Youn T, Park HJ, Kim JJ, Kim MS, Kwon JS.
hemispheric asymmetry and positive symptoms in schizophrenia: equivalent current
dipole of auditory mismatch negativity.
Schizophr Res. 2003
"The abnormality of mismatch negativity (MMN) in
schizophrenia is thought to be associated with perceptional disturbance and cognitive
dysfunction. The purpose of the present study was to investigate the change of
the normal functional hemispheric lateralization in schizophrenia by employing
the equivalent current dipole (ECD) model of auditory MMN with individual MRI
and high-density electroencephalography (EEG). The MMNs resulting from auditory
stimuli with passive oddball paradigm in a group of schizophrenics (n = 15), and
also a group of age-, sex-, and handedness-matched normal controls, were recorded
by 128 channel EEG. The location and power of ECD sources at the peak point were
calculated. Individual 3-D brain magnetic resonance images (MRI) were used for
realistic head modeling and for source localization. For both groups, the MMN
source was determined to be located in the superior temporal gyrus (STG). However,
the normal functional hemispheric asymmetry of ECD power was significantly altered
in the schizophrenics (chi(2) test = 16.13, p < 0.001). Left MMN ECD power
and the asymmetry coefficient (AC) were negatively correlated with the positive
scores from Positive and Negative Syndrome Scale (PANSS) (r = -0.673, p = 0.008),
especially with the hallucinatory behavior subscale (r = -0.677, p = 0.008). These
findings support the deficits in preattentive automatic processing of auditory
stimuli, especially in the left hemisphere, and indicate the correlation between
positive symptoms, especially auditory hallucination, and left temporal lobe dysfunction
in schizophrenia." [Abstract]
D, Koller R, Vollenweider FX, Schmid L.
Mismatch negativity predicts
psychotic experiences induced by NMDA receptor antagonist in healthy volunteers.
Psychiatry. 2002 Mar 1;51(5):400-6.
"BACKGROUND: Previous studies indicate
that mismatch negativity (MMN)-a preattentive auditory event-related potential
(ERP)-depends on NMDA receptor (NMDAR) functioning. To explore if the strength
of MMN generation reflects the functional condition of the NMDAR system in healthy
volunteers, we analyzed correlations between MMN recorded before drug administration
and subsequent responses to the NMDAR antagonist ketamine or the 5-HT2a agonist
psilocybin. METHODS: In two separate studies, MMN was recorded to both frequency
and duration deviants prior to administration of ketamine or psilocybin. Behavioral
and subjective effects of ketamine and psilocybin were assessed with the Brief
Psychiatric Rating Scale and the OAV Scale-a rating scale developed to measure
altered states of consciousness. Correlations between ERP amplitudes (MMN, N1,
and P2) and drug-induced effects were calculated in each study group and compared
between them. RESULTS: Smaller MMN to both pitch and duration deviants was significantly
correlated to stronger effects during ketamine, but not psilocybin administration.
No significant correlations were observed for N1 and P2. CONCLUSIONS: Smaller
MMN indicates a NMDAR system that is more vulnerable to disruption by the NMDAR
antagonist ketamine. MMN generation appears to index the functional state of NMDAR-mediated
neurotransmission even in subjects who do not demonstrate any psychopathology."
D, Vollenweider FX, Schmid L, Grubel C, Skrabo A, Huber T, Koller R.
of the 5-HT2A agonist psilocybin on mismatch negativity generation and AX-continuous
performance task: implications for the neuropharmacology of cognitive deficits
Neuropsychopharmacology. 2003 Jan;28(1):170-81.
the NMDA (N-methyl-D-aspartate) receptor (NMDAR) antagonist ketamine was shown
to disrupt generation of the auditory event-related potential (ERP) mismatch negativity
(MMN) and the performance of an 'AX'-type continuous performance test (AX-CPT)--measures
of auditory and visual context-dependent information processing--in a similar
manner as observed in schizophrenia. This placebo-controlled study investigated
effects of the 5-HT(2A) receptor agonist psilocybin on the same measures in 18
healthy volunteers. Psilocybin administration induced significant performance
deficits in the AX-CPT, but failed to reduce MMN generation significantly. These
results indirectly support evidence that deficient MMN generation in schizophrenia
may be a relatively distinct manifestation of deficient NMDAR functioning. In
contrast, secondary pharmacological effects shared by NMDAR antagonists and the
5-HT(2A) agonist (ie disruption of glutamatergic neurotransmission) may be the
mechanism underlying impairments in AX-CPT performance observed during both psilocybin
and ketamine administration. Comparable deficits in schizophrenia may result from
independent dysfunctions of 5-HT(2A) and NMDAR-related neurotransmission."
AK, Pinals DA, Adler CM, Elman I, Clifton A, Pickar D, Breier A.
exacerbation of psychotic symptoms and cognitive impairment in neuroleptic-free
Neuropsychopharmacology. 1997 Sep;17(3):141-50.
N-methyl-d-aspartate (NMDA) receptor has been implicated in the pathophysiology
of schizophrenia. We administered subanesthetic doses of the NMDA receptor antagonist
ketamine in a double-blind, placebo-controlled design to 13 neuroleptic-free schizophrenic
patients to investigate if schizophrenics will experience an exacerbation of psychotic
symptoms and cognitive impairments with ketamine. We also examined whether schizophrenics
experienced quantitative or qualitative differences in ketamine response in comparison
to normal controls. Schizophrenics experienced a brief-ketamine-induced exacerbation
of positive and negative symptoms with further decrements in recall and recognition
memory. They also displayed greater ketamine-induced impairments in free recall
than normals. Qualitative differences included auditory hallucinations and paranoia
in patients but not in normals. These data indicate that ketamine is associated
with exacerbation of core psychotic and cognitive symptoms in schizophrenia. Moreover,
ketamine may differentially affect cognition in schizophrenics in comparison to
normal controls." [Abstract]
D, Koller R, Schmid L, Skrabo A, Grubel C, Huber T, Stassen H.
specific are deficits in mismatch negativity generation to schizophrenia?
Psychiatry. 2003 Jun 15;53(12):1120-31.
"BACKGROUND: Mismatch negativity
(MMN) is an auditory event-related potential that provides an index of auditory
sensory memory. Deficits in MMN generation have been repeatedly demonstrated in
chronic schizophrenia. Their specificity to schizophrenia has not been established.
METHODS: Mismatch negativity to both duration and frequency deviants was investigated
in gender- and age-matched patients with schizophrenia or schizoaffective disorder
(n = 26), bipolar disorder (n = 16), or major depression (n = 22) and healthy
control subjects (n = 25). RESULTS: Only patients with schizophrenia demonstrated
significantly smaller mean MMN than did healthy control subjects. Detailed analyses
showed significantly smaller MMN to both duration and frequency deviants in patients
with schizophrenia than in healthy control subjects; however, the reduction of
frequency MMN in patients with schizophrenia was not significant in the comparison
across all groups. Mismatch negativity topography did not differ among groups.
No consistent correlations with clinical, psychopathologic, or treatment variables
were observed. CONCLUSIONS: Mismatch negativity deficits, and by extension deficits
in early cortical auditory information processing, appear to be specific to schizophrenia.
Animal and human studies implicate dysfunctional N-methyl-D-aspartate receptor
functioning in MMN deficits. Thus MMN deficits may become a useful endophenotype
to investigate the genetic underpinnings of schizophrenia, particularly with regard
to the N-methyl-D-aspartate receptor." [Abstract]
C. Javitt, Mitchell Steinschneider, Charles E. Schroeder, and Joseph C. Arezzo
Role of cortical N-methyl-D-aspartate receptors in auditory sensory
memory and mismatch negativity generation: Implications for schizophrenia
93: 11962-11967. 1996.
"Working memory refers to the ability of the brain
to store and manipulate information over brief time periods, ranging from seconds
to minutes. As opposed to long-term memory, which is critically dependent upon
hippocampal processing, critical substrates for working memory are distributed
in a modality-specific fashion throughout cortex. N-methyl-D-aspartate (NMDA)
receptors play a crucial role in the initiation of long-term memory. Neurochemical
mechanisms underlying the transient memory storage required for working memory,
however, remain obscure. Auditory sensory memory, which refers to the ability
of the brain to retain transient representations of the physical features (e.g.,
pitch) of simple auditory stimuli for periods of up to approximately 30 sec, represents
one of the simplest components of the brain working memory system. Functioning
of the auditory sensory memory system is indexed by the generation of a well-defined
event-related potential, termed mismatch negativity (MMN). MMN can thus be used
as an objective index of auditory sensory memory functioning and a probe for investigating
underlying neurochemical mechanisms. Monkeys generate cortical activity in response
to deviant stimuli that closely resembles human MMN. This study uses a combination
of intracortical recording and pharmacological micromanipulations in awake monkeys
to demonstrate that both competitive and noncompetitive NMDA antagonists block
the generation of MMN without affecting prior obligatory activity in primary auditory
cortex. These findings suggest that, on a neurophysiological level, MMN represents
selective current flow through open, unblocked NMDA channels. Furthermore, they
suggest a crucial role of cortical NMDA receptors in the assessment of stimulus
familiarity/unfamiliarity, which is a key process underlying working memory performance."
Donald C., Coyle, Joseph T.
The Emerging Role of Glutamate in the
Pathophysiology and Treatment of Schizophrenia
Am J Psychiatry
2001 158: 1367-1377
"OBJECTIVE: Research has implicated dysfunction of
glutamatergic neurotransmission in the pathophysiology of schizophrenia. This
review evaluates evidence from preclinical and clinical studies that brain glutamatergic
neurotransmission is altered in schizophrenia, may affect symptom expression,
and is modulated by antipsychotic drugs. METHOD: A comprehensive review of scientific
articles published over the last decade that address the role of glutamate in
the pathophysiology of schizophrenia was carried out. RESULTS: Glutamatergic neurons
are the major excitatory pathways linking the cortex, limbic system, and thalamus,
regions that have been implicated in schizophrenia. Postmortem studies have revealed
alterations in pre- and postsynaptic markers for glutamatergic neurons in several
brain regions in schizophrenia. The N-methyl-D-aspartic acid (NMDA) subtype of
glutamate receptor may be particularly important as blockade of this receptor
by the dissociative anesthetics reproduces in normal subjects the symptomatic
manifestations of schizophrenia, including negative symptoms and cognitive impairments,
and increases dopamine release in the mesolimbic system. Agents that indirectly
enhance NMDA receptor function via the glycine modulatory site reduce negative
symptoms and variably improve cognitive functioning in schizophrenic subjects
receiving typical antipsychotics. CONCLUSIONS: Dysfunction of glutamatergic neurotransmission
may play an important role in the pathophysiology of schizophrenia, especially
of the negative symptoms and cognitive impairments associated with the disorder,
and is a promising target for drug development." [Full
Yang CQ, Kitamura N, Nishino N, Shirakawa
O, Nakai H.
Isotype-specific G protein abnormalities in the left
superior temporal cortex and limbic structures of patients with chronic schizophrenia.
Psychiatry. 1998 Jan 1;43(1):12-9.
"BACKGROUND: The potential role of
signal transducing guanine nucleotide-binding regulatory protein (G protein) in
schizophrenia is largely unknown. METHODS: We immunoquantified isotypes of G protein
using specific antisera against alpha and beta subunits of G protein in the superior
temporal, prefrontal, and entorhinal cortices as well as the nucleus accumbens
and amygdala of postmortem brains from 19 schizophrenic and 28 control subjects.
