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Borgen I, Romney MC, Redwood N, Delgado B, Alea P, George BH, Puzziferro J, Shihabuddin L. From Hospital to Home: An Intensive Transitional Care Management Intervention for Patients with COVID-19. Popul Health Manag 2020; 24:27-34. [PMID: 33054603 DOI: 10.1089/pop.2020.0178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Implementing emergency department (ED) and hospital patient throughput management coupled with at-home medical and tele-management upon discharge may increase surge capacity during national emergencies and pandemics. This novel intensive transitional care management (ITCM) intervention presents the opportunity to optimize hospital bed capacity through prevention of inpatient admissions for patients who could be discharged home safely with appropriate in-home medical support and tele-management. This observational cohort intervention was conducted between April 7, 2020 and April 30, 2020, at the 4 largest inpatient facilities of RWJBarnabas Health System in New Jersey. The intervention group included a convenience sample of 192 patients who were evaluated in the ED, monitored in the observation unit, or admitted to the hospital with a diagnosis of mild-to-moderate COVID-19 infection. Their outcomes were compared to a matched comparison group of 593 patients who were admitted with the same COVID-19-related diagnosis and severity. The primary outcome was the reduction in inpatient days as a result of the intervention that included provision of at-home oxygen supplementation therapy, expanded home care services, and tele-management sessions. Secondary outcomes were re-encounters with the health system in the ED, observation unit, or inpatient readmissions. A total of 481.6 hospital patient days were avoided for 78 patients who had been discharged from the ED or observation unit stays. Secondary analysis included hospital readmission rates. The ITCM intervention demonstrated a feasible strategy for improving throughput of patients with COVID-19, resulting in increased hospital bed capacity.
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Mitelman SA, Bralet MC, Haznedar MM, Hollander E, Shihabuddin L, Hazlett EA, Buchsbaum MS. Diametrical relationship between gray and white matter volumes in autism spectrum disorder and schizophrenia. Brain Imaging Behav 2018; 11:1823-1835. [PMID: 27882449 DOI: 10.1007/s11682-016-9648-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Autism spectrum disorders and schizophrenia have been variously characterized as separate nosological entities with overlapping deficits in social cognition or diametrical extremes of a phenotypic continuum. This study aimed to determine how these models apply to comparative morphometric data. MRI scans of the brain were obtained in 49 subjects with schizophrenia, 20 subjects with autism and 39 healthy controls. Images were parcellated into 40 Brodmann areas and entered into repeated-measures ANOVA for between-group comparison of global and localized gray and white matter volumes. A pattern of lower gray mater volumes and greater white matter volumes was found in subjects with schizophrenia in comparison to subjects with autism. For both gray and white matter, this pattern was most pronounced in regions associated with motor-premotor and anterior frontal cortex, anterior cingulate, fusiform, superior and middle temporal gyri. Patient groups tended to diverge from healthy controls in opposite directions, with greater-than-normal gray matter volumes and lower-than-normal white matter volumes in subjects with autism and reversed patterns in subjects with schizophrenia. White matter reductions in subjects with autism were seen in posterior frontal lobe and along the cingulate arch. Normal hemispheric asymmetry in the temporal lobe was effaced in subjects with autism and schizophrenia, especially in the latter. Nearly identical distribution of changes and diametrically divergent volumetry suggest that autism and schizophrenia may occupy opposite extremes of the same cognitive continuum.
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Mitelman SA, Bralet MC, Mehmet Haznedar M, Hollander E, Shihabuddin L, Hazlett EA, Buchsbaum MS. Positron emission tomography assessment of cerebral glucose metabolic rates in autism spectrum disorder and schizophrenia. Brain Imaging Behav 2018; 12:532-546. [PMID: 28425060 PMCID: PMC5648637 DOI: 10.1007/s11682-017-9721-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Several models have been proposed to account for observed overlaps in clinical features and genetic predisposition between schizophrenia and autism spectrum disorder. This study assessed similarities and differences in topological patterns and vectors of glucose metabolism in both disorders in reference to these models. Co-registered 18fluorodeoxyglucose PET and MRI scans were obtained in 41 schizophrenia, 25 ASD, and 55 healthy control subjects. AFNI was used to map cortical and subcortical regions of interest. Metabolic rates were compared between three diagnostic groups using univariate and multivariate repeated-measures ANOVA. Compared to controls, metabolic rates in schizophrenia subjects were decreased in the frontal lobe, anterior cingulate, superior temporal gyrus, amygdala and medial thalamic nuclei; rates were increased in the occipital cortex, hippocampus, basal ganglia and lateral thalamic nuclei. In ASD subjects metabolic rates were decreased in the parietal lobe, frontal premotor and eye-fields areas, and amygdala; rates were increased in the posterior cingulate, occipital cortex, hippocampus and basal ganglia. In relation to controls, subjects with ASD and schizophrenia showed opposite changes in metabolic rates in the primary motor and somatosensory cortex, anterior cingulate and hypothalamus; similar changes were found in prefrontal and occipital cortices, inferior parietal lobule, amygdala, hippocampus, and basal ganglia. Schizophrenia and ASD appear to be associated with a similar pattern of metabolic abnormalities in the social brain. Divergent maladaptive trade-offs, as postulated by the diametrical hypothesis of their evolutionary relationship, may involve a more circumscribed set of anterior cingulate, motor and somatosensory regions and the specific cognitive functions they subserve.
