Abstract
This study investigated whether resting-state functional connectivity is associated with long-term clinical outcomes of patients with schizophrenia. Resting-state brain images were obtained from 79 outpatients with schizophrenia and 30 healthy controls (HC), using a 3 T-MRI scanner. All patients were 20–50 years old with >3 years' duration of illness and appeared clinically stable. We assessed their psychopathology using the 18-item Brief Psychiatric Rating Scale (BPRS-18) and divided them into “good,” “moderate,” and “poor” outcome (SZ-GO, SZ-MO, and SZ-PO) groups depending on BPRS-18 total score. We obtained individual functional connectivity maps between a seed region of the bilateral posterior cingulate cortex (PCC) and all other brain regions and compared the functional connectivity of the default mode network (DMN) among the HC and 3 schizophrenia outcome groups, with a voxel-wise threshold of P < .001 within a cluster-extent threshold of 114 voxels. Additionally, we assessed correlations between functional connectivity and BPRS-18 scores. The SZ-MO and SZ-PO groups showed decreased functional connectivity between PCC and right ventromedial prefrontal cortex (vmPFC), left middle cingulate cortex, and left frontopolar cortex (FPC) compared to the SZ-GO and HC groups. DMN connectivity in the right vmPFC and left FPC negatively correlated with subscale scores of the BPRS-18, except the negative symptoms subscale. In this study, poorer clinical outcomes in patients with schizophrenia were associated with decreased DMN connectivity. In particular, the decreased functional connectivity might be related to the severity of positive and mood symptoms rather than negative symptoms.
Highlights
Schizophrenia is a mental illness characterized by delusions, hallucinations, disordered formal thought, disorganized behaviors, negative symptoms, and cognitive dysfunctions (Kahn et al, 2015)
This study investigated the relationship between default mode network (DMN) connectivity and long-term clinical outcomes of schizophrenia
To the best of our knowledge, this study is the first to investigate the associations between DMN connectivity and long-term clinical outcomes of schizophrenia
Summary
Schizophrenia is a mental illness characterized by delusions, hallucinations, disordered formal thought, disorganized behaviors, negative symptoms, and cognitive dysfunctions (Kahn et al, 2015). The outcomes of schizophrenia vary widely among individuals, but the majority of patients with schizophrenia experience residual symptoms and impaired social functioning. The positive symptoms, such as delusions and hallucinations, tend to relapse and remit, some patients suffer from treatment-resistant residual psychotic symptoms (Bertelsen et al, 2009). Even after patients achieve remission from psychotic symptoms, the negative symptoms and cognitive dysfunctions tend to be chronic, which leads to impairments in social and occupational functioning (Buchanan, 2007). In terms and outcome of schizophrenia, it is generally known that approximately one-third of patients have a relatively good outcome, with no more than mild symptoms and functional impairments, and the remaining two-thirds have moderate to severe symptoms and functional impairments (Menezes et al, 2006). Considering evidence of progressive loss of synaptic activity in patients with schizophrenia (Marsman et al, 2013), clinical progression or deterioration in schizophrenia might be associated with impaired control of synaptic plasticity leading to dysfunctional integration of neural systems, i.e., dysconnectivity (Friston, 1999; Friston and Frith, 1995; Stephan et al, 2006)
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