a modifying influence on brain activation in general than impacts directly on performance of the particular neurocognitive test, and (2) P300 amplitude seems to be a correlate of this activation reflecting, along with information processing, the subject's affective and personality features.