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Bralet MC, Buchsbaum MS, DeCastro A, Hazlett EA, Mehmet Haznedar M, Shihabuddin L, Mitelman SA. Erratum to: FDG-PET scans in patients with Kraepelinian and non-Kraepelinian schizophrenia. Eur Arch Psychiatry Clin Neurosci 2016; 266:379. [PMID: 26620489 DOI: 10.1007/s00406-015-0661-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Casey DA, Rodriguez M, Northcott C, Vickar G, Shihabuddin L. Schizophrenia: medical illness, mortality, and aging. Int J Psychiatry Med 2011; 41:245-51. [PMID: 22073763 DOI: 10.2190/pm.41.3.c] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Schizophrenia is a devastating and common psychiatric disorder which is associated with a high degree of medical morbidity and reduced life span in addition to psychosis. In this article, these problems will be discussed in the context of schizophrenia and aging. METHOD The recent literature was reviewed using Pubmed, Medline, and Google scholar with the search terms "schizophrenia, aging, medical problems." RESULTS Schizophrenia is associated with significant medical morbidity and mortality. Diabètes and cardiovascular disease, along with smoking and obesity, are over-represented and contribute to reduced quality of life and life span. Schizophrenics often receive poor medical care. CONCLUSIONS The impacts of schizophrenia on physical health and successful aging have been underestimated. Psychiatrists and primary care physicians need to address the overlapping medical and psychiatric aspects of the disorder while the medical care system for these patients requires a much higher degree of coordination than is currently available.
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Studer S, Regala M, Migliore C, Sharif I, Shihabuddin L, Zucker M, Baran D. 303 A Pilot Observational Study of the Correlation between Depression and Quality of Life Measured by the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR). J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Mitelman SA, Nikiforova YK, Canfield EL, Hazlett EA, Brickman AM, Shihabuddin L, Buchsbaum MS. A longitudinal study of the corpus callosum in chronic schizophrenia. Schizophr Res 2009; 114:144-53. [PMID: 19713080 PMCID: PMC2763416 DOI: 10.1016/j.schres.2009.07.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 07/25/2009] [Accepted: 07/27/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Decreased callosal size and anisotropy have been described in schizophrenia patients but their longitudinal progression remains poorly understood. METHODS We performed diffusion-tensor and structural magnetic resonance imaging at baseline and at follow-up four years later in 49 chronic schizophrenia patients and 16 healthy comparison subjects. Schizophrenia patients were subdivided into good-outcome (n=23) and poor-outcome (n=26) groups. Baseline-to-follow-up changes in size, shape, position and fractional anisotropy of the corpus callosum, divided into five sagittal sections and five rostro-caudal segments, were assessed. RESULTS At baseline scan and in comparison to healthy subjects, schizophrenia patients displayed 1) smaller callosal size, 2) lower average anisotropy in all sagittal sections except the midline, and 3) more dorsal average coordinate position. During the four years after the baseline scan, patients with schizophrenia exhibited a more pronounced decline in absolute size of the corpus callosum than healthy comparison subjects. As compared with the good-outcome group, the corpus callosum in poor-outcome patients at baseline was of smaller size and lower average anisotropy, more elongated and posteriorly positioned. During the follow-up interval, poor-outcome patients displayed a more pronounced decline in size but less pronounced decline in anisotropy of the corpus callosum than patients with good outcomes. CONCLUSIONS Differences in callosal size between schizophrenia patients and healthy subjects seen at baseline continue to widen in the chronic phase of the illness, especially in patients with poor functional outcome. Baseline differences in callosal anisotropy among patients with different outcomes, however, diminish over time.
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Mitelman SA, Canfield EL, Newmark RE, Brickman AM, Torosjan Y, Chu KW, Hazlett EA, Haznedar MM, Shihabuddin L, Buchsbaum MS. [Not Available]. Open Neuroimag J 2009; 3:31-47. [PMID: 19547667 PMCID: PMC2700015 DOI: 10.2174/1874440000903010031] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Revised: 02/17/2009] [Accepted: 02/18/2009] [Indexed: 11/22/2022] Open
Abstract
Previous studies have reported continued focal gray matter loss after the clinical onset of schizophrenia. Longitudinal assessments in chronic illness, of white matter in particular, have been less conclusive. We used diffusion-tensor and structural magnetic resonance imaging in 16 healthy subjects and 49 chronic schizophrenia patients, subdivided into good-outcome (n=23) and poor-outcome (n=26) groups, scanned twice 4 years apart. Fractional anisotropy, gray matter and white matter volumes were parcellated into the Brodmann’s areas and entered into multiway ANCOVAs. At baseline, schizophrenia patients had 1) lower anisotropy in frontoparietal white matter, 2) larger posterior frontal white matter volumes, and 3) smaller frontal, temporal, and parietal gray matter volumes. On follow-up, healthy subjects showed a more pronounced 1) decline in anisotropy, 2) expansion of regional white matter volumes, and 3) reduction in regional gray matter volumes than schizophrenia patients. Good-outcome patients showed a more pronounced decline in white matter anisotropy and a less pronounced increase in white matter volumes than poor-outcome patients. Poor-outcome patients displayed a greater gray matter loss throughout the brain than good-outcome patients. In the chronic phase of the illness, longitudinal changes in both gray and white matter are in the direction of an effacement of between-group differences among schizophrenia patients and healthy subjects. Similarly, preexisting white matter differences between good-outcome and poor-outcome patients diminish over time. In contrast, gray matter volumes in poor-outcome patients continue to decline more rapidly than in patients with good outcome. These patterns are consistent with earlier onset of aging-associated changes in schizophrenia.