RESULTS: In the left hemisphere of schizophrenics, the amount of Gi alpha, Go
alpha, and Gq alpha but not that of Gs alpha or G beta decreased in the superior
temporal cortex by 27%, 27%, and 16%, respectively, as compared with the values
in ipsilateral controls; the amount of any G protein isotype in the prefrontal
and entorhinal cortices was not changed. In the nucleus accumbens and amygdala,
the paranoid type schizophrenics showed a smaller amount of Gi alpha and Go alpha
than the disorganized type schizophrenics. In the right superior temporal cortex,
the isotype amount did not differ between the schizophrenic and control groups.
CONCLUSIONS: The decreased Gq alpha immunoreactivity in the schizophrenic left
superior temporal cortex may reflect the down-regulation of Gq alpha, resulting
from chronic stimulation of Gq alpha-coupled receptors, while the decreased Gi
alpha and Go alpha in the nucleus accumbens and amygdala of paranoid type schizophrenics
may be related to the dopaminergic hyperactivity via dopamine D2 receptors."
XH, Kitamura N, Hashimoto T, Shirakawa O, Maeda K.
in phosphoinositide-specific phospholipase C immunoreactivity in the left prefrontal
and superior temporal cortex of patients with chronic schizophrenia.
Psychiatry. 1999 Dec 15;46(12):1665-71.
"BACKGROUND: Abnormalities in
types of neurotransmitter signaling that are coupled with phosphoinositide-specific
phospholipase C (PLC) have previously been reported in brains from patients with
schizophrenia. PLC, a main component of this pathway, may be affected in schizophrenia.
METHODS: We immunoquantified PLC beta 1, gamma 1 and delta 1 in the left prefrontal
cortex and superior temporal cortex, nucleus accumbens and amygdala, and in the
right superior temporal cortex of postmortem brains obtained from a total of 19
patients with schizophrenia and a total of 27 controls. RESULTS: PLC beta 1 immunoreactivities
were increased in the particulate fraction from the prefrontal cortex (by 64%),
although they were decreased in the particulate fraction from the left superior
temporal cortex (by 28%), as compared with the values in controls. There was no
difference in PLC beta 1 immunoreactivities in the nucleus accumbens, the amygdala
or the right superior temporal cortex between schizophrenic patients and controls.
PLC gamma 1 and delta 1 immunoreactivities did not differ between the two groups
in any of the regions studied. CONCLUSIONS: Changes in PLC beta 1 immunoreactivities
in the prefrontal and superior temporal cortex of patients with schizophrenia
may reflect abnormalities in neurotransmissions via receptors that are coupled
with the Gq alpha-PLC beta 1 cascade." [Abstract]
Shirakawa O, Kitamura N, Lin XH, Hashimoto T, Maeda
Abnormal neurochemical asymmetry in the temporal lobe of schizophrenia.
Neuropsychopharmacol Biol Psychiatry. 2001 May;25(4):867-77.
asymmetries are known to be present in the human brain, and loss of reversal of
these asymmetries, particularly through changes in the left temporal lobe, have
been found in the brains of patients with schizophrenia. In addition to disturbed
neuroanatomical asymmetries, disturbed neurochemical asymmetries have also been
reported in the brains of patients with schizophrenia. However, in the temporal
lobe, the laterality of most of these neurochemical changes has not been specifically
evaluated. Few neurochemical studies have addressed left-right differences in
the superior temporal gyrus (STG). A deteriorated serotonin2A receptor-G protein
qalpha (Gqalpha)-phosphoinositide-specific phospholipase C beta1(PLC beta1) cascade
has been found in the left, but not right, STG of patients with schizophrenia.
Not only neuroanatomical but also neurochemical evidence supports the loss or
reversal of normal asymmetry of the temporal lobe in schizophrenia, which might
be due to a disruption of the neurodevelopmental processes involved in hemispheric
PW, Eastwood SL, Harrison PJ.
5-HT1A and 5-HT2A receptor mRNAs and
binding site densities are differentially altered in schizophrenia.
"We have investigated 5-HT1A (serotonin1A) and
5-HT2A (serotonin2A) receptor mRNA abundance and binding site densities in various
neocortical and hippocampal regions of schizophrenics and control subjects. Age,
agonal state (brain pH), and post mortem interval were included where necessary
as covariates in our analyses. In schizophrenics, 5-HT1A binding site densities,
determined autoradiographically by [3H]8-hydroxy-2,3-(dipropylamino)-tetralin
([3H]8-OH-DPAT), were significantly increased (+23%) in the dorsolateral prefrontal
cortex, with a similar trend in anterior cingulate gyrus. These increases were
not accompanied by any change in 5-HT1A receptor mRNA. No differences between
the groups in [3H]8-OH-DPAT binding or 5-HT1A receptor mRNA were seen in superior
temporal gyrus, striate cortex, or hippocampus. 5-HT2A binding sites, determined
by [3H]ketanserin, were decreased in the dorsolateral prefrontal cortex (-27%)
and parahippocampal gyrus (-38%) of schizophrenics, with a similar trend in cingulate
gyrus, but not in superior temporal gyrus or striate cortex. 5-HT2A receptor mRNA
abundance was reduced in schizophrenics in the dorsolateral prefrontal (-49%),
superior temporal (-48%), anterior cingulate (-63%) and striate (-63%) cortices,
but not in parahippocampal gyrus. Parallel analyses of rat brain tissue showed
no changes in 5-HT1A or 5-HT2A receptor mRNAs or binding site densities after
chronic administration of haloperidol. These data show that schizophrenia is associated
with alterations in the expression of central 5-HT1A and 5-HT2A receptors. They
confirm reports of increased 5-HT1A and decreased 5-HT2A binding site densities
in prefrontal cortex, and reveal more extensive decreases in 5-HT2A receptor gene
expression at the mRNA level. The resulting imbalance in the 5-HT1A to 5-HT2A
receptor ratio, when considered in terms of the chemoarchitectural distribution
of these receptors, may contribute to an impairment of corticocortical association
pathways. The apparent dissociation of the normal relationships between the abundance
of each 5-HT receptor and its mRNA in schizophrenia introduces a separate complexity
to the data, which may give clues to the underlying molecular mechanisms."
JN, Goldsmith SG, Gurevich EV.
Limbic circuits and monoamine receptors:
dissecting the effects of antipsychotics from disease processes.
Psychiatr Res. 1997 Mar-Apr;31(2):197-217.
"There is considerable evidence
for the involvement of brain dopaminergic and serotonergic systems in schizophrenia
pathology. However, post-mortem studies have been limited by difficulties in separating
the effects of chronic exposure to antipsychotics from that of the disease process.
Our recent studies directly explored this by comparing groups that were free from
antipsychotic treatment for up to a year prior to death and that were maintained
on antipsychotics. We have used this approach to identify that there are prominent
effects of both disease and of antipsychotic treatment. There appears to be a
high association for schizophrenics between elevations of D3 receptors in target
regions of the mesolimbic dopamine (DA) system and elevated numbers of 5-HT(1A)
receptors in prefrontal cortex (PFc). Antipsychotic treatment was correlated with
a reduction of D3 receptors in the ventral striatum and its output structures.
It also led to a reduction in the number of 5-HT2 receptors in some regions of
the PFc without modifying the concentration of 5-HT(1A) receptors. The limbic
loop interconnecting the PFc and ventral striatum may be the site of antipsychotic
regulation of certain symptoms in schizophrenia, particularly anhedonia and depression.
The positive symptoms of schizophrenia are more likely to be associated with disturbances
in the temporal lobe. However, dopaminergic systems in the temporal lobe have
historically been thought to be underdeveloped compared to that in the basal ganglia
and unlikely to be the target of antipsychotics. Our studies of the expression
of the DA D2 receptor in the temporal lobe has shown a complex organization in
the perirhinal and temporal cortices that is disrupted in schizophrenia. The disturbances,
which might be of neurodevelopmental origin and are unrelated to antipsychotic
treatment, include altered laminar distribution of the D2 receptor and modified
modular organization of D2 receptors in the superior temporal gyrus. We hypothesize
that modified expression of D2 receptors in these regions play a key role in the
genesis of hallucinations. Treatment with antipsychotics leading to D2 receptor
blockade in temporal cortex may reduce the presence of positive symptoms."
JM, Mathalon DH.
Electrophysiological evidence of corollary discharge
dysfunction in schizophrenia during talking and thinking.
Psychiatr Res. 2004 Jan;38(1):37-46.
"Failure of corollary discharge,
a mechanism for distinguishing self-generated from externally-generated percepts,
has been posited to underlie certain positive symptoms of schizophrenia, including
auditory hallucinations. Although originally described in the visual system, corollary
discharge may exist in the auditory system, whereby signals from motor speech
commands prepare auditory cortex for self-generated speech. While associated with
sensorimotor systems, it might also apply to inner speech or thought, regarded
as our most complex motor act. We had four aims in the studies summarized in this
paper: (1) to demonstrate the corollary discharge phenomenon during talking and
inner speech in human volunteers using event-related brain potentials (ERPs),
(2) to demonstrate that the corollary discharge is abnormal in patients with schizophrenia,
(3) to demonstrate the role of frontal speech areas in the corollary discharge
during talking, and (4) to relate the dysfunction of the corollary discharge in
schizophrenia to auditory hallucinations. Using EEG and ERP measures, we addressed
each aim in patients with schizophrenia (DSM IV) and healthy control subjects.
The N1 component of the ERP reflected dampening of auditory cortex responsivity
during talking and inner speech in control subjects but not in patients. EEG measures
of coherence indicated inter-dependence of activity in the frontal speech production
and temporal speech reception areas during talking in control subjects, but not
in patients, especially those who hallucinated. These data suggest that a corollary
discharge from frontal areas where thoughts are generated fails to alert auditory
cortex that they are self-generated, leading to the misattribution of inner speech
to external sources and producing the experience of auditory hallucinations."
Efference copy and corollary discharge: implications for thinking
and its disorders.
Schizophr Bull. 1978;4(4):636-40.
motor commands in the nervous system are associated with corollary discharges
which alter the excitability in both sensory and motor systems. These discharges
may assist in the distinction between self-generated and externally produced movements;
they also allow (or represent) monitoring of the motor commands before the effector
response has occurred. Here, I hypothesize that this mechanism of control and
integration is also present in thinking, which as Hughlings Jackson pointed out,
may be considered the highest and most complex form of motor activity. I speculate
that if corollary discharges are normally part of the motor mechanisms of thought,
their derangement could produce many of the symptoms of schizophrenia." [Abstract]
SS, Bullmore ET, Brammer MJ, Williams SC, Murray RM, McGuire PK.
functional study of auditory verbal imagery.
"BACKGROUND: We used functional MRI to examine
the functional anatomy of inner speech and different forms of auditory verbal
imagery (imagining speech) in normal volunteers. We hypothesized that generating
inner speech and auditory verbal imagery would be associated with left inferior
frontal activation, and that generating auditory verbal imagery would involve
additional activation in the lateral temporal cortices. METHODS: Subjects were
scanned, while performing inner speech and auditory verbal imagery tasks, using
a 1.5 Tesla magnet. RESULTS: The generation of inner speech was associated with
activation in the left inferior frontal/insula region, the left temporo-parietal
cortex, right cerebellum and the supplementary motor area. Auditory verbal imagery
in general, as indexed by the three imagery tasks combined, was associated with
activation in the areas engaged during the inner speech task, plus the left precentral
and superior temporal gyri (STG), and the right homologues of all these areas.
CONCLUSIONS: These results are consistent with the use of the 'articulatory loop'
during both inner speech and auditory verbal imagery, and the greater engagement
of verbal self-monitoring during auditory verbal imagery." [Abstract]
SUKHWINDER S., BRAMMER, MICHAEL J., FUKUDA, RIMMEI, WILLIAMS, STEVEN C. R., MURRAY,
ROBIN M., McGUIRE, PHILIP K.
