Schizophrenia (Heidelberg, Germany)最新文献

Cognitive deficits in schizophrenia significantly hinder functional outcomes and often remain unresponsive to conventional treatments. While initial evidence suggested potential pro-cognitive effects of electrical brain stimulation in schizophrenia, recent meta-analyses have not supported these findings, warranting further investigation on intervention optimization. This sham-controlled crossover study explored cognitive and emotional effects of bilateral dorsolateral prefrontal cortex (DLPFC) anodal transcranial direct current stimulation (tDCS) and high-frequency transcranial random noise stimulation (tRNS) in schizophrenia. Thirty-six male patients with schizophrenia participated in a crossover trial, receiving three sessions (tDCS, tRNS, sham) in counterbalanced order with 1-week intervals. tDCS and tRNS sessions involved 20-min 2 mA anodal stimulation and 2 mA 100-640 Hz random noise stimulation targeting the left and right DLPFCs (F3-F4) with two extracephalic return electrodes. Executive functions (working memory, spatial planning) were assessed during stimulation, and emotional changes were measured with the Positive and Negative Affect Schedule (PANAS) pre- and post-stimulation. Additionally, side effects and blinding efficacy were evaluated. Both bilateral DLPFC anodal tDCS and high-frequency tRNS significantly improved planning performance (mean problems solved, mean number of moves) compared to sham, with tRNS additionally enhancing working memory accuracy and strategy score. Both interventions increased positive affect and reduced negative affect after the intervention, with tRNS showing greater enhancement of positive emotions. Reduced negative affect after tRNS was correlated with improved executive planning. Side effects were minimal, and blinding was effective for the sham condition. Bilateral DLPFC anodal tDCS and high-frequency tRNS show promise as adjunctive treatments for schizophrenia, especially for cognitive deficits, with broader cognitive and emotional benefits observed with tRNS. ClinicalTrials.gov Identifier: NCT06155786 https://clinicaltrials.gov/study/NCT06155786 .

Previous studies have found that individuals with schizophrenia (SZ) benefit less from semantic context in verbal recall than comparison (HC) subjects. This has not been systematically studied in individuals with schizotypal personality disorder (SPD), a group that does not carry the confounding effects of chronic medication usage and/or hospitalization, but has a high genetic loading for SZ. The purpose of the current study was to examine the effect of context on verbal learning performance in men and women with DSM-5-defined SPD. The effect of semantic context on verbal recall was measured in 69 right-handed men and women with clinically-defined schizotypal personality disorder and 56 right-handed healthy controls. On a semantic facilitation task, subjects were asked to listen to and recall eight 10-word lists with increasing context, ranging from random order to text format. Verbal recall performance of male and female SPD subjects was contrasted with gender-matched HCs. Male SPD subjects benefited significantly less from context in verbal learning, while female SPDs performed similarly to controls. The current study examined the effect of gender and semantic facilitation on learning in clinically-defined SPD. The results are consistent with previous hypotheses of gender-specific left hemisphere dysfunction in male SPD, and provide further support for a primary deficit in early learning processes in this population.

Accumulating evidence suggests that oxidative stress (OS) contributes to the onset and progression of schizophrenia (SCZ). However, the pattern of OS alterations in first-episode, drug-naïve patients and their associations with clinical and cognitive features remain unclear. In this study, 98 first-episode SCZ patients and 96 matched healthy controls were recruited. Plasma levels of total antioxidant capacity (TAC), malondialdehyde (MDA), lipid peroxidation (LPO), NADPH oxidase (NOX), glutathione S-transferase (GST), and glutathione reductase (GR) were measured. Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), and cognitive performance was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Compared with controls, patients exhibited significantly higher TAC, MDA, and LPO levels but lower NOX levels, while GST and GR showed no significant differences. RBANS total and subscale scores were markedly reduced in patients, indicating generalized cognitive impairment. Correlation analyses revealed that GST was positively correlated with total PANSS scores, GR with negative symptoms, and LPO with overall cognition, attention, and delayed recall. These findings indicate that first-episode SCZ patients display an imbalance between oxidative and antioxidant systems, and specific OS markers are linked to symptom severity and cognitive dysfunction. OS alterations may serve as potential early biomarkers and therapeutic targets for schizophrenia.