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Schneiderman JS, Buchsbaum MS, Haznedar MM, Hazlett EA, Brickman AM, Shihabuddin L, Brand JG, Torosjan Y, Newmark RE, Canfield EL, Tang C, Aronowitz J, Paul-Odouard R, Hof PR. Age and diffusion tensor anisotropy in adolescent and adult patients with schizophrenia. Neuroimage 2009; 45:662-71. [PMID: 19168139 DOI: 10.1016/j.neuroimage.2008.12.057] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 12/15/2008] [Accepted: 12/31/2008] [Indexed: 11/24/2022] Open
Abstract
Findings of white matter pathology as indicated by diffusion tensor anisotropy values in schizophrenia are well established, but the differences in this measure between the onset of the disease and the chronic state are not well known. To investigate the differences between these states in the progression of the disease of schizophrenia we acquired 1.5 T diffusion tensor anisotropy images on 35 adult patients with schizophrenia and schizoaffective disorder, 23 adolescents having their first psychotic episode, and age and sex matched controls (33 adults and 15 adolescents). Regions of interest in major cortical white matter tracts chosen as salient to the prefrontal executive deficit in schizophrenia were assessed using stereotaxic coordinates from the Talairach and Tournoux atlas. Regions of each tract along anterior-posterior and/or inferior-superior directions in both hemispheres were evaluated in multiway ANOVA. Tracts between the frontal lobe and other brain regions, but not temporal, occipital and interhemispheric tracts, showed a differential aging pattern in normals and patients indicating that the white matter pathology in these regions is not stable between the onset and the chronic state in schizophrenia. This suggests that tracts involved in the connectivity of the temporal lobe white matter deficits were already well in place in adolescent patients, while frontal lobe pathology continues to develop from adolescence to adulthood.
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Dodge J, Treleaven C, Yang W, Clarke J, Martin H, Handy C, Hester M, Taksir T, Griffiths D, Cheng S, Kaspar B, Shihabuddin L. G.P.11.07 AAV mediated gene transfer of IGF-1 and VEGF to the ventricular system provides significant therapeutic benefit in a mouse model of amyotrophic lateral sclerosis. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mitelman SA, Brickman AM, Shihabuddin L, Newmark RE, Hazlett EA, Haznedar MM, Buchsbaum MS. A comprehensive assessment of gray and white matter volumes and their relationship to outcome and severity in schizophrenia. Neuroimage 2007; 37:449-62. [PMID: 17587598 PMCID: PMC1994089 DOI: 10.1016/j.neuroimage.2007.04.070] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 04/17/2007] [Accepted: 04/30/2007] [Indexed: 10/23/2022] Open
Abstract
Preliminary data suggest an association of posterior cortical gray matter reduction with poor outcome in schizophrenia. We made a systematic MRI assessment of regional gray and white matter volumes, parcellated into 40 Brodmann's areas, in 104 patients with schizophrenia (51 with good outcomes, 53 with poor outcomes) and 41 normal comparison subjects, and investigated correlations of regional morphometry with outcome and severity of the illness. Schizophrenia patients displayed differential reductions in frontal and to a lesser degree temporal gray matter volumes in both hemispheres, most pronounced in the frontal pole and lateral temporal cortex. White matter volumes in schizophrenia patients were bilaterally increased, primarily in the frontal, parietal, and isolated temporal regions, with volume reductions confined to anterior cingulate gyrus. In patients with schizophrenia as a group, higher illness severity was associated with reduced temporal gray matter volumes and expanded frontal white matter volumes in both hemispheres. In comparison to good-outcome group, patients with poor outcomes had lower temporal, occipital, and to a lesser degree parietal gray matter volumes in both hemispheres and temporal, parietal, occipital, and posterior cingulate white matter volumes in the right hemisphere. While gray matter deficits in the granular cortex were observed in all schizophrenia patients, agranular cortical deficits in the left hemisphere were peculiar to patients with poor outcomes. These results provide support for frontotemporal gray matter reduction and frontoparietal white matter expansion in schizophrenia. Poor outcome is associated with more posterior distribution (posteriorization) of both gray and white matter changes, and with preferential impairment in the unimodal visual and paralimbic cortical regions.