Engagement of brain areas implicated
in processing inner speech in people with auditory hallucinations
J Psychiatry 2003 182: 525-531
"BACKGROUND: The neurocognitive basis of
auditory hallucinations is unclear, but there is increasing evidence implicating
abnormalities in processing inner speech. Previous studies have shown that people
with schizophrenia who were prone to auditory hallucinations demonstrated attenuated
activation of brain areas during the monitoring of inner speech. AIMS: To investigate
whether the same pattern of functional abnormalities would be evident as the rate
of inner speech production was varied. METHOD: Eight people with schizophrenia
who had a history of prominent auditory hallucinations and eight control participants
were studied using functional magnetic resonance imaging while the rate of inner
speech generation was varied experimentally. RESULTS: When the rate of inner speech
generation was increased, the participants with schizophrenia showed a relatively
attenuated response in the right temporal, parietal, parahippocampal and cerebellar
cortex. CONCLUSIONS: In people with schizophrenia who are prone to auditory hallucinations,
increasing the demands on the processing of inner speech is associated with attenuated
engagement of the brain areas implicated in verbal self-monitoring." [Abstract]
PK, Silbersweig DA, Wright I, Murray RM, David AS, Frackowiak RS, Frith CD.
monitoring of inner speech: a physiological basis for auditory hallucinations.
1995 Sep 2;346(8975):596-600.
"Auditory verbal hallucinations ("voices")
are thought to arise from a disorder of inner speech (thinking in words). We examined
the neural correlates of tasks which involve inner speech in subjects with schizophrenia
who hear voices (hallucinators), subjects with schizophrenia who do not (nonhallucinators),
and normal controls. There were no differences between hallucinators and controls
in regional cerebral blood flow during thinking in sentences. However, when imagining
sentences being spoken in another person's voice--which entails both the generation
and monitoring of inner speech--hallucinators had a normal left frontal response,
but reduced activation in the left middle temporal gyrus and the rostral supplementary
motor area, regions which were activated by both normal subjects and nonhallucinators
(p < 0.001). These findings suggest that a predisposition to verbal hallucinations
is associated with a failure to activate areas concerned with the monitoring of
inner speech." [Abstract]
PK, Silbersweig, DA, Wright, I, Murray, RM, Frackowiak, RS, Frith, CD
neural correlates of inner speech and auditory verbal imagery in schizophrenia:
relationship to auditory verbal hallucinations.
Br J Psychiatry
1996 169: 148-159
"BACKGROUND: Auditory verbal hallucinations are thought
to arise from the disordered monitoring of inner speech (thinking in words). We
tested the hypothesis that a predisposition to verbal auditory hallucinations
would be associated with an abnormal pattern of brain activation during tasks
which involved the generation and monitoring of inner speech. METHOD: The neural
correlates of tasks which engaged inner speech and auditory verbal imagery were
examined using positron emission tomography in (a) schizophrenic patients with
a strong predisposition to auditory verbal hallucinations (hallucinators), (b)
schizophrenic patients with no history of hallucinations (nonhallucinators), and
(c) normal controls. RESULTS: There were few between-group differences in activation
during the inner speech task. However, when imagining sentences spoken in another
person's voice, which entails the monitoring of inner speech, hallucinators showed
reduced activation in the left middle temporal gyrus and the rostral supplementary
motor area, regions which were strongly activated by both normal subjects and
nonhallucinators (P < 0.001). Conversely, when nonhallucinators imagined speech,
they differed from both hallucinators and controls in showing reduced activation
in the right parietal operculum. CONCLUSIONS: A predisposition to verbal hallucinations
in schizophrenia is associated with a failure to activate areas implicated in
the normal monitoring of inner speech, whereas the absence of a history of hallucinations
may be linked to reduced activation in an area concerned with verbal prosody.
Peter W.R., Wright, Ian C., Bullmore, Edward T., Brammer, Michael, Howard, Robert
J., Williams, Steven C.R., Shapleske, Jane, Rossell, Susan, David, Anthony S.,
McGuire, Philip K., Murray, Robin M.
Auditory Hallucinations and
the Temporal Cortical Response to Speech in Schizophrenia: A Functional Magnetic
Resonance Imaging Study
Am J Psychiatry 1997 154: 1676-1682
The authors explored whether abnormal functional lateralization of temporal cortical
language areas in schizophrenia was associated with a predisposition to auditory
hallucinations and whether the auditory hallucinatory state would reduce the temporal
cortical response to external speech. METHOD: Functional magnetic resonance imaging
was used to measure the blood-oxygenation-level-dependent signal induced by auditory
perception of speech in three groups of male subjects: eight schizophrenic patients
with a history of auditory hallucinations (trait-positive), none of whom was currently
hallucinating; seven schizophrenic patients without such a history (trait-negative);
and eight healthy volunteers. Seven schizophrenic patients were also examined
while they were actually experiencing severe auditory verbal hallucinations and
again after their hallucinations had diminished. RESULTS: Voxel-by-voxel comparison
of the median power of subjects' responses to periodic external speech revealed
that this measure was reduced in the left superior temporal gyrus but increased
in the right middle temporal gyrus in the combined schizophrenic groups relative
to the healthy comparison group. Comparison of the trait-positive and trait-negative
patients revealed no clear difference in the power of temporal cortical activation.
Comparison of patients when experiencing severe hallucinations and when hallucinations
were mild revealed reduced responsivity of the temporal cortex, especially the
right middle temporal gyrus, to external speech during the former state. CONCLUSIONS:
These results suggest that schizophrenia is associated with a reduced left and
increased right temporal cortical response to auditory perception of speech, with
little distinction between patients who differ in their vulnerability to hallucinations.
The auditory hallucinatory state is associated with reduced activity in temporal
cortical regions that overlap with those that normally process external speech,
possibly because of competition for common neurophysiological resources."
D, Koenig T, Strik W, Federspiel A, Kreis R, Boesch C, Maier SE, Schroth G, Lovblad
K, Dierks T.
Pathways that make voices: white matter changes in auditory
Arch Gen Psychiatry. 2004 Jul;61(7):658-68.
The origin of auditory hallucinations, which are one of the core symptoms of schizophrenia,
is still a matter of debate. It has been hypothesized that alterations in connectivity
between frontal and parietotemporal speech-related areas might contribute to the
pathogenesis of auditory hallucinations. These networks are assumed to become
dysfunctional during the generation and monitoring of inner speech. Magnetic resonance
diffusion tensor imaging is a relatively new in vivo method to investigate the
directionality of cortical white matter tracts. OBJECTIVE: To investigate, using
diffusion tensor imaging, whether previously described abnormal activation patterns
observed during auditory hallucinations relate to changes in structural interconnections
between the frontal and parietotemporal speech-related areas. METHODS: A 1.5 T
magnetic resonance scanner was used to acquire twelve 5-mm slices covering the
Sylvian fissure. Fractional anisotropy was assessed in 13 patients prone to auditory
hallucinations, in 13 patients without auditory hallucinations, and in 13 healthy
control subjects. Structural magnetic resonance imaging was conducted in the same
session. Based on an analysis of variance, areas with significantly different
fractional anisotropy values between groups were selected for a confirmatory region
of interest analysis. Additionally, descriptive voxel-based t tests between the
groups were computed. RESULTS: In patients with hallucinations, we found significantly
higher white matter directionality in the lateral parts of the temporoparietal
section of the arcuate fasciculus and in parts of the anterior corpus callosum
compared with control subjects and patients without hallucinations. Comparing
patients with hallucinations with patients without hallucinations, we found significant
differences most pronounced in the left hemispheric fiber tracts, including the
cingulate bundle. CONCLUSION: Our findings suggest that during inner speech, the
alterations of white matter fiber tracts in patients with frequent hallucinations
lead to abnormal coactivation in regions related to the acoustical processing
of external stimuli. This abnormal activation may account for the patients' inability
to distinguish self-generated thoughts from external stimulation." [Abstract]
D. Hunter , Timothy D. Griffiths , Tom F. D. Farrow , Ying Zheng , Iain D. Wilkinson
, Nakul Hegde , William Woods , Sean A. Spence , and Peter W. R. Woodruff
neural basis for the perception of voices in external auditory space
126: 161-169. 2002.
"We used functional imaging of normal subjects to
identify the neural substrate for the perception of voices in external auditory
space. This fundamental process can be abnormal in psychosis, when voices that
are not true external auditory objects (auditory verbal hallucinations) may appear
to originate in external space. The perception of voices as objects in external
space depends on filtering by the outer ear. Psychoses that distort this process
involve the cerebral cortex. Functional magnetic resonance imaging was carried
out on 12 normal subjects using an inside-the-scanner simulation of inside
head and outside head voices in the form of typical auditory
verbal hallucinations. Comparison between the brain activity associated with the
two conditions allowed us to test the hypothesis that the perception of voices
in external space (outside head) is subserved by a temperoparietal
network comprising association auditory cortex posterior to Heschls gyrus
[planum temporale (PT)] and inferior parietal lobule. Group analyses of response
to outside head versus inside head voices showed significant
activation solely in the left PT. This was demonstrated in three experiments in
which the predominant lateralization of the stimulus was to the right, to the
left or balanced. These findings suggest a critical involvement of the left PT
in the perception of voices in external space that is not dependent on precise
spatial location. Based on this, we suggest a model for the false perception of
externally located auditory verbal hallucinations." [Full
Bentaleb LA, Beauregard M, Liddle P, Stip
Cerebral activity associated with auditory verbal hallucinations:
a functional magnetic resonance imaging case study.
Neurosci. 2002 Mar;27(2):110-5.
"Among the many theories that have been
advanced to explain the mechanism by which auditory verbal hallucinations (AVH)
arise, 2 that have received a degree of empirical support are: the hypothesis
that AVHs arise from misinterpreted inner speech and the proposal that they arise
from aberrant activation of the primary auditory cortex. To test these hypotheses,
we were fortunate to be able to study the interesting and rare case of a woman
with schizophrenia who experienced continuous AVH which disappeared when she listened
to loud external speech. Functional magnetic resonance imaging (fMRI) was used
to measure the patient's brain activity in the temporal and inferior frontal regions
during the AVHs and while the she was listening to external speech. The brain
activity of a matched control subject was also recorded under the same experimental
conditions. AVHs were associated with increased metabolic activity in the left
primary auditory cortex and the right middle temporal gyrus. Our results suggest
a possible interaction between these areas during AVHs and also that the hypotheses
of defective internal monitoring and aberrant activation are not mutually exclusive.
Potential limitations to the generalization of our results are discussed."
TT, Brammer M, Bullmore E, Simmons A, Bartels M, David AS.
correlates of intentional and incidental self processing.
"The neuroscientific study of the 'Self' is just beginning
to emerge. We used functional Magnetic Resonance Imaging (fMRI) to investigate
cerebral activation while subjects processed words describing personality traits
and physical features, in two experiments with contrasting designs: incidental
and intentional. In the first experiment (intentional self processing), subjects
were presented with personality trait adjectives and made judgements as to their
self descriptiveness (versus non self descriptiveness). In the second experiment
(incidental self processing), subjects categorised words according to whether
they described physical versus psychological attributes, while unaware that the
words had been arranged in blocks according to self descriptiveness. The subjects
had previously rated all words for self descriptiveness 6 weeks prior to the scanning
session. A reaction time advantage was present in both experiments for self descriptive
trait words, suggesting a facilitation effect. Common areas of activation for
the two experiments included the left superior parietal lobe, with adjacent regions
of the lateral prefrontal cortex also active in both experiments. Differential
signal changes were present in the left precuneus for the intentional and the
right middle temporal gyrus for the incidental experiment. The results suggest
that self processing involves distinct processes and can occur on more than one
cognitive level with corresponding functional neuroanatomic correlates in areas
previously implicated in the awareness of one's own state." [Abstract]
Tracy J, Flanders A, Madi S, Natale P, Delvecchio
N, Pyrros A, Laskas J.