Schizophrenia has been linked to reduced cortical thickness and abnormal gene expression. While antipsychotic treatment has been found to affect cortical morphology and gene expression, its impact on subject-specific deviations in cortical morphometric similarity and the underlying genetic mechanisms remain unclear. To quantify risperidone-related changes in morphometric similarity at the individual level and test their spatial alignment with cortical transcriptomic patterns. Twenty-four drug-naive first-episode schizophrenia patients and 30 healthy controls underwent T1-weighted imaging scans. Patients were scanned before and after 12 weeks of treatment with risperidone; symptoms and cognitive function were assessed with PANSS and MCCB scale. For each scan, cortical morphometric similarity matrices were built from regional cortical thickness distributions using the Wasserstein distance. We defined Morphometric Similarity Deviation (MSD) as a subject-level, normative-referenced departure from the healthy morphometric similarity pattern, derived from node-wise fingerprint correlations with the healthy template. Partial least squares regression related treatment-induced MSD changes to cortical transcriptomic data obtained from the Allen Human Brain Atlas. Patients exhibited high MSD in the frontal, temporal, and temporoparietal regions. Greater baseline MSD across the whole brain and multiple networks were associated with more severe positive symptoms. After treatment, MSD decreased, and reductions within the salience/ventral attention network associated with improved Emotional Intelligence. Moreover, risperidone-induced changes in MSD were spatially correlated with the expression of specific genes enriched in neurotransmission, cell adhesion, immune function, and schizophrenia. Specific expression analyses revealed that these genes were specifically expressed in astrocytes and oligodendrocytes, and spanned almost all developmental stages. Risperidone reduces MSD, reflecting convergence toward a normative cortical morphometric similarity pattern. These changes were spatially aligned with gene expression patterns involved in neurotransmission and immune processes, suggesting a molecular basis for treatment-linked structural normalization and its cognitive benefits.

Schizophrenia is a multifactorial psychiatric disorder in which monoaminergic neurotransmission, particularly dopamine (DA), serotonin (5-HT), and norepinephrine (NE), is implicated in both pathophysiology and response to treatments. However, the regional composition and functional interaction among these neurotransmitters and their catabolites remain unclear. In this study, using high-performance liquid chromatography (HPLC), we quantified DA, 5-HT, NE and their metabolites, HVA, DOPAC, and 5-HIAA, along with protein levels of key monoamine-metabolizing enzymes (MAO-A, MAO-B, and COMT isoforms) in post-mortem dorsolateral prefrontal cortex (DLPFC) and hippocampus from chronic schizophrenia patients and matched healthy controls. Although absolute monoamine and enzyme levels did not differ between cases and controls, partial correlation analyses revealed remarkable schizophrenia-specific interactions. In particular, patients exhibited distinct 5-HT-DOPAC correlations in both regions, suggesting an abnormal coupling between serotonergic and dopaminergic metabolism. In the DLPFC, the DA-NE correlation was markedly attenuated in schizophrenia, potentially reflecting disrupted catecholaminergic integration relevant to cognitive function and salience processing. Furthermore, an increased 5-HIAA-5-HT correlation emerged in the hippocampus of schizophrenia patients, indicative of abnormal serotonin turnover. In conclusion, our observations indicate that while the cerebral concentrations of monoamines and their catabolites remain relatively stable in patients with schizophrenia, their interactions are significantly dysregulated compared to those reported in healthy controls. These postmortem findings provide new insights into the monoaminergic neurotransmission crosstalk in the schizophrenia brain.