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Mitelman SA, Torosjan Y, Newmark RE, Schneiderman JS, Chu KW, Brickman AM, Haznedar MM, Hazlett EA, Tang CY, Shihabuddin L, Buchsbaum MS. Internal capsule, corpus callosum and long associative fibers in good and poor outcome schizophrenia: a diffusion tensor imaging survey. Schizophr Res 2007; 92:211-24. [PMID: 17329081 DOI: 10.1016/j.schres.2006.12.029] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 12/25/2006] [Accepted: 12/29/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prior voxelwise studies of white matter anisotropy found widespread reductions involving all major fiber tracts of the schizophrenic brain. We set out to confirm these exploratory findings and evaluate their relation to illness severity using a hypothesis-driven region-of-interest approach. METHODS 104 schizophrenia patients (51 with good outcomes, 53 with poor outcomes) and 41 matched comparison subjects participated in the study. Regions of interest were selected on the basis of published voxelwise findings and placed within major fiber tracts using Talairach's stereotaxic coordinates. RESULTS Fractional anisotropy reductions in schizophrenia patients were confirmed in the left cingulum, anterior thalamic radiation, fronto-occipital and inferior longitudinal fasciculi, as well as bilaterally in the corpus callosum, anterior and posterior limbs of internal capsule, superior longitudinal fasciculus, optic radiation, and frontotemporal extrafascicular white matter. Anisotropy reductions were more extensive in patients with poor outcomes ("Kraepelinian"), particularly in the posterior corpus callosum, fronto-occipital fasciculus, left optic radiation and frontotemporal white matter. Lower anisotropy in the right hemisphere tracts was associated with more prominent positive symptomatology, whereas negative symptoms were inversely associated with anisotropy values in both hemispheres. CONCLUSIONS These results support a global neural disconnectivity in schizophrenia patients, which is more severe in those with poor clinical outcomes.
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Schneiderman JS, Buchsbaum MS, Haznedar MM, Hazlett EA, Brickman AM, Shihabuddin L, Brand JG, Torosjan Y, Newmark RE, Tang C, Aronowitz J, Paul-Odouard R, Byne W, Hof PR. Diffusion tensor anisotropy in adolescents and adults. Neuropsychobiology 2007; 55:96-111. [PMID: 17587876 PMCID: PMC2806688 DOI: 10.1159/000104277] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 10/03/2006] [Indexed: 12/13/2022]
Abstract
We acquired diffusion tensor images on 33 normal adults aged 22-64 and 15 adolescents aged 14-21. We assessed relative anisotropy in stereotaxically located regions of interest in the internal capsule, corpus callosum, anterior thalamic radiations, frontal anterior fasciculus, fronto-occipital fasciculus, temporal lobe white matter, cingulum bundle, frontal inferior longitudinal fasciculus, frontal superior longitudinal fasciculus, and optic radiations. All of these structures except the optic radiations, corpus callosum, and frontal inferior longitudinal fasciculus exhibited differences in anisotropy between adolescents and adults. Areas with anisotropy increasing with age included the anterior limb of the internal capsule, superior levels of the frontal superior longitudinal fasciculus and the inferior portion of the temporal white matter. Areas with anisotropy decreasing with age included the posterior limb of the internal capsule, anterior thalamic radiations, fronto-occipital fasciculus, anterior portion of the frontal anterior fasciculus, inferior portion of the frontal superior longitudinal fasciculus, cingulum bundle and superior portion of the temporal axis. Sex differences were found in the majority of areas but were most marked in the cingulum bundle and internal capsule. These results suggest continuing white matter development between adolescence and adulthood.
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Buchsbaum MS, Schoenknecht P, Torosjan Y, Newmark R, Chu KW, Mitelman S, Brickman AM, Shihabuddin L, Haznedar MM, Hazlett EA, Ahmed S, Tang C. Diffusion tensor imaging of frontal lobe white matter tracts in schizophrenia. Ann Gen Psychiatry 2006; 5:19. [PMID: 17132158 PMCID: PMC1687182 DOI: 10.1186/1744-859x-5-19] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Accepted: 11/28/2006] [Indexed: 11/17/2022] Open
Abstract
We acquired diffusion tensor and structural MRI images on 103 patients with schizophrenia and 41 age-matched normal controls. The vector data was used to trace tracts from a region of interest in the anterior limb of the internal capsule to the prefrontal cortex. Patients with schizophrenia had tract paths that were significantly shorter in length from the center of internal capsule to prefrontal white matter. These tracts, the anterior thalamic radiations, are important in frontal-striatal-thalamic pathways. These results are consistent with findings of smaller size of the anterior limb of the internal capsule in patients with schizophrenia, diffusion tensor anisotropy decreases in frontal white matter in schizophrenia and hypothesized disruption of the frontal-striatal-thalamic pathway system.