The brain's response to incidental intruded
words during focal text processing.
Neuroimage. 2003 Jan;18(1):117-26.
functional neuroanatomy associated with processing single words incidentally,
outside focal attention, was investigated. We asked subjects (n = 15) to listen,
focus on, and comprehend a story narrative, and then single, unrelated but meaningful
words were intruded into the ongoing narrative. We also manipulated the type of
intruded word, using either neutral or emotionally valent words, to evaluate the
extent of semantic processing and a potential encoding advantage for one type
of material. Analyses emphasized the areas of activation unique to the intruded
words as distinguished from the narrative text. Subjects were normal, healthy
adults (n = 15). Compared to narrative text, the intruded words were associated
with activation in the right middle temporal gyrus (BA 39) and posterior cingulate/precuneus
regions (BA 30, 23). We conclude that the intruded words did make contact with
word-level lexical but not necessarily semantic structures in the middle temporal
region. The data suggested that the intruded words were processed by a "nonexecutive"
monitoring system implemented by a pairing of activation in posterior, medial
structures such as the posterior cingulate with deactivation in brain stem structures.
This pattern induced a shift to more passive, less effortful, nonstrategic monitoring
of the words. Thus, attention processing, not semantic processing, changes best
characterized the brain activation unique to the intruded words. This posterior,
medial region is discussed as a substrate dedicated to processing a second, incidental
stream of information and thereby providing a crucial mechanism for implementing
dual processing of the kind examined here." [Abstract]
Sukhwinder S., Brammer, Michael J., Williams, Steven C. R., Murray, Robin M.,
McGuire, Philip K.
Mapping Auditory Hallucinations in Schizophrenia
Using Functional Magnetic Resonance Imaging
Arch Gen Psychiatry
2000 57: 1033-1038
"BACKGROUND: Perceptions of speech in the absence of
an auditory stimulus (auditory verbal hallucinations) are a cardinal feature of
schizophrenia. Functional neuroimaging provides a powerful means of measuring
neural activity during auditory hallucinations, but the results from previous
studies have been inconsistent. This may reflect the acquisition of small numbers
of images in each subject and the confounding effects of patients actively signaling
when hallucinations occur. METHODS: We examined 6 patients with schizophrenia
who were experiencing frequent auditory hallucinations, using a novel functional
magnetic resonance imaging method that permitted the measurement of spontaneous
neural activity without requiring subjects to signal when hallucinations occurred.
Approximately 50 individual scans were acquired at unpredictable intervals in
each subject while they were intermittently hallucinating. Immediately after each
scan, subjects reported whether they had been hallucinating at that instant. Neural
activity when patients were and were not experiencing hallucinations was compared
in each subject and the group as a whole. RESULTS: Auditory hallucinations were
associated with activation in the inferior frontal/insular, anterior cingulate,
and temporal cortex bilaterally (with greater responses on the right), the right
thalamus and inferior colliculus, and the left hippocampus and parahippocampal
cortex (P<.0001). CONCLUSIONS: Auditory hallucinations may be mediated by a
distributed network of cortical and subcortical areas. Previous neuroimaging studies
of auditory hallucinations may have identified different components of this network."
MF, Hugdahl K, Mitchell S.
Dichotic listening during auditory hallucinations
in patients with schizophrenia.
Am J Psychiatry. 1994 Mar;151(3):357-62.
Auditory hallucinations are a serious problem for a large subgroup of psychotic
patients who do not respond optimally to neuroleptic medication. It has been hypothesized
that hearing imaginary voices involves the same physiological processes as those
involved in hearing real voices, but this hypothesis has not been conclusively
confirmed. METHOD: In this study a consonant-vowel version of the Dichotic Listening
Test was used to assess the functional integration of the left hemisphere in hallucinating
and nonhallucinating psychotic patients. The test was administered under three
conditions: a nonforced attention condition, a condition in which attention was
forced to the left ear, and one in which attention was forced to the right ear.
RESULTS: The nonhallucinating patients showed the normal right ear advantage,
which indicates a left hemisphere superiority in the processing of linguistic
stimuli. In contrast, the hallucinating patients showed no ear advantage. Neither
group was able to modify its performance when instructed to attend to either the
left or the right ear. A subgroup of patients was tested in both hallucinating
and nonhallucinating states, but the ear asymmetry was not noticeably different
between these states. CONCLUSIONS: The results suggest that auditory hallucinations
are associated with abnormalities in left hemisphere functioning and that these
abnormalities might not be limited to the time of the auditory hallucinations.
It is hypothesized that a relatively enduring left hemisphere abnormality may
leave some patients at risk for auditory hallucinations." [Abstract]
BR, Park SB, Medley I, Morris PG, Jones PB.
The functional anatomy
of auditory hallucinations in schizophrenia.
Res. 2000 Nov 20;100(1):13-20.
"We used continuous whole brain functional
magnetic resonance imaging (fMRI) with a 3-T magnet to map the cerebral activation
associated with auditory hallucinations in four subjects with schizophrenia. The
subjects experienced episodes of hallucination whilst in the scanner so that periods
of hallucination could be compared with periods of rest in the same individuals.
Group analysis demonstrated shared areas of activation in right and left superior
temporal gyri, left inferior parietal cortex and left middle frontal gyrus. When
the data were examined on an individual basis, the temporal cortex and prefrontal
cortex areas were activated during episodes of hallucination in all four subjects.
These findings support the theory that auditory hallucination reflects abnormal
activation of normal auditory pathways." [Abstract]
Dierks T, Linden DE, Jandl M, Formisano E, Goebel
R, Lanfermann H, Singer W.
Activation of Heschl's gyrus during auditory
Neuron. 1999 Mar;22(3):615-21.
from being a common feature of mental illness, auditory hallucinations provide
an intriguing model for the study of internally generated sensory perceptions
that are attributed to external sources. Until now, the knowledge about the cortical
network that supports such hallucinations has been restricted by methodological
limitations. Here, we describe an experiment with paranoid schizophrenic patients
whose on- and offset of auditory hallucinations could be monitored within one
functional magnetic resonance imaging (fMRI) session. We demonstrate an increase
of the blood oxygen level-dependent (BOLD) signal in Heschl's gyrus during the
patients' hallucinations. Our results provide direct evidence of the involvement
of primary auditory areas in auditory verbal hallucinations and establish novel
constraints for psychopathological models." [Abstract]
Ishii R, Shinosaki K, Ikejiri Y, Ukai S, Yamashita
K, Iwase M, Mizuno-Matsumoto Y, Inouye T, Yoshimine T, Hirabuki N, Robinson SE,
Theta rhythm increases in left superior temporal cortex
during auditory hallucinations in schizophrenia: a case report.
2000 Sep 28;11(14):3283-7.
"Auditory hallucinations (AH), the perception
of sounds and voices in the absence of external stimuli, remain a serious problem
for a large subgroup of patients with schizophrenia. Functional imaging of brain
activity associated with AH is difficult, since the target event is involuntary
and its timing cannot be predicted. Prior efforts to image the patterns of cortical
activity during AH have yielded conflicting results. In this study, MEG was used
to directly image the brain electrophysiological events associated with AH in
schizophrenia. We observed an increase in theta rhythm, as sporadic bursts, in
the left superior temporal area during the AH states, whereas there was steady
theta band activity in the resting state. The present finding suggests strong
association of the left superior temporal cortex with the experience of AH in
this patient. This is consistent with the hypothesis that AH arises from areas
of auditory cortex subserving receptive language processing." [Abstract]
JM, Mathalon DH, Whitfield S, Faustman WO, Roth WT.
between frontal and temporal lobes during talking in schizophrenia.
Psychiatry. 2002 Mar 15;51(6):485-92.
"BACKGROUND: Communication between
the frontal lobes, where speech and verbal thoughts are generated, and the temporal
lobes, where they are perceived, may occur through the action of a corollary discharge.
Its dysfunction may underlie failure to recognize inner speech as self-generated
and account for auditory hallucinations in schizophrenia. METHODS: Electroencephalogram
was recorded from 10 healthy adults and 12 patients with schizophrenia (DSM-IV)
in two conditions: talking aloud and listening to their own played-back speech.
Event-related electroencephalogram coherence to acoustic stimuli presented during
both conditions was calculated between frontal and temporal pairs, for delta,
theta, alpha, beta, and gamma frequency bands. RESULTS: Talking produced greater
coherence than listening between frontal-temporal regions in all frequency bands;
however, in the lower frequencies (delta and theta), there were significant interactions
of group and condition. This finding revealed that patients failed to show an
increase in coherence during talking, especially over the speech production and
speech reception areas of the left hemisphere, and especially in patients prone
to hallucinate. CONCLUSIONS: Reduced fronto-temporal functional connectivity may
contribute to the misattribution of inner thoughts to external voices in schizophrenia."
Nudmamud S, Reynolds GP.
density of glutamate/N-methyl-D-aspartate receptors in superior temporal cortex
Neurosci Lett. 2001 May 18;304(1-2):9-12.
radioligand binding of [(3)H]L-689,560 to the glycine site of the N-methyl-D-aspartate
(NMDA) receptor was determined bilaterally in superior temporal cortex (BA22)
and prefrontal cortex (BA10) taken post mortem from patients with schizophrenia
and matched control subjects. A significant increase in NMDA receptor density
above control values was found bilaterally in BA22 in schizophrenia, but not in
BA10. The effect was greatest in those patients described as primarily type II,
in whom the effect was significantly lateralized, with a greater elevation in
the left hemisphere. A significant decrease in NMDA receptor density was found
in rat frontal cortex following chronic antipsychotic drug administration, indicating
that prior drug treatment was unlikely to have contributed to the differences
in schizophrenia." [Abstract]
Corre S, Harper CG, Lopez P, Ward P, Catts S.
Increased levels of
expression of an NMDARI splice variant in the superior temporal gyrus in schizophrenia.
2000 Apr 7;11(5):983-6.
"Expression patterns of mRNAs for the NMDARI subunit
(NRI) carboxy-terminus isoforms were investigated in postmortem brain tissue using
isotopic in situ hybridization. Three brain regions (superior temporal, middle
frontal and visual cortices) were examined in patients with schizophrenia (n =
6) and control subjects (n = 6). A 22% higher level of expression of the NRI isoform
that contains neither spliced exon was observed in the superior temporal gyrus
of patients with schizophrenia compared with controls (p = 0.01). No differences
were observed in the expression of the other isoforms in the three regions studied.
