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Brain connectivity abnormalities predating the onset of psychosis: correlation with the effect of medication.

Abstract：

IMPORTANCE:Brain imaging studies have identified robust changes in brain structure and function during the development of psychosis, but the contribution of abnormal brain connectivity to the onset of psychosis is unclear. Furthermore, antipsychotic treatment can modulate brain activity and functional connectivity during cognitive tasks. OBJECTIVES:To investigate whether dysfunctional brain connectivity during working memory (WM) predates the onset of psychosis and whether connectivity parameters are related to antipsychotic treatment. DESIGN:Dynamic causal modeling study of functional magnetic resonance imaging data. SETTING:Participants were recruited from the specialized clinic for the early detection of psychosis at the Department of Psychiatry, University of Basel, Basel, Switzerland. PARTICIPANTS:Seventeen participants with an at-risk mental state (mean [SD] age, 25.24 [6.3] years), 21 individuals with first-episode psychosis (mean [SD] age, 28.57 [7.2] years), and 20 healthy controls (mean [SD] age, 26.5 [4] years). MAIN OUTCOME AND MEASURE:Functional magnetic resonance imaging data were recorded while participants performed an N-back WM task. Functional interactions among brain regions involved in WM, in particular between frontal and parietal brain regions, were characterized using dynamic causal modeling. Bayesian model selection was performed to evaluate the likelihood of alternative WM network architectures across groups, whereas bayesian model averaging was used to examine group differences in connection strengths. RESULTS:We observed a progressive reduction in WM-induced modulation of connectivity from the middle frontal gyrus to the superior parietal lobule in the right hemisphere in healthy controls, at-risk mental state participants, and first-episode psychosis patients. Notably, the abnormal modulation of connectivity in first-episode psychosis patients was normalized by treatment with antipsychotics. CONCLUSIONS AND RELEVANCE:Our findings suggest that the vulnerability to psychosis is associated with a progressive failure of functional integration of brain regions involved in WM processes, including visual encoding and rule updating, and that treatment with antipsychotics may have the potential to counteract this.

journal_name

JAMA Psychiatry

journal_title

JAMA psychiatry

authors

Schmidt A,Smieskova R,Aston J,Simon A,Allen P,Fusar-Poli P,McGuire PK,Riecher-Rössler A,Stephan KE,Borgwardt S

doi

10.1001/jamapsychiatry.2013.117

subject

Has Abstract

pub_date

2013-09-01 00:00:00

pages

903-12

issue

eissn

2168-622X

issn

2168-6238

pii

1707651

journal_volume

pub_type

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Brain connectivity abnormalities predating the onset of psychosis: correlation with the effect of medication.