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Brickman AM, Buchsbaum MS, Ivanov Z, Borod JC, Foldi NS, Hahn E, Mitelman SA, Hazlett EA, Lincoln SJ, Newmark RE, Shihabuddin L. Internal capsule size in good-outcome and poor-outcome schizophrenia. J Neuropsychiatry Clin Neurosci 2006; 18:364-76. [PMID: 16963586 DOI: 10.1176/jnp.2006.18.3.364] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Converging lines of research suggest that white matter abnormalities may be central to the pathophysiology of schizophrenia. The purpose of this study was to examine regional white matter in the anterior limb of the internal capsules in patients with schizophrenia. The authors obtained high-resolution magnetic resonance imaging in 106 patients with schizophrenia and 42 age and sex-matched healthy comparison subjects. The area of the anterior limb of the internal capsule was measured at five proportionately spaced dorsal-to-ventral levels. Schizophrenia patients were divided into good-outcome and poor-outcome groups, based on longitudinal analysis of self-care deficits. Patients with poor-outcome had significantly smaller dorsal areas than healthy comparison subjects, but good-outcome patients did not differ from healthy comparison subjects. Larger relative volumes of the caudate, putamen, and thalamus tended to be associated with relatively larger volumes of the internal capsule in healthy comparison subjects and good-outcome patients, consistent with the known frontal-striatal-thalamic pathways. Larger ventricles were associated with smaller internal capsules, particularly in healthy comparison subjects. The findings suggest disruption of internal capsule fibers in poor-outcome patients with schizophrenia. These abnormalities may be independent of other structural changes in schizophrenia.
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Mitelman SA, Newmark RE, Torosjan Y, Chu KW, Brickman AM, Haznedar MM, Hazlett EA, Tang CY, Shihabuddin L, Buchsbaum MS. White matter fractional anisotropy and outcome in schizophrenia. Schizophr Res 2006; 87:138-59. [PMID: 16854563 DOI: 10.1016/j.schres.2006.06.016] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Revised: 06/03/2006] [Accepted: 06/07/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Disparate white matter fractional anisotropy (FA) findings have been reported in patients with schizophrenia in recent years. This may in part reflect heterogeneity of subjects in the studies, including differences in outcome and severity of the illness. We examined whether there is a relationship between white matter FA and outcome in patients with schizophrenia. METHOD Diffusion-tensor images were obtained in 41 normal subjects and 104 patients with schizophrenia, divided into good-outcome (n=51) and poor-outcome (Kraepelinian; n=53) subtypes based on their ability for self-care. White matter FA and its relationship to regional tissue volumes were evaluated across 40 individual Brodmann's areas using a semi-automated parcellation technique. RESULTS Overall white matter FA was lower in schizophrenia patients than normal subjects, with regional reductions in widespread temporoparietal and selected prefrontal white matter regions. In schizophrenia patients, lower regional white matter FA was associated with lower regional gray matter volumes. In comparison to normal subjects, overall white matter FA was reduced in patients with poor outcomes in both hemispheres, but to a lesser extent and only in the right hemisphere in good-outcome patients. Lower regional FA was associated with larger regional white matter volumes in good-outcome group. CONCLUSIONS Global FA reductions implicate white matter as tissue type in the pathophysiology of schizophrenia. In contrast to poor outcome, good outcome in schizophrenia patients may be associated with less extensive FA reductions, higher FA in regional frontal and cingulate white matter, and correlated increases in regional white matter volumes, particularly in the left hemisphere.
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Mitelman SA, Buchsbaum MS, Brickman AM, Shihabuddin L. Cortical intercorrelations of frontal area volumes in schizophrenia. Neuroimage 2005; 27:753-70. [PMID: 15990338 DOI: 10.1016/j.neuroimage.2005.05.024] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2004] [Revised: 05/03/2005] [Accepted: 05/05/2005] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Abnormal regional volume intercorrelations between selected cortical areas in schizophrenia patients were previously reported in several MRI studies. METHODS A detailed analysis of frontal gray and white matter volume correlations with Brodmann's area volumes in the rest of the cortex was undertaken in normal subjects (n = 42) and patients with schizophrenia (n = 106), divided into good-outcome (n = 52) and poor-outcome (Kraepelinian; n = 54) subtypes. RESULTS Frontal gray matter volumes were correlated with temporal lobe volumes in schizophrenics but not in normal subjects. Some frontal-parietal and frontal-occipital correlations showed a similar pattern. In comparison to normal subjects, schizophrenia patients showed weaker or absent intercorrelations intrafrontally, specifically between left motor-premotor and eye-movement areas (4, 6, 8) and dorsolateral area 44, as well as between left areas 9 and 46 vs. area 24 (cingulate gyrus). Poor outcome among patients with schizophrenia was associated with weaker correlations between left frontal area 9 and both medial and lateral temporal cortices, as compared to normal subjects or good-outcome patients. CONCLUSIONS There appears to be a structural component in the task or symptom-related dysfunctional interactions between the frontal and more posterior cortical regions with preferential pathological involvement of frontotemporal and more limited involvement of frontoparietal and fronto-occipital systems in schizophrenia. Impaired regional associations within the frontal lobe, between left motor-premotor and Broca's areas, may play a role in language processing deficits in schizophrenia, while frontocingulate disconnection may result in working memory disturbances. Poor outcome may be associated with more widespread disconnections between prefrontal vs. cingulate and temporal regions in the left hemisphere, consistent with a disruption along the course of the left cingulum or uncinate bundles.