These data suggest that NRI alternative splicing might be abnormal in schizophrenia
and reinforce previous findings implicating the superior temporal gyrus as a site
of neural dysfunction in schizophrenia." [Abstract]
Pei, Frank J. S. Lee, Anna Moszczynska, Brian Vukusic, and Fang Liu
of Dopamine D1 Receptor Function by Physical Interaction with the NMDA Receptors
J. Neurosci. 24: 1149-1158; doi:10.1523/JNEUROSCI.3922-03.2004
interactions between dopamine D1-like receptors and NMDA subtype glutamate receptors
have been implicated in the maintenance of normal brain activity and neurological
dysfunction. Although modulation of NMDA receptor functions by D1 receptor activation
has been the subject of extensive investigation, little is known as to how the
activation of NMDA receptors alters D1 function. Here we report that NMDA receptors
regulate D1 receptor function via a direct proteinprotein interaction mediated
by the carboxyl tail regions of both receptors. In both cotransfected cells and
cultured hippocampal neurons the activation of NMDA receptors increases the number
of D1 receptors on the plasma membrane surface and enhances D1 receptor-mediated
cAMP accumulation via a SNARE-dependent mechanism. Furthermore, overexpression
of mini-genes encoding either NR1 or D1 carboxyl tail fragments disrupts the D1NR1
direct proteinprotein interaction and abolishes NMDA-induced changes in
both D1 cell surface expression and D1-mediated cAMP accumulation. Our results
demonstrate that the D1NR1 physical interaction enables NMDA receptors to
increase plasma membrane insertion of D1 receptors and provides a novel mechanism
by which the activation of NMDA receptors upregulates D1 receptor function. Understanding
the molecular mechanisms by which D1 and NMDA receptors functionally interact
may provide insight toward elucidating the molecular neurobiological mechanisms
involved in many neuropsychiatric illnesses, such as schizophrenia." [Abstract]
Chen, and Charles R. Yang
Interaction of Dopamine D1 and NMDA Receptors
Mediates Acute Clozapine Potentiation of Glutamate EPSPs in Rat Prefrontal Cortex
J Neurophysiol 87: 2324-2336, 2002.
antipsychotic drug clozapine effectively alleviates both negative and positive
symptoms of schizophrenia via unclear cellular mechanisms. Clozapine may modulate
both glutamatergic and dopaminergic transmission in the prefrontal cortex (PFC)
to achieve part of its therapeutic actions. Using whole cell patch-clamp techniques,
current-clamp recordings in layers V-VI pyramidal neurons from rat PFC slices
showed that stimulation of local afferents (in 2 microM bicuculline) evoked mixed
[AMPA/kainate and N-methyl-D-aspartate (NMDA) receptors] glutamate receptor-mediated
excitatory postsynaptic potentials (EPSPs). Clozapine (1 microM) potentiated polysynaptically
mediated evoked EPSPs (V(Hold) = -65 mV), or reversed EPSPs (rEPSP, V(Hold) =
+20 mV) for >30 min. The potentiated EPSPs or rEPSPs were attenuated by elevating
[Ca(2+)](O) (7 mM), by application of NMDA receptor antagonist 2-amino5-phosphonovaleric
acid (50 microM), or by pretreatment with dopamine D1/D5 receptor antagonist SCH23390
(1 microM) but could be further enhanced by a dopamine reuptake inhibitor bupropion
(1 microM). Clozapine had no significant effect on pharmacologically isolated
evoked NMDA-rEPSP or AMPA-rEPSPs but increased spontaneous EPSPs without changing
the steady-state resting membrane potential. Under voltage clamp, clozapine (1
microM) enhanced the frequency, and the number of low-amplitude (5-10 pA) AMPA
receptor-mediated spontaneous EPSCs, while there was no such changes with the
mini-EPSCs (in 1 microM TTX). Taken together these data suggest that acute clozapine
can increase spike-dependent presynaptic release of glutamate and dopamine. The
glutamate stimulates distal dendritic AMPA receptors to increase spontaneous EPSCs
and enabled a voltage-dependent activation of neuronal NMDA receptors. The dopamine
released stimulates postsynaptic D1 receptor to modulate a lasting potentiation
of the NMDA receptor component of the glutamatergic synaptic responses in the
PFC neuronal network. This sequence of early synaptic events induced by acute
clozapine may comprise part of the activity that leads to later cognitive improvement
in schizophrenia." [Full
Grimwood S, Slater P, Deakin JF, Hutson
NR2B-containing NMDA receptors are up-regulated in temporal cortex
Neuroreport. 1999 Feb 25;10(3):461-5.
analyses of [3H]L-689,560, [3H]CGP 39653 and NMDA-specific [3H]ifenprodil binding
revealed an equivalent increase (0.7 pmol/mg) in the number of [3H]L-689,560 and
[3H]ifenprodil binding sites in superior temporal cortex (BA22) from drug-treated
chronic schizophrenic patients and control subjects. No differences were observed
between control and schizophrenic subjects for [3H]CGP 39653 binding in BA22,
or for any of the radioligands binding to pre-motor cortex (BA6). Since [3H]L-689,560,
[3H]CGP 39653 and [3H]ifenprodil label the glycine, glutamate and ifenprodil sites
of the NMDA receptor complex, which are associated with NR1, NR1/NR2A and NR1/NR2B
subunits respectively, our findings suggest that NR2B-containing receptors are
selectively up-regulated in superior temporal cortex in schizophrenia." [Abstract]
J, Rajakumar N.
Role of NR2B-containing N-methyl-D-aspartate receptors
in haloperidol-induced c-Fos expression in the striatum and nucleus accumbens.
"Administration of haloperidol in rats leads to a
robust induction of immediate-early genes including c-Fos throughout the striatum,
which is significantly attenuated by pretreatment with the non-competitive N-methyl-D-aspartate
(NMDA) receptor antagonist, MK-801. The striatum expresses mainly NR1/NR2A and
NR1/NR2B subtypes of NMDA receptors, each having different functional and pharmacological
properties. In this study, rats were pretreated with Ro 25-6981, a selective antagonist
for NR2B-containing NMDA receptors, in order to determine the relative contribution
of this NMDA receptor subtype in NMDA-dependent haloperidol-induced c-Fos expression.
Furthermore, to determine whether NMDA receptor subtype dependence of haloperidol-induced
c-Fos expression is unique to the binding profile of haloperidol or whether it
is a property of D2 receptor antagonism, the selective D2/D3 dopamine receptor
antagonist, raclopride, was also used. Pretreatment with Ro 25-6981 led to a significant
reduction in the number of nuclei showing c-Fos immunoreactivity in both the medial
and lateral parts of the striatum. In the medial part of the striatum, this attenuation
was almost as marked as that seen following pretreatment with MK-801; however,
in the lateral part MK-801 pretreatment led to a significantly greater reduction
in the number of c-Fos positive nuclei than did Ro 25-6981 pretreatment. This
suggests that NR2B-containing NMDA receptors are involved in mediating most of
the NMDA-dependent c-Fos expression in the medial striatum, but only responsible
for mediating part of this induction in the lateral striatum. Furthermore, the
pattern of attenuation of raclopride-induced c-Fos expression following Ro 25-6981
pretreatment was similar to that of haloperidol-induced c-Fos expression, indicating
that the NMDA receptor subtype dependence of haloperidol-induced c-Fos expression
is a property of D2 antagonism. The results indicate that NR2B-containing NMDA
receptors are mainly involved in mediating haloperidol-induced c-Fos expression
in the medial or "limbic" striatum, and suggest that NR2A-containing
NMDA receptors may preferentially mediate haloperidol induced c-Fos expression
in the lateral or "motor" striatum. This may have implications in the
treatment of schizophrenia because co-administration of a selective blocker of
NR2A-containing NMDA receptors may be able to reduce the severity of extrapyramidal
motor symptoms caused by haloperidol treatment without interfering with its therapeutic
effect that is presumably mediated via the medial part of the striatum."
S, Sucher NJ, Bradley D, Tafazzoli A, Trinh D, Hetrick WP, Potkin SG, Sandman
CA, Bunney WE Jr, Jones EG.
Selective alterations in gene expression
for NMDA receptor subunits in prefrontal cortex of schizophrenics.
J Neurosci. 1996 Jan;16(1):19-30.
"NMDA receptor antagonists can induce
a schizophrenia-like psychosis, but the role of NMDA receptors in the pathophysiology
of schizophrenia remains unclear. Expression patterns of mRNAs for five NMDA receptor
subunits (NR1/NR2A-D) were determined by in situ hybridization in prefrontal,
parieto-temporal, and cerebellar cortex of brains from schizophrenics and from
neuroleptic-treated and nonmedicated controls. In the cerebral cortex of both
schizophrenics and controls, mRNAs for NR1, NR2A, NR2B, and NR2D subunits were
preferentially expressed in layers II/III, Va, and VIa, with much higher levels
in the prefrontal than in the parieto-temporal cortex. Levels of mRNA for the
NR2C subunit were very low overall. By contrast, the cerebellar cortex of both
schizophrenics and controls contained very high levels of NR2C subunit mRNA, whereas
levels for the other subunit mRNAs were very low, except NR1, for which levels
were moderate. Significant alterations in the schizophrenic cohort were confined
to the prefrontal cortex. Here there was a shift in the relative proportions of
mRNAs for the NR2 subunit family, with a 53% relative increase in expression of
the NR2D subunit mRNA. No comparable changes were found in neuroleptic-treated
or untreated controls. These findings indicate regional heterogeneity of NMDA
receptor subunit expression in human cerebral and cerebellar cortex. In schizophrenics,
the alterations in expression of NR2 subunit mRNA in prefrontal cortex are potential
indicators of deficits in NMDA receptor-mediated neurotransmission accompanying
functional hypoactivity of the frontal lobes." [Abstract]
DAVID A., GLANTZ, LEISA A., PIERRI, JOSEPH N., SWEET, ROBERT A.
Cortical Glutamate Neurotransmission in Schizophrenia: Evidence from Morphological
Studies of Pyramidal Neurons
Ann NY Acad Sci 2003 1003:
"Multiple lines of evidence from pharmacological, neuroimaging,
and postmortem studies implicate disturbances in cortical glutamate neurotransmission
in the pathophysiology of schizophrenia. Given that pyramidal neurons are the
principal source of cortical glutamate neurotransmission, as well as the targets
of the majority of cortical glutamate-containing axon terminals, understanding
the nature of altered glutamate neurotransmission in schizophrenia requires an
appreciation of both the types of pyramidal cell abnormalities and the specific
class(es) of pyramidal cells that are affected in the illness. In this chapter,
we review evidence indicating that a subpopulation of pyramidal neurons in the
dorsolateral prefrontal cortex exhibits reductions in dendritic spine density,
a marker of the number of excitatory inputs, and in somal volume, a measure correlated
with a neuron's dendritic and axonal architecture. Specifically, pyramidal neurons
located in deep layer 3 of the dorsolateral prefrontal cortex and that lack immunoreactivity
for nonphosphorylated neurofilament protein may be particularly involved in the
pathophysiology of schizophrenia. The presence of similar changes in pyramidal
neurons located in deep layer 3 of auditory association cortex suggests that a
shared property, which remains to be determined, confers cell type-specific vulnerability
to a subpopulation of cortical glutamatergic neurons in schizophrenia." [Abstract]
L J, Ong, W Y, Patel, T S, Kanani, M, Davis, A, Mortimer, A M, Barnes, T R E,
Hirsch, S R
Reduced dendritic spine density on cerebral cortical
pyramidal neurons in schizophrenia
J Neurol Neurosurg Psychiatry
1998 65: 446-453
"OBJECTIVE: A pilot study of the density of dendritic
spines on pyramidal neurons in layer III of human temporal and frontal cerebral
neocortex in schizophrenia. METHODS: Postmortem material from a group of eight
prospectively diagnosed schizophrenic patients, five archive schizophrenic patients,
11 non-schizophrenic controls, and one patient with schizophrenia-like psychosis,
thought to be due to substance misuse, was impregnated with a rapid Golgi method.