A key function of the perceptual system is to predict the (multi)sensory outcomes of actions and recalibrate these predictions in response to changing conditions. In schizophrenia spectrum disorders (SSD), impairments in this ability have been linked to difficulties in self-other distinction. This study investigated the neural correlates of the recalibration of action-outcome predictions to delays, the transfer of this process across sensory modalities, and whether participants with SSD exhibit alterations in the underlying neural processes. SSD participants and healthy controls (HC) underwent fMRI while exposed to delays between active or passive button presses and auditory outcomes. A delay detection task assessed recalibration effects on auditory perception (unimodal trials) and its transfer to visual perception (cross-modal trials). In unimodal trials, HC exhibited reduced activation in left middle frontal gyrus (MFG) after recalibration, particularly for active movements, whereas this effect was reversed in SSD. In cross-modal trials, recalibration was linked to increased activation in bilateral cerebellum in HC, especially for active movements, a pattern significantly reduced in SSD. These findings suggest that unimodal temporal recalibration of action-outcome predictions in HC is reflected in reduced prediction error-related MFG activity, which is significantly reduced in SSD revealing potentially disrupted recalibration processes. Additionally, cerebellar engagement appears crucial for cross-modal transfer of recalibrated action-outcome timings, a process that may be impaired in SSD, leading to severe perceptual disturbances like hallucinations.

Resting-state functional magnetic resonance imaging (rs-fMRI) has offered insights into the neural mechanisms underlying psychosis, particularly when associated with clinically relevant features. 102 individuals at ultra-high risk for psychosis (UHR) and 105 matched healthy controls (HC) aged 18-40 underwent clinical and cognitive assessments and rs-fMRI at baseline. Using a recently developed prediction-based extension of the network-based statistics (NBS-predict), incorporating nested cross-validation, we tested the predictive power of functional connectivity estimated from rs-fMRI data, investigating diagnostic classification and prediction of level of functioning, estimated IQ, and UHR-symptoms. Hyper-connectivity predicted group with a classification accuracy of 0.58, p = 0.043, and hypo-connectivity predicted group with a classification accuracy of 0.59, p = 0.018. Hyper-connectivity in UHR-individuals was observed primarily in interhemispheric and cortico-thalamic connections, within networks that predicted poorer levels of functioning across groups. Hypo-connectivity in UHR-individuals was observed mainly in thalamic connections with posterior cingulate cortex, frontal medial, and precuneus, within networks that predicted higher level of functioning across groups. Post hoc analyses identified a significant groupwise interaction effect on the association between functional connectivity and level of functioning (ρ = 0.34, p < 0.001), with main nodes in the frontal medial regions connected across hemispheres. Within-group, no connections predicted level of functioning or UHR-symptoms. Whole-brain functional connectivity predicted UHR-status in hyper- and hypo-connected networks, with thalamus as a central integrative hub across networks. Connections that predicted level of functioning across groups were equivalent to the connections predicting UHR-status, hence capturing a neural correlate to a key clinical component of the UHR-status.

Converging evidence indicates that dysregulated cortico-subcortical connectivity underpins core cognitive impairment in schizophrenia (SCZ). However, the mechanistic basis linking this disrupted brain function to cognitive deficits remains elusive. We hypothesized that dysfunction within the hippocampal-thalamocortical circuitry mediates the impact of peripheral inflammation on cognitive deficits in SCZ. We recruited 62 drug-native patients with SCZ and 44 age and sex-matched healthy controls (HCs), assessing: serum levels of cytokines, cognition using the MATRICS Consensus Cognitive Battery, and resting-state functional connectivity (FC) and functional connectivity network (FCN) features. Correlation and mediation analyses were employed to examine relationships among peripheral inflammation, brain functional alterations, and cognitive deficits. The findings revealed reduced FC in SCZ between the right subiculum of the hippocampus and the anterior division of the right parahippocampal gyrus (aPaHC), as well as the entorhinal cortex and the left lingual gyrus/precuneus. Conversely, the thalamus exhibited aberrant hyperconnectivity with widespread areas, including the Cornu Ammonis of the hippocampus, right lateral occipital cortex, intraparietal sulcus (IPS), and sensorimotor areas. Conjunction analysis identified distinct disruptions within hippocampal-thalamo-visual circuitry, suggesting that an imbalance in thalamo-visual and intra-hippocampal connectivity may mediate the relationship between peripheral inflammation (e.g., IL-4, CCL-2) and working memory dysfunction. This study advances our understanding of the role of peripheral inflammation in SCZ, revealing complex cross-domain interactions between pathophysiological changes (e.g., dysregulated peripheral immunity and circuit-specific dysfunction) and behavioral features. Our findings highlight a novel combinatorial therapeutic strategy-integrating cytokine-specific agents (e.g., for CCL-2 and IL-4) with circuit-directed neuromodulation of the dysfunctional hippocampal-thalamic-visual circuitry, thereby ameliorating cognitive deficits in SCZ.