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Mitelman SA, Shihabuddin L, Brickman AM, Buchsbaum MS. Cortical intercorrelations of temporal area volumes in schizophrenia. Schizophr Res 2005; 76:207-29. [PMID: 15949654 DOI: 10.1016/j.schres.2005.01.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Revised: 01/14/2005] [Accepted: 01/18/2005] [Indexed: 12/27/2022]
Abstract
BACKGROUND Abnormal temporal connections with other cortical areas may underlie some of the most prominent cognitive deficits described in schizophrenia. In order to evaluate the relationship between temporal and other cortical regions in schizophrenia, we examined the intercorrelations of volumetric measures of gray and white matter for each Brodmann's area of the temporal lobe with volumes in the rest of the cortex in patients with schizophrenia and normal comparison subjects. METHODS MR images were acquired in normal subjects (n=46) and patients with schizophrenia (n=106), divided into good-outcome (n=52) and poor-outcome (Kraepelinian; n=54) subtypes; and correlational patterns between the volumes of individual Brodmann's areas were compared and examined in relation to outcome. RESULTS Positive frontotemporal intercorrelations were significantly stronger while negative frontotemporal intercorrelations were weaker in schizophrenia patients as compared to normal subjects. Correlations between the right temporal pole and other temporal regions were significantly weaker in schizophrenia patients than in controls. When compared to normal controls and good-outcome patients, schizophrenia patients with poor outcomes showed a selective pattern of stronger gray matter correlations between the medial temporal vs. primary visual and between primary auditory vs. dorsolateral prefrontal cortices, all in the left hemisphere. CONCLUSIONS Strengthening of positive associations among the temporal and extratemporal (mainly frontal and occipital) regions as well as weakening of regional intercorrelations within the temporal lobe in patients appear to constitute the major differences of correlational patterns in schizophrenia patients and normal subjects. Present findings may be implicated in object recognition deficits seen in patients with schizophrenia, as well as in purportedly deficient spatial and semantic processing of both auditory and visual information that may be associated with poor outcome.
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Mitelman SA, Brickman AM, Shihabuddin L, Newmark R, Chu KW, Buchsbaum MS. Correlations between MRI-assessed volumes of the thalamus and cortical Brodmann's areas in schizophrenia. Schizophr Res 2005; 75:265-81. [PMID: 15885518 DOI: 10.1016/j.schres.2004.10.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2004] [Revised: 10/25/2004] [Accepted: 10/29/2004] [Indexed: 11/22/2022]
Abstract
BACKGROUND We compared the thalamic-cortical volumetric correlational patterns in patients with schizophrenia and normal comparison subjects, and evaluated their relations to outcome. METHODS High-resolution MR images were acquired in patients with schizophrenia (n=106) and normal comparison subjects (n=42). Patients were divided into good-outcome (n=52) and poor-outcome (Kraepelinian, n=54) subtypes based on their ability for self-care. Correlations between the relative gray and white matter volumes of the individual cortical Brodmann's areas and five dorsoventral levels of the thalamus were assessed. RESULTS Compared to normal subjects, schizophrenia patients lacked significant thalamic gray matter volume correlations with the prefrontal and medial temporal cortical regions in the right hemisphere, and with frontal, cingulate, posterior parietal and occipital regions in the left hemisphere, while normal white matter volume cortical-thalamic correlations along the cingulate gyrus and in the temporal lobe were not found in schizophrenia patients in both hemispheres. In contrast to both normal comparison subjects and good-outcome group, schizophrenia patients with poor outcomes showed significant bilateral gray matter volume correlations between the dorsal thalamus and ventral prefrontal cortex, while the group differences in the white matter volume correlations were mostly restricted to the cingulate arch. CONCLUSIONS Whereas patients with schizophrenia exhibit deficiencies in cortical-thalamic correlational patterns, poor outcome is associated with abnormal interregional correlations not observed in either normal subjects or patients with good outcomes. This latter finding may be explained by a core neurodevelopmental disturbance that results in aberrant cortical-thalamic connectivity in poor-outcome schizophrenia.