Spines were counted on the dendrites of pyramidal neurons in temporal and frontal
association areas, of which the soma was in layer III (which take part in corticocortical
connectivity) and which met strict criteria for impregnation quality. Altogether
25 blocks were studied in the schizophrenic group and 21 in the controls. If more
than one block was examined from a single area, the counts for that area were
averaged. All measurements were made blind: diagnoses were only disclosed by a
third party after measurements were completed. Possible confounding affects of
coexisting Alzheimer's disease were taken into account, as were the effects of
age at death and postmortem interval. RESULTS: There was a significant (p<0.001)
reduction in the numerical density of spines in schizophrenia (276/mm in control
temporal cortex and 112/mm in schizophrenic patients, and 299 and 101 respectively
in the frontal cortex). An analysis of variance, taking out effects of age at
death and postmortem interval, which might have explained the low spine density
for some of the schizophrenic patients, did not affect the significance of the
results. CONCLUSION: The results support the concept of there being a defect in
the fine structure of dendrites of pyramidal neurons, involving loss of spines,
in schizophrenia and may help to explain the loss of cortical volume without loss
of neurons in this condition, although the effect of neuroleptic drugs cannot
be ruled out." [Full
Hoffman RE, McGlashan TH.
network models of schizophrenia.
Neuroscientist. 2001 Oct;7(5):441-54.
is considerable neurobiological evidence suggesting that schizophrenia is associated
with reduced corticocortical connectivity. The authors describe two neural network
computer simulations that explore functional consequences of these abnormalities.
The first utilized an "attractor" neural network capable of content-addressable
memory. Application of a pruning rule that eliminated weaker connections over
longer distances produced functional fragmentation and the emergence of localized,
"parasitic" attractors that intruded into network dynamics. These pathologies
generally were expressed only when input information was ambiguous and provide
models for delusions and cognitive disorganization. A second neural network simulation
examined effects of corticocortical pruning in a speech perception network. Excessive
pruning caused the network to produce percepts spontaneously, that is, in the
absence of inputs, thereby simulating hallucinations. The "hallucinating"
network also demonstrated subtle impairments in narrative speech perception. A
parallel study of human patients found similar impairments when comparing hallucinating
patients with nonhallucinating patients. In addition, the authors have used transcranial
magnetic stimulation (TMS) to directly probe speech perception neurocircuitry
in patients with these hallucinations. As predicted by the neural network model,
the authors confirmed that "suppressive" low-frequency TMS reduces auditory
hallucinations. Neural network simulations provide empirically testable concepts
linking phenomenological, cognitive, and neurobiological findings in schizophrenia."
Jacobs , Matthew Schall , Melissa Prather , Elisa Kapler , Lori Driscoll , Serapio
Baca , Jesse Jacobs , Kevin Ford , Marcy Wainwright , and Melinda Treml
Dendritic and Spine Variation in Human Cerebral Cortex: a Quantitative Golgi Study
Cereb. Cortex 11: 558-571.
"The present study
explored differences in dendritic/spine extent across several human cortical regions.
Specifically, the basilar dendrites/spines of supragranular pyramidal cells were
examined in eight Brodmann's areas (BA) arranged according to Benson's (1993,
Behav Neurol 6:75-81) functional hierarchy: primary cortex (somatosensory, BA3-1-2;
motor, BA4), unimodal cortex (Wernicke's area, BA22; Broca's area, BA44), heteromodal
cortex (supple- mentary motor area, BA6beta; angular gyrus, BA39) and supramodal
cortex (superior frontopolar zone, BA10; inferior frontopolar zone, BA11). To
capture more general aspects of regional variability, primary and unimodal areas
were designated as low integrative regions; heteromodal and supramodal areas were
designated as high integrative regions. Tissue was obtained from the left hemisphere
of 10 neurologically normal individuals (M(age) = 30 +/- 17 years; five males,
five females) and stained with a modified rapid Golgi technique. Ten neurons were
sampled from each cortical region (n = 800) and evaluated according to total dendritic
length, mean segment length, dendritic segment count, dendritic spine number and
dendritic spine density. Despite considerable inter-individual variation, there
were significant differences across the eight Brodmann's areas and between the
high and low integrative regions for all dendritic and spine measures. Dendritic
systems in primary and unimodal regions were consistently less complex than in
heteromodal and supramodal areas. The range within these rankings was substantial,
with total dendritic length in BA10 being 31% greater than that in BA3-1-2, and
dendritic spine number being 69% greater. These findings demonstrate that cortical
regions involved in the early stages of processing (e.g. primary sensory areas)
generally exhibit less complex dendritic/spine systems than those regions involved
in the later stages of information processing (e.g. prefrontal cortex). This dendritic
progression appears to reflect significant differences in the nature of cortical
processing, with spine-dense neurons at hierarchically higher association levels
integrating a broader range of synaptic input than those at lower cortical levels."
From sensation to cognition
121: 1013-1052. 1998.
"Sensory information undergoes extensive associative
elaboration and attentional modulation as it becomes incorporated into the texture
of cognition. This process occurs along a core synaptic hierarchy which includes
the primary sensory, upstream unimodal, downstream unimodal, heteromodal, paralimbic
and limbic zones of the cerebral cortex. Connections from one zone to another
are reciprocal and allow higher synaptic levels to exert a feedback (top-down)
influence upon earlier levels of processing. Each cortical area provides a nexus
for the convergence of afferents and divergence of efferents. The resultant synaptic
organization supports parallel as well as serial processing, and allows each sensory
event to initiate multiple cognitive and behavioural outcomes. Upstream sectors
of unimodal association areas encode basic features of sensation such as colour,
motion, form and pitch. More complex contents of sensory experience such as objects,
faces, word-forms, spatial locations and sound sequences become encoded within
downstream sectors of unimodal areas by groups of coarsely tuned neurons. The
highest synaptic levels of sensory-fugal processing are occupied by heteromodal,
paralimbic and limbic cortices, collectively known as transmodal areas. The unique
role of these areas is to bind multiple unimodal and other transmodal areas into
distributed but integrated multimodal representations. Transmodal areas in the
midtemporal cortex, Wernicke's area, the hippocampal-entorhinal complex and the
posterior parietal cortex provide critical gateways for transforming perception
into recognition, word-forms into meaning, scenes and events into experiences,
and spatial locations into targets for exploration. All cognitive processes arise
from analogous associative transformations of similar sets of sensory inputs.
The differences in the resultant cognitive operation are determined by the anatomical
and physiological properties of the transmodal node that acts as the critical
gateway for the dominant transformation. Interconnected sets of transmodal nodes
provide anatomical and computational epicentres for large-scale neurocognitive
networks. In keeping with the principles of selectively distributed processing,
each epicentre of a large-scale network displays a relative specialization for
a specific behavioural component of its principal neurospychological domain. The
destruction of transmodal epicentres causes global impairments such as multimodal
anomia, neglect and amnesia, whereas their selective disconnection from relevant
unimodal areas elicits modality-specific impairments such as prosopagnosia, pure
word blindness and category-specific anomias." [Abstract/PDF]
S, Reynolds LM, Reynolds GP.
N-acetylaspartate and N-Acetylaspartylglutamate
deficits in superior temporal cortex in schizophrenia and bipolar disorder: a
Biol Psychiatry. 2003 Jun 15;53(12):1138-41.
N-acetylaspartylglutamate is found in neurons and its metabolite N-acetylaspartate,
which can be measured by magnetic resonance spectroscopy, is considered a marker
of neuronal integrity. Several magnetic resonance spectroscopy studies have found
evidence of N-acetylaspartate deficits in schizophrenia. METHODS: We employed
a high-pressure liquid chromatography method to determine N-acetylaspartate and
N-acetylaspartylglutamate in postmortem brain tissues taken from a well-defined
series of psychiatric cases. N-acetylaspartate and N-acetylaspartylglutamate concentrations
were measured in superior temporal and frontal cortices of patients with schizophrenia,
bipolar disorder, and depression and control subjects. RESULTS: N-acetylaspartate
was significantly decreased below controls in superior temporal cortex in schizophrenia
(p <.01) and bipolar disorder (p <.01), but no deficits were found in frontal
cortex. N-acetylaspartylglutamate was significantly decreased only in superior
temporal cortex in schizophrenia. CONCLUSIONS: The results are consistent with
evidence of superior temporal cortex abnormalities in schizophrenia. The finding
in bipolar disorder suggests that temporal cortex N-acetylaspartate deficits may
be a common feature of psychotic disorders." [Abstract]
Kiyoto, Shenton, Martha E., Salisbury, Dean F., Hirayasu, Yoshio, Lee, Chang-Uk,
Ciszewski, Aleksandra A., Yurgelun-Todd, Deborah, Kikinis, Ron, Jolesz, Ferenc
A., McCarley, Robert W.
Progressive Decrease of Left Superior Temporal
Gyrus Gray Matter Volume in Patients With First-Episode Schizophrenia
J Psychiatry 2003 160: 156-164
"OBJECTIVE: Smaller temporal lobe cortical
gray matter volumes, including the left superior temporal gyrus, have been reported
in magnetic resonance imaging (MRI) studies of patients with chronic schizophrenia
and, more recently, in patients with first-episode schizophrenia. However, it
remains unknown whether there are progressive decreases in temporal lobe cortical
gray matter volumes in patients with first-episode schizophrenia and whether similarly
progressive volume decreases are present in patients with affective psychosis.
METHOD: High-spatial-resolution MRI scans at initial hospitalization and 1.5 years
later were obtained from 13 patients with first-episode schizophrenia, 15 patients
with first-episode affective psychosis (mainly manic), and 14 healthy comparison
subjects. MRI volumes were calculated for gray matter of superior temporal gyrus
and for the amygdala-hippocampal complex. RESULTS: Patients with first-episode
schizophrenia showed significant decreases in gray matter volume over time in
the left superior temporal gyrus compared with patients with first-episode affective
psychosis or healthy comparison subjects. This progressive decrease was more pronounced
in the posterior portion of the left superior temporal gyrus (mean=9.6%) than
in the anterior portions (mean=8.4%). No group differences in the rate of change
over time were present in other regions. CONCLUSIONS: These findings demonstrate
a progressive volume reduction of the left posterior superior temporal gyrus gray
matter in patients with first-episode schizophrenia but not in patients with first-episode
affective psychosis." [Abstract]
LE, Hoff AL, Neale C, Kushner M.
Asymmetries in the superior temporal
lobe in male and female first-episode schizophrenic patients: measures of the
planum temporale and superior temporal gyrus by MRI.
Res. 1994 Apr;12(1):19-28.
"Schizophrenia has been hypothesized to be
associated with an underlying brain developmental anomaly, specifically affecting
normal brain asymmetries. The most pronounced asymmetries are present on the superior
surface of the temporal lobes, the left plane, as measured along the sylvian fissure
(planum temporale) being longer than the right in the majority of normal individuals.
These asymmetries encompass Wernicke's area, the anatomical substrate for language,
and have been found to be less pronounced in individuals with developmental language
problems, i.e. dyslexia. Since disordered language is one of the hallmarks of
schizophrenia, the present study focuses on the planum temporale and related superior
temporal gyrus. Eighty-five first-episode schizophrenic patients and 40 controls
had measurements of the sylvian fissure taken from coronal slices. The pattern
of asymmetry in controls was for the right length to be longer than the left in
anterior slices, and for left to be longer than right in posterior slices (corresponding
to the planum temporale). Schizophrenic patients as a group demonstrated less
asymmetry (R > L) in anterior slices, and female patients showed a trend for
less (L > R) asymmetry in posterior slices. In contrast to the report of Barta
et al. (1990), the volume of the anterior superior temporal gyrus did not differ
from controls in first-episode schizophrenic patients. Neither the presence of
formal thought disorder nor auditory hallucinations defined a subgroup of patients
with reduced size or lateralization of the planum temporal or superior temporal
Barta PE, Pearlson GD, Powers RE, Richards SS, Tune
Auditory hallucinations and smaller superior temporal gyral volume
Am J Psychiatry. 1990 Nov;147(11):1457-62.
neuropathologic investigations in schizophrenia report smaller volume of medial
temporal lobe structures. These findings are confirmed by preliminary magnetic
resonance imaging (MRI) studies. Direct stimulation of lateral temporal lobe structures
in the region of the superior temporal gyrus provokes hallucinations. The authors'
MRI study of young schizophrenic patients demonstrates smaller volume of the superior
temporal gyrus (an auditory association area) and of the left amygdala. Smaller
size of the left superior temporal gyrus and left amygdala is not accounted for
by smaller size of the overall brain or temporal lobe. Shrinkage of the left superior
temporal gyrus is strongly and selectively correlated with severity of auditory
RP, DeQuardo JR, Nalepa R, Tandon R.