Second-generation antipsychotics (SGAs) were found to have varying metabolic side-effects for patients with schizophrenia, while no studies have examined the associations between adding or switching low-risk SGAs and metabolic outcomes. This real-world observational study aimed to examine the association of adding or switching to low-risk SGAs with metabolic syndrome and metabolic abnormalities for patients with schizophrenia from 25 healthcare organizations across Zhejiang Province, China. Participants were dichotomized into the low-risk SGAs group and the high/intermediate SGAs group according to whether adding or switching to low-risk SGAs. A 1:1 propensity score matching (PSM) using a nearest-neighbor method was conducted to balance the baseline characteristics between groups. The mean [standard deviation (SD)] age of included patients was 50.0 (12.4) years, and 288 (37.7%) were women. The PSM yielded 223 matched pairs, with no between-group differences in baseline characteristics. Compared to the high/intermediate SGAs group, the low-risk SGAs group showed consistent decreases in the proportion of participants with metabolic syndrome [e.g., at 6 months: risk differences = 19.28%, 95% confidence interval (CI) = -28.19% to -10.38%; odds ratio = 0.47, 95% CI = 0.30 to 0.72] and the number of metabolic abnormalities [e.g., at 6 months: mean difference (MD) = -0.52, 95% CI = -0.75 to -0.29; relative risk = 0.79, 95% CI = 0.71 to 0.87]. The low-risk SGAs group presented significant improvement in metabolic parameters, including lower levels of weight, glucose and triglyceride (e.g., for triglycerise, (MD = -0.41 mmol/L, 95% CI = -0.61 to -0.21 mmol/L at 6 months), compared to the high/intermediate risk SGAs group. These assocaitions were more pronounced in those with no comorbid physical conditions, lower BMI, shorter duration and reporting smoking or drinking. Adding or switching to low-risk antipsychotics was associated with a decrease in metabolic outcomes, which can be considered as an appropriate secondary prevention strategy for patients with both schizophrenia and metabolic abnormalities.

Stigma substantially contributes to the burden of psychotic disorders such as schizophrenia. Previous attempts to reduce stigma based on neurobiological illness models were unsuccessful. In this Perspective article, we argue that these models may have failed to reduce stigma in schizophrenia because of their lack of explanatory power and their connotations of biological otherness and determinism. We suggest that recent developments in the realm of computational psychiatry may help to remedy this situation. In particular, we discuss the potential of predictive processing, a highly influential computational framework of brain function, to reduce the stigma associated with schizophrenia. We argue that predictive processing accounts may do so by bridging the explanatory gap between biology and psychotic experiences within a normative theory of brain function, thus offering a normalizing perspective on the neural underpinnings of schizophrenia. This may facilitate not only a better understanding of psychotic experiences but also counteract connotations of biological determinism and foster belief in change. Viewing schizophrenia through the lens of predictive processing may thus pave the way for the integration of neurobiologically grounded models into the communication with patients, their relatives, and the public, which have the potential to reduce stigma.