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Mitelman SA, Shihabuddin L, Brickman AM, Hazlett EA, Buchsbaum MS. Volume of the cingulate and outcome in schizophrenia. Schizophr Res 2005; 72:91-108. [PMID: 15560955 DOI: 10.1016/j.schres.2004.02.011] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2003] [Revised: 01/28/2004] [Accepted: 02/02/2004] [Indexed: 12/21/2022]
Abstract
BACKGROUND Previous studies indicated that schizophrenia patients have reduced frontal volumes in comparison with normal, but among schizophrenics, reduced volumes of the posterior (temporal, parietal and occipital) cortex were associated with poor outcome. We examined whether this pattern is seen within the anteroposterior arch of the cingulate gyrus. METHODS MR images were acquired in 37 schizophrenia patients (Kraepelinian, n = 13; non-Kraepelinian, n = 24) and 37 controls, and CSF, gray and white matter volumes in individual Brodmann's areas (BA) of the cingulate arch (areas 25, 24, 23, 31, 30, 29) were assessed and examined in relation to outcome. RESULTS Schizophrenia patients had significant gray matter reductions in the absolute (mm(3)) volume of Brodmann's area 24 in anterior cingulate and, when corrected for brain size, in the whole cingulate and retrosplenial (areas 29-30) cortex. White matter volumes were increased in right posterior cingulate (area 31). Schizophrenia patients also showed abnormal lateralization of white matter volumes in retrosplenial cortex (area 30) and had lower correlations between frontal and anterior cingulate regions than controls. Poor-outcome subgroup exhibited significant bilateral gray matter deficits in posterior cingulate and retrosplenial cortices compared to good-outcome patients, while no white matter increases in these areas were seen. CONCLUSIONS Poor outcome was associated with gray matter deficits in posterior cingulate while compensatory white matter increases in dorsal posterior regions may be related to better outcome. Possible consequences of this may include thought disorder, disturbance of consciousness, treatment resistance, and cognitive decline indicative of a dementing process as a superimposed or inherent part of this schizophrenia subtype.
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Haznedar MM, Buchsbaum MS, Hazlett EA, Shihabuddin L, New A, Siever LJ. Cingulate gyrus volume and metabolism in the schizophrenia spectrum. Schizophr Res 2004; 71:249-62. [PMID: 15474896 DOI: 10.1016/j.schres.2004.02.025] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2003] [Revised: 02/12/2004] [Accepted: 02/19/2004] [Indexed: 11/30/2022]
Abstract
BACKGROUND The cingulate gyrus, which is involved in affect, attention, memory and higher executive functions, has been implicated as a dysfunctional region in schizophrenia. Postmortem studies report cytoarchitectural changes in the anterior cingulate gyrus (ACG) and functioning imaging studies show correlations between the degree of hypometabolism of the anterior cingulate and clinical symptoms in schizophrenia. METHODS Unmedicated patients with schizophrenia (n=27) and schizotypal personality disorder (SPD) (n=13), as well as sex- and age-matched control subjects (n=32), were studied with (18)F-fluorodeoxyglucose positron emission tomography (PET) scans and magnetic resonance imaging (MRI). As a control over mental activity, all subjects performed a verbal working memory task during the PET protocol. The cingulate gyrus was first outlined on the MRI scans and, after coregistration, the coordinates were applied to the PET scans to yield a three-dimensional metabolic map of the cingulate gyrus for each subject. A statistical resampling method was used to analyze the metabolic differences between groups. RESULTS Compared with controls, patients with schizophrenia had lower relative glucose metabolic rates in the left anterior cingulate and the right posterior cingulate gyrus (PCG) assessed by 3-D significance probability mapping. SPD patients had higher glucose metabolic rates (GMRs) in the left posterior cingulate than did controls. Furthermore, volumetric measurement with MRI showed the left anterior cingulate and Brodmann area 24' to be smaller in schizophrenic patients than controls. CONCLUSIONS Compared with controls, patients with schizophrenia have metabolic and volumetric reductions in a cingulate gyrus area that is related to higher executive functions. Schizotypal patients rely more on sensory association areas to perform a cognitive task than do controls and seem to be a group that is partially distinct in its physiological and functional characteristics.
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Brickman AM, Buchsbaum MS, Shihabuddin L, Byne W, Newmark RE, Brand J, Ahmed S, Mitelman SA, Hazlett EA. Thalamus size and outcome in schizophrenia. Schizophr Res 2004; 71:473-84. [PMID: 15474918 DOI: 10.1016/j.schres.2004.03.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2003] [Revised: 02/25/2004] [Accepted: 03/01/2004] [Indexed: 11/22/2022]
Abstract
The size of the thalamus was assessed in 106 patients with schizophrenia and 42 normal controls using high-resolution magnetic resonance imaging. The thalamus was traced at five axial levels proportionately spaced from dorsal to ventral directions. Patients with schizophrenia had significantly smaller thalamic areas at more ventral levels. Thalamic size was positively associated with frontal lobe and temporal lobe size. The effects were most marked in the patients with poorer clinical outcome (i.e., "Kraepelinian" patients). These findings are consistent with post-mortem and MRI measurement suggesting reduction in volume of the pulvinar, which occupies a large proportion of the ventral thalamus and which has prominent connections to the temporal lobe.