Superior temporal gyrus in schizophrenia:
a volumetric magnetic resonance imaging study.
Res. 2000 Jan 21;41(2):303-12.
"The left superior temporal gyrus (STG)
has been reported to be smaller in patients with schizophrenia. The volume of
the STG has been found to correlate negatively with severity of hallucinations
and thought disorder. In this study, we measured the STG volume of 20 normal controls
and 20 patients with schizophrenia using 3 mm contiguous coronal T1 magnetic resonance
images. We found that patients had a significantly smaller left anterior STG,
and that the volume of this region negatively correlated with the severity of
hallucinations. The left posterior STG was not significantly smaller in patients
than in controls, but its volume negatively correlated with severity of thought
disorder. We also found that the left anterior STG was smaller than the right
STG in patients but not in controls. The STG has at least three histologically
distinct areas, each with different connections to the rest of the brain. These
data are consistent with the proposition that dysfunction of the primary auditory
cortex in the anterior and middle STG and auditory association cortex in the posterior
STG may play a role in the production of auditory perceptual abnormalities and
poor organization of thought respectively." [Abstract]
Tyrone D. Cannon, Paul M. Thompson, Theo G. M. van
Erp, Arthur W. Toga, Veli-Pekka Poutanen, Matti Huttunen, Jouko Lonnqvist, Carl-Gustav
Standerskjold-Nordenstam, Katherine L. Narr, Mohammad Khaledy, Chris I. Zoumalan,
Rajneesh Dail, and Jaakko Kaprio
Cortex mapping reveals regionally
specific patterns of genetic and disease-specific gray-matter deficits in twins
discordant for schizophrenia
PNAS 99: 3228-3233; published
online before print as 10.1073/pnas.052023499
"The symptoms of schizophrenia
imply disruption to brain systems supporting higher-order cognitive activity,
but whether these systems are impacted differentially against a background of
diffuse cortical gray-matter deficit remains ambiguous. Some unaffected first-degree
relatives of schizophrenics also manifest cortical gray-matter deficits, but it
is unclear whether these changes are isomorphic with those in patients, and the
answer is critical to understanding the neurobiological conditions necessary for
disease expression given a predisposing genotype. Here we report three-dimensional
cortical surface maps (probabilistic atlases matching subjects' anatomy point
by point throughout cortex) in monozygotic (MZ) and dizygotic (DZ) twins discordant
for chronic schizophrenia along with demographically matched control twins. A
map encoding the average differences between schizophrenia patients and their
unaffected MZ co-twins revealed deficits primarily in dorsolateral prefrontal
cortex, superior temporal gyrus, and superior parietal lobule. A map encoding
variation associated with genetic proximity to a patient (MZ co-twins > DZ
co-twins > control twins) isolated deficits primarily in polar and dorsolateral
prefrontal cortex. In each case, the statistical significance was confirmed through
analysis of 10,000 Monte Carlo permutations, and the remaining cortex was shown
to be significantly less affected by contrast analysis. The disease-related deficits
in gray matter were correlated with measures of symptom severity and cognitive
dysfunction but not with duration of illness or antipsychotic drug treatment.
Genetic and disease-specific influences thus affect gray matter in partially nonoverlapping
areas of predominantly heteromodal association cortex, changes that may act synergistically
in producing overt behavioral features of the disorder." [Full
Havermans R, Honig A, Vuurman EF, Krabbendam
L, Wilmink J, Lamers T, Verheecke CJ, Jolles J, Romme MA, van Praag HM.
controlled study of temporal lobe structure volumes and P300 responses in schizophrenic
patients with persistent auditory hallucinations.
Res. 1999 Aug 17;38(2-3):151-8.
"Recent studies of cerebral pathology
in patients with schizophrenia have focused on symptomatological and electrophysiological
correlates of reduced temporal lobe structure volumes. Volume deficits of the
left superior temporal gyrus have been correlated with auditory hallucinations
as well as to left-sided P300 amplitude reduction. However, caution is needed
to interpret correlational data as evidence of a specific relationship. Therefore,
a controlled study was undertaken on schizophrenic patients with and without auditory
hallucinations. MRI-defined volumes of the left superior temporal gyrus and other
temporal lobe structures were quantified from 3-mm coronal slices in 15 schizophrenic
patients with chronic auditory hallucinations (hallucinators), 15 schizophrenic
patients without auditory hallucinations (nonhallucinators) and 17 healthy controls.
In all subjects a simple oddball paradigm was used to elicit P300 responses at
temporal and centro-parietal electrode sites. No evidence was found for volume
reductions of temporal lobe structures in the combined patient group compared
with controls, or in the hallucinators compared with the nonhallucinators. The
patients did show left P300 amplitude reduction compared with controls, particularly
in the hallucinator group. Correlations between volumes of left temporal lobe
structures and left P300 amplitudes were low and not significant. The results
of the present study do not indicate that auditory hallucinations and associated
abnormal electrophysiological activity are the consequence of atrophy of localized
temporal lobe structures. However, replication in a larger sample of subjects
is needed before firm conclusions can be drawn." [Abstract]
IC, McGuire PK, Poline JB, Travere JM, Murray RM, Frith CD, Frackowiak RS, Friston
A voxel-based method for the statistical analysis of gray and
white matter density applied to schizophrenia.
"We describe a novel technique for characterizing
regional cerebral gray and white matter differences in structural magnetic resonance
images by the application of methods derived from functional imaging. The technique
involves automatic scalp-editing of images followed by segmentation, smoothing,
and spatial normalization to a symmetrical template brain in stereotactic Talairach
space. The basic idea is (i) to convert structural magnetic resonance image data
into spatially normalized images of gray (or white) matter density, effected by
segmenting the images and smoothing, and then (ii) to use Statistical Parametric
Mapping to make inferences about the relationship between gray (or white) matter
density and symptoms (or other pathophysiological measures) in a regionally specific
fashion. Because the whole brain sum of gray (or white) matter indices is treated
as a confound, the analysis reduces to a characterization of relative gray (or
white) matter density on a voxel by voxel basis. We suggest that this is a powerful
approach to voxel-based statistical anatomy. Using the technique, we constructed
maps of the regional cerebral gray and white matter density correlates of syndrome
scores (distinct psychotic symptoms) in a group of 15 schizophrenic patients.
There was a negative correlation between the score for the reality distortion
syndrome and regional gray matter density in the left superior temporal lobe (P
= 0.01) and regional white matter density in the corpus callosum (P < 0.001).
These abnormalities may be associated with functional changes predisposing to
auditory hallucinations and delusions. This method permits the detection of structural
differences within the entire brain (as opposed to selected regions of interest)
and may be of value in the investigation of structural gray and white matter abnormalities
in a variety of brain diseases." [Abstract]
C, Nenadic I, Volz HP, Buchel C, Sauer H.
Neuroanatomy of "hearing
voices": a frontotemporal brain structural abnormality associated with auditory
hallucinations in schizophrenia.
Cereb Cortex. 2004 Jan;14(1):91-6.
hallucinations are a frequent symptom in schizophrenia. While functional imaging
studies have suggested the association of certain patterns of brain activity with
sub-syndromes or single symptoms (e.g. positive symptoms such as hallucinations),
there has been only limited evidence from structural imaging or post-mortem studies.
In this study, we investigated the relation of local brain structural deficits
to severity of auditory hallucinations, particularly in perisylvian areas previously
reported to be involved in auditory hallucinations. In order to overcome certain
limitations of conventional volumetric methods, we used deformation-based morphometry
(DBM), a novel automated whole-brain morphometric technique, to assess local gray
and white matter deficits in structural magnetic resonance images of 85 schizophrenia
patients. We found severity of auditory hallucinations to be significantly correlated
(P < 0.001) with volume loss in the left transverse temporal gyrus of Heschl
(primary auditory cortex) and left (inferior) supramarginal gyrus, as well as
middle/inferior right prefrontal gyri. This demonstrates a pattern of distributed
structural abnormalities specific for auditory hallucinations and suggests hallucination-specific
alterations in areas of a frontotemporal network for processing auditory information
and language." [Abstract]
A viral-anatomical explantation of schizophrenia.
"Recent neuropathological and neuroradiological
studies of schizophrenia have pointed to the medial temporal cortex, especially
the hippocampus, parahippocampal gyrus, and amygdala, as the areas primarily affected
by this disease. Localization of the disease process to these structures may be
explained anatomically because they are immediately contiguous to the foramen
rotundum. Some viruses are known to ascend the trigeminal nerve and enter the
cranial cavity through the foramen rotundum. They might latently infect the medial
temporal cortex and be reactivated in early adulthood, producing the symptoms
of schizophrenia. The distance from the nasal mucosa to the medial temporal cortex
is less than 2 cm in infants. An anatomical explanation of schizophrenia could
account for the seasonality of schizophrenic births, the observed excess birth
trauma in schizophrenic individuals, the clinical aspects of schizophrenia, such
as auditory hallucinations, and the genetic component of the disease." [Abstract]
Bachevalier J, Alvarado MC, Malkova L.
and socioemotional behavior in monkeys after hippocampal damage incurred in infancy
or in adulthood.
Biol Psychiatry. 1999 Aug 1;46(3):329-39.
present study reviews the long-term effects of neonatal hippocampal damage in
monkeys on the development of memory functions and socioemotional behavior. The
results showed that neonatal damage to the hippocampal formation impairs specific
memory processes, such as those subserving automatic (as opposed to effortful)
recognition memory and relational learning, while sparing the abilities to acquire
skills, such as object discriminations. Furthermore, the neonatal hippocampectomy
led to a progressive loss of social affiliation and a protracted emergence of
locomotor stereotypies. While the memory losses following neonatal hippocampal
lesions resemble those found after similar lesions acquired in adulthood, only
the neonatal lesions resulted in a protracted emergence of abnormal behaviors.
These later findings suggested that, presumably, the neonatal lesions impacted
on neural systems remote from the site of damage. This was confirmed by our more
recent neurobiological studies, demonstrating that neonatal, but not late, lesions
of the medial temporal lobe region, disrupt the normal behavioral and cognitive
processes subserved by the prefrontal cortex and the caudate nucleus. All together
the data support the neurodevelopmental hypothesis viewing early insult to the
medial temporal region as the origin of developmental psychosis in humans, such
as schizophrenia." [Abstract]
H, Sawada T, Asai H, Okuda J, Shiraishi J.
of complex auditory hallucinations.
Acta Psychiatr Scand.
"A case is described of a patient who developed
a transient verbal hallucination, lateralized to the right ear, and fluent aphasia
after a hemorrhagic infarction in the left superior temporal gyrus. On the basis
of this patient and the cases in the literature showing unilateral complex auditory
hallucinations, the clinical significance of the lateralization phenomenon of
complex auditory hallucinations was investigated. As a result, the lateralization
phenomenon of complex auditory hallucinations could be considered a significant
clinical sign indicating the existence of a lesion in the superior temporal gyrus
opposite the hallucination side." [Abstract]
P, Smith JS, Cathcart S.
