Abstract
Some symptoms of schizophrenia might be present before full-blown psychosis, so white matter changes must be studied both in individuals with emerging psychosis and chronic schizophrenia. A total of 86 patients—12 ultra-high risk of psychosis (UHR), 20 first episode psychosis (FEP), 54 chronic schizophrenia (CS), and 33 healthy controls (HC)—underwent psychiatric examination and diffusion tensor imaging (DTI) in a 3-Tesla MRI scanner. We assessed fractional anisotropy (FA) and mean diffusivity (MD) of the superior longitudinal fasciculus (SLF) and inferior longitudinal fasciculus (ILS). We found that CS patients had lower FA than FEP patients (p = 0.025) and HC (p = 0.088), and higher MD than HC (p = 0.037) in the right SLF. In the CS group, we found positive correlations of MD in both right ILF (rho = 0.39, p < 0.05) and SLF (rho = 0.43, p < 0.01) with disorganization symptoms, as well as negative correlation of FA in the right ILF with disorganization symptoms (rho = −0.43, p < 0.05). Among UHR individuals, we found significant negative correlations between MD in the left ILF and negative (r = −0.74, p < 0.05) and general symptoms (r = −0.77, p < 0.05). However promising, these findings should be treated as preliminary, and further research must verify whether they can be treated as potential biomarkers of psychosis.
Highlights
Schizophrenia is a debilitating disease with a poor prognosis
Post hoc analyses showed that ultra-high risk of psychosis (UHR) and first episode psychosis (FEP) groups were younger than patients with chronic schizophrenia patients (CS) and healthy controls (HC) (p < 0.001)
Our study found decreased fractional anisotropy (FA) in the right superior longitudinal fasciculus (SLF) among CS and FEP patients and higher mean diffusivity (MD) in the right SLF in the CS group compared with HC, but no significant differences were found between any of the groups in either FA or MD in the inferior longitudinal fasciculus (ILF)
Summary
Schizophrenia is a debilitating disease with a poor prognosis. It affects many mental processes, resulting in a variety of disturbances in perception, thinking, cognitive functions, and multiple domains of functioning [1–3]. Most common demonstrations of the disorder may be organized, after Timothy Crow, into two domains: (a) positive symptoms— additional or exaggerated mental processes, such as hallucinations or delusions; and (b) negative symptoms—meaning the absence of normal processes (i.e., apathy, poverty of speech, or flattened affect) [6]. Both dimensions can be measured and compared with different psychometric scales, such as, among others, the Positive and Negative Syndrome Scale (PANSS) [7], Scale for the Assessment of Positive Symptoms (SAPS) [8], Scale for the Assessment of Negative Symptoms (SANS) [9], Clinical Assessment Interview for Negative Symptoms (CAINS) [10], or Brief Negative Symptom Scale (BNSS) [11]. Given that schizophrenia affects multiple mental processes, other dimensions of symptoms can be distinguished, as in a recent meta-analysis: positive symptoms (items: P1—Delusions, P3—Hallucinatory behavior, P5—Grandiosity, P6—Suspiciousness and persecution, G9— Unusual thought content), negative symptoms (items: N1—Blunted affect, N2—Emotional withdrawal, N3—Poor rapport, N4—Passive apathetic social withdrawal, N6—Lack of spontaneity, G7—Motor retardation, G16—Active social avoidance), disorganization (items: P2—Conceptual disorganization, N5—Difficulty in abstract thinking, N7—Stereotyped thinking, G5—Mannerisms/posturing, G10—Disorientation, G11—Poor attention, G13— Disturbance of volition, G15—Preoccupation), affect (items: G1—Somatic concern, G2— Anxiety, G3—Guilt feelings, G4—Tension, G6—Depression) and resistance (items: P4— Excitement, P7—Hostility, G8—Uncooperativeness, G14—Poor impulse control) [12]
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