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Brickman AM, Buchsbaum MS, Bloom R, Bokhoven P, Paul-Odouard R, Haznedar MM, Dahlman KL, Hazlett EA, Aronowitz J, Heath D, Shihabuddin L. Neuropsychological functioning in first-break, never-medicated adolescents with psychosis. J Nerv Ment Dis 2004; 192:615-22. [PMID: 15348978 DOI: 10.1097/01.nmd.0000138229.29157.3e] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of the current study was to examine neuropsychological functioning in a group of never-medicated first-break adolescents with psychosis. It is the first report of cognition in a sample of adolescents with psychosis in which all patients were drug-naive. Twenty-nine adolescent patients (mean age = 16.07; SD = 2.00; 15 male and 14 female patients) experiencing their first psychotic episode and 17 age-matched and sex-matched normal volunteers (mean age = 16.88; SD = 2.39; 9 male and 8 female subjects) were recruited and assessed with a neuropsychological battery. Measures of attention, memory, language, executive functioning, perceptual motor processing, and motor speed were obtained. Psychiatric symptomatology, estimated verbal IQ, and parental socioeconomic status were also determined. Patients with psychosis were significantly more impaired than normal volunteers; effect sizes were greatest in the areas of executive functioning, attention, and memory, and significantly smaller in areas of language, perceptual motor processing, and motor speed. The pattern was not altered when differences in verbal IQ and parental socioeconomic status were controlled. Sex and age interactions indicated that younger male patients were particularly impaired. The findings demonstrate neuropsychological deficits in adolescents with psychosis and suggest that cognitive deficits are core symptoms in psychotic disorders.
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Hazlett EA, Buchsbaum MS, Kemether E, Bloom R, Platholi J, Brickman AM, Shihabuddin L, Tang C, Byne W. Abnormal glucose metabolism in the mediodorsal nucleus of the thalamus in schizophrenia. Am J Psychiatry 2004; 161:305-14. [PMID: 14754780 DOI: 10.1176/appi.ajp.161.2.305] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Three thalamic nuclei--the mediodorsal nucleus, pulvinar, and centromedian nucleus--each have unique reciprocal circuitry with cortical and subcortical areas known to be affected in schizophrenia. To determine if the disorder is also associated with dysfunction in the mediodorsal nucleus, pulvinar, and centromedian nucleus, relative glucose metabolism in these regions was measured in a large group of unmedicated patients with schizophrenia. METHOD [18F]-deoxyglucose positron emission tomography (PET) and matching T1-weighted magnetic resonance imaging (MRI) scans were obtained for 41 unmedicated patients with schizophrenia and 60 age- and sex-matched healthy subjects. The PET and MRI images for each subject were coregistered, and the whole thalamus, mediodorsal nucleus, pulvinar, and centromedian nucleus were traced on the MRI image. Relative glucose metabolism in these regions was assessed. RESULTS Patients with schizophrenia showed significantly lower relative glucose metabolism in the mediodorsal nucleus and the centromedian nucleus and significantly higher relative glucose metabolism in the pulvinar, compared with the healthy subjects. Lower relative glucose metabolism in the total thalamus, mediodorsal nucleus, and pulvinar was associated with greater overall clinical symptoms as measured by the Brief Psychiatric Rating Scale. Lower relative glucose metabolism in the pulvinar was associated with more hallucinations and more positive symptoms, while lower relative glucose metabolism in the mediodorsal nucleus was associated with more negative symptoms. CONCLUSIONS The findings suggest that patients with schizophrenia exhibit dysfunction in thalamic subdivisions with distinct cortical connections and that these thalamic subdivisions have specific associations with clinical symptoms.
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Mitelman SA, Shihabuddin L, Brickman AM, Hazlett EA, Buchsbaum MS. MRI assessment of gray and white matter distribution in Brodmann's areas of the cortex in patients with schizophrenia with good and poor outcomes. Am J Psychiatry 2003; 160:2154-68. [PMID: 14638586 DOI: 10.1176/appi.ajp.160.12.2154] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE High-resolution magnetic resonance imaging (MRI) was used to compare cortical gray and white matter and CSF volumes in schizophrenia patients with poor outcomes, schizophrenia patients with good outcomes, and healthy comparison subjects. METHOD T(1)-weighted, 1.2-mm-thick MR images were acquired for 37 patients with schizophrenia and 37 healthy, age- and sex-matched comparison subjects. The patients were assigned to subgroups with poor outcomes (N=13) and good outcomes (N=24) on the basis of clinical characteristics. Poor-outcome patients were those who were continuously hospitalized or completely dependent on others for basic needs, were unemployed, and had severe negative symptoms and severe formal thought disorder. The MR images were reoriented to standard position parallel to the anterior commissure-posterior commissure line and segmented into CSF, gray matter, and white matter tissue types. The tissue types were assigned to Brodmann's areas by using the Perry postmortem histological atlas, and tissue-type volumes in the three subject groups were compared. RESULTS Compared to the healthy subjects, the overall patient group had a significantly smaller mean cortical gray matter volume and significantly larger mean CSF volume, especially in the frontal lobe and left temporal lobe. The smaller frontal lobe volume in schizophrenia was confirmed for unadjusted volumes and for volumes with adjustment for whole brain volumes. Compared to patients with good outcomes, patients with poor outcomes (Kraepelinian schizophrenia) had significantly smaller gray matter volumes in the temporal and occipital lobes, but no difference between groups was found for total frontal lobe volume. Only 21% of the healthy subjects had volumes 0.5 standard deviations below the mean for healthy subjects in any area of the frontal or temporal lobes, compared with 62% of poor-outcome patients. CONCLUSIONS Poor outcome in patients with schizophrenia may be associated with a more posterior distribution (posteriorization) of gray matter deficits across widely distributed cortical regions.
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