Schizophrenia-like psychosis following traumatic
brain injury: a chart-based descriptive and case-control study.
Med. 2001 Feb;31(2):231-9.
"BACKGROUND: Head injury has been reported
to increase the likelihood of the development of schizophrenia-like psychosis
(SLP), but its features and risk factors have been insufficiently investigated.
METHOD: Between 1987 and 1997, we examined 45 referred patients with SLP following
brain trauma. These subjects were matched with 45 head-injured subjects without
SLP on age (current and at injury) and gender, and their case records reviewed
systematically. The groups were compared and logistic regression analyses performed.
RESULTS: The psychoses had a mean age of onset of 26.3 years, a mean latency of
54.7 months after head injury, usually a gradual onset and a subacute or chronic
course. Prodromal symptoms were common and depression often present at onset.
Paranoid delusions and auditory hallucinations were the predominant features,
with formal thought disorder, catatonic features and negative symptoms being uncommon.
The SLP group had more widespread brain damage on neuroimaging, especially in
the left temporal and right parietal regions, and were more impaired cognitively.
Fewer (non-significantly) SLP subjects had epilepsy which was more likely to be
well-controlled in this group. On regression analysis, a positive family history
of psychosis and duration of loss of consciousness were the best predictors of
SLP. CONCLUSIONS: Head injury-related psychosis is usually paranoid-hallucinatory
and subacute or chronic in its presentation. A genetic predisposition to schizophrenia
and severity of injury with significant brain damage and cognitive impairment
may be vulnerability factors." [Abstract]
Tilo T.J., Rapp, Alexander, Grodd, Wolfgang, Buchkremer, Gerhard, Weiskopf, Nikolaus,
Lutzenberger, Werner, Ackermann, Hermann, Mathiak, Klaus
Negativity Responses in Schizophrenia: A Combined fMRI and Whole-Head MEG Study
J Psychiatry 2004 161: 294-304
"OBJECTIVE: Mismatch negativity is an event-related
brain response sensitive to deviations within a sequence of repetitive auditory
stimuli. It is thought to reflect short-term sensory memory and is independent
of higher-level cognitive processes. Mismatch negativity response is diminished
in patients with schizophrenia. Little is known about the mechanisms of this decreased
response, the contribution of the different hemispheres, and its locus of generation.
METHOD: Patients with schizophrenia (N=12) and matched comparison subjects (N=12)
were studied. A novel design to measure mismatch negativity responses to deviant
auditory stimuli was generated by using the switching noises from the functional
magnetic resonance imaging (fMRI) scanner, thus avoiding any interfering background
sound. Stimuli included deviants of amplitude (9 dB lower) and duration (76 msec
shorter) presented in a random sequence. The scanner noise was recorded and applied
to the same subjects in a whole-head magnetoencephalography (MEG) device. Neuromagnetic
and hemodynamic responses to the identical stimuli were compared between the patients
and comparison subjects. RESULTS: As expected, neuromagnetic mismatch fields were
smaller in the patient group. More specifically, a lateralization to the right
for duration deviance was only found in comparison subjects. For the relative
amplitude of the blood-oxygen-level-dependent signal (measured with fMRI), differences
emerged in the secondary (planum temporale), but not primary (Heschl's gyrus),
auditory cortex. Duration deviants achieved a right hemispheric advantage only
in the comparison group. A significantly stronger lateralization to the left was
found for the deviant amplitude stimuli in the patients. CONCLUSIONS: The data
support the view of altered hemispheric interactions in the formation of the short-term
memory traces necessary for the integration of auditory stimuli. This process
is predominantly mediated by the planum temporale (secondary auditory cortex).
Altered interaction of regions within the superior temporal plane and across hemispheres
could be in part responsible for language-mediated cognitive (e.g., verbal memory)
and psychopathological (hallucinations, formal thought disorder) symptoms in schizophrenia."
J, Rossell SL, Woodruff PW, David AS.
The planum temporale: a systematic,
quantitative review of its structural, functional and clinical significance.
Res Brain Res Rev. 1999 Jan;29(1):26-49.
"The planum temporale (PT) is
a triangular area situated on the superior temporal gyrus (STG), which has enjoyed
a resurgence of interest across several disciplines, including neurology, psychiatry
and psychology. Traditionally, the planum is thought to be larger on the left
side of the brain in the majority of normal subjects [N. Geschwind, W. Levitsky,
Human brain: left-right asymmetries in temporal speech regions, Science 161 (1968)
186-87.]. It coincides with part of Wernicke's area and it is believed to consist
cytoarchitectonically of secondary auditory cortex. Consequently, it has long
been thought to be intimately involved in language function. The PT is, therefore,
of relevance to disorders where language function is impaired, such as schizophrenia
and dyslexia. The gross anatomical boundaries remain in dispute, and only recently
has its cytoarchitecture begun to be studied again after 60 years silence, and
finally its functional significance is only now being explored. In the first part
of this review the structural aspects and anatomical boundaries of the PT in the
normal brain from post mortem and magnetic resonance imaging (MRI) and methods
of measurement are discussed. In the second part, studies of the functional significance
of the PT in the normal brain are reviewed critically. Finally a meta-analysis
of MRI measurements of the distribution of planum anatomy in normal subjects is
presented. Comparison is made with clinical populations, including schizophrenia
and dyslexia, and the influence of handedness and gender on such measurements
is quantified. Although there are many ways of defining and measuring the PT with
a wide variety of results, overall there is a significant leftward asymmetry in
normals, which is reduced in left handers and females. The leftward asymmetry
is much reduced in patients with schizophrenia due to a relatively larger right
PT than normal controls. The review is intended to guide future researchers in
this area." [Abstract]
E, Katila H, Ahveninen J, Karhu J, Huotilainen M, Tiihonen J.
temporal lobe processing of preattentive auditory discrimination in schizophrenia.
"Feature-specific stimulus discrimination related
to short-term auditory sensory memory can be studied electrophysiologically using
a specific event-related potential (ERP) component termed mismatch negativity
(MMN), which is generated in the auditory cortex, indexing automatic comparison
of the existing memory trace to incoming novel stimuli. Previous results with
electroencephalography (EEG) and magnetoencephalography (MEG) suggest that schizophrenia
patients have attenuated MMN response and that preattentive auditory processing
preceding MMN appears to be functionally asymmetric in schizophrenia. Here we
studied parallel MMN activity of the hemispheres using a whole-head MEG by presenting
stimulus blocks consisting of frequent standard and infrequent deviant tones to
15 schizophrenia patients and 19 healthy control subjects. Auditory evoked fields
(AEFs) were recorded simultaneously over both auditory cortices. The equivalent
current dipole (ECD) modeling revealed that patients had significant MMNm reduction
(magnetic counterpart of MMN) in both temporal lobes. In addition, patients had
significantly delayed MMNm in the left but not in the right hemisphere to ipsilateral
auditory stimuli. These results suggest that patients with schizophrenia have
impaired auditory processing in the temporal lobes underlying preattentive stimulus
discrimination that is also selectively delayed in the left hemisphere."
Cynthia G., Kubicki, Marek, Yoo, Seung-Schik, Kacher, Daniel F., Salisbury, Dean
F., Anderson, Mark C., Shenton, Martha E., Hirayasu, Yoshio, Kikinis, Ron, Jolesz,
Ferenc A., McCarley, Robert W.
A Functional Magnetic Resonance Imaging
Study of Auditory Mismatch in Schizophrenia
Am J Psychiatry
2001 158: 938-943
"OBJECTIVE: Previous research has noted functional and
structural temporal lobe abnormalities in schizophrenia that relate to symptoms
such as auditory hallucinations and thought disorder. The goal of the study was
to determine whether the functional abnormalities are present in schizophrenia
at early stages of auditory processing. METHOD: Functional magnetic resonance
imaging activity was examined during the presentation of the mismatch stimuli,
which are deviant tones embedded in a series of standard tones. The mismatch stimuli
are used to elicit the mismatch negativity, an early auditory event-related potential.
Ten patients with schizophrenia and 10 comparison subjects were presented the
mismatch stimuli condition and a control condition in which only one tone was
presented repeatedly. RESULTS: The superior temporal gyrus showed the most prevalent
and consistent activation. The superior temporal gyrus showed less activation
in the schizophrenic subjects than in the comparison subjects only during the
mismatch stimuli condition. CONCLUSIONS: This result is consistent with those
of mismatch negativity event-related potential studies and suggests that early
auditory processing is abnormal in chronic schizophrenia." [Full
Bramon E, Croft RJ, McDonald C, Virdi GK,
Gruzelier JG, Baldeweg T, Sham PC, Frangou S, Murray RM.
negativity in schizophrenia: a family study.
2004 Mar 1;67(1):1-10.
"BACKGROUND: Mismatch negativity (MMN) is a measure
of cortical activity that occurs in response to a change in auditory stimuli.
We investigated whether MMN is a potential marker of genetic vulnerability to
schizophrenia by comparing MMN in a group of patients with schizophrenia, their
unaffected relatives, and controls. METHOD: There are 25 schizophrenic patients,
37 of their unaffected first-degree relatives, and 20 unrelated controls that
performed the MMN task. Linear regression with robust standard errors, and accounting
for correlations within families, was employed to test for differences in MMN
amplitude between the groups. RESULTS: Patients had significantly smaller MMN
amplitudes compared to both their unaffected relatives and controls at FZ (P<0.01)
and at F3 (P=0.01), whereas relatives and controls did not differ at FZ or at
F3. No differences were found between any of the groups at F4. Furthermore, we
found no strong evidence that the MMN amplitude is a familial trait. CONCLUSIONS:
Our results confirm that the MMN amplitude is reduced in schizophrenia. However,
the MMN does not show a significant familial influence and is normal among the
unaffected relatives. We conclude that while the MMN is abnormal in patients with
schizophrenia, it is a weak or unreliable marker of vulnerability when applied
to subclinical populations, and therefore is unlikely to be an endophenotype for
the disorder." [Abstract]
PT, Innes-Brown H, Todd J, Jablensky AV.
Duration mismatch negativity
in biological relatives of patients with schizophrenia spectrum disorders.
Psychiatry. 2002 Oct 1;52(7):749-58.
"BACKGROUND: One of the most consistent
findings in schizophrenia research over the past decade is a reduction in the
amplitude of an auditory event-related brain potential known as mismatch negativity
(MMN), which is generated whenever a deviant sound occurs in a background of repetitive
auditory stimulation. The reduced amplitude of MMN in schizophrenia was first
observed for deviant sounds that differ in duration relative to background standard
sounds, and similar findings have been observed for sounds that are deviant in
frequency. The aim of this study was to determine whether first-degree relatives
of schizophrenia patients show a similar reduction in MMN amplitude to duration
deviants. METHODS: We measured MMN to duration increments (deviants 100 msec vs.
standards 50 msec) in 22 medicated patients with a diagnosis in the schizophrenia
spectrum, 17 individuals who were first-degree unaffected relatives of patients,
and 21 healthy control subjects. RESULTS: Mismatch negativity amplitude was reduced
in patients and relatives compared with control subjects. There were no significant
differences between patients and relatives. In contrast, the subsequent positive
component, P3a, was larger in relatives compared with patients. CONCLUSIONS: These
findings suggest that a reduced MMN amplitude may be an endophenotype marker of
the predisposition to schizophrenia." [Abstract]