Search

Background and aims: Understanding the emotional state of others is fundamental to effective social interaction and the development of empathy. Critical information is conveyed via the eyes, and reduced attention to the eyes is associated with poorer emotion recognition and empathic deficits in individuals with disorders affecting social cognition such as autism or some types of conduct problems. Deliberately redirecting attention to the eyes may be a way of improving behaviour. However, the effects of directing attention on brain activity during emotional processing has not been studied previously. Our aim was to determine whether manipulation of visual attention in youths affects their eye gaze patterns and brain responses to expression of emotions in others. Method: Eighteen typically developing male youths aged 8-16 performed an implicit facial emotion processing task while viewing different facial expressions (fearful, neutral, happy), presented in three separate blocks under three different instructions: undirected, eye-gaze and mouth-gaze. Eye tracking (dwell time) and functional-MRI data were acquired concurrently as measures of visual attention and brain response, respectively. Results: Eye tracking indicated that the youths attended more to the eyes than the mouth in the undirected condition. Redirecting attention to the eyes and mouth significantly increased attention to these areas. Compared to undirected, directing attention to the fearful eyes also produced a greater increase in attention than neutral eyes. Attention directed to eyes elicited greater brain activity in frontal regions than undirected attention. Conclusions: The undirected eye gaze patterns indicate natural orienting to eyes in healthy youths, which can be effectively altered with instruction. Directing attention to fearful eyes engaged attention relatively longer than neutral, consistent with the threat value of fearful faces. These data also demonstrate that

Abnormal hypothalamic-pituitary-adrenal (HPA) axis function, as indexed by elevated diurnal cortisol levels and a blunted cortisol awakening response (CAR), has been observed among patients with first- episode psychosis and also has been associated with neurocognitive deficits in this population . However, the extent to which HPA axis dysfunction precedes illness onset is currently unclear . Whilst elevated diurnal cortisol levels have been reported in samples of youth at ultra high-risk for psychosis, such elevations may relate to distress associated with emerging illness and might also be influenced by psychotropic medication . Further- more, studies of high-risk individuals with a family history of illness have typically included adult relatives who have passed the peak age of illness onset . As yet, no study of high-risk youth has examined the CAR or the extent to which HPA axis dysfunction is associated with neurocognitive performance . The current study aimed to determine whether children at putatively elevated risk for schizophrenia who present psychotic-like experiences and other antecedents of schizophrenia (ASz) and high-risk children with a family history of illness (FHx) are characterised by abnormal HPA axis function relative to their typically-developing (TD) peers . A further aim was to examine associations between HPA axis function and performance on tasks of memory and executive function among ASz and FHx children .

The idea that the content of delusions and hallucinations may have meaning or be symbolically significant is not new. From a psychodynamic perspective, the experience of psychosis has long been conceptualised as a defence against unbearable or unmanageable emotions (Martindaleetal2013)andthecontentofpsychoticexperiencesistherefore considered to have meaning and relevance for clinical practice (Martindale 2007). In adult samples, the content of delusions and hallucinations has been found to be associated with the experience of trauma and abuse (Raune et al. 2006, Reiff et al. 2012). To the best of our knowledge, no study to date has examined the content of sub-clinical psychotic-like experiences (PLEs) using non-clinical child or adolescent samples. This study aims to identify the presence of themes in the content of PLEs among children and adolescents from the general population and to examine associations between the content of the psychotic experience and adverse or abusive life events.

Background: A robust marker of brain dysfunction in schizophrenia (Cohen’s d=0.89) is reduction in amplitude of the P3 (or P300) event-related potential (ERP) that indexes attention and working memory processes. It is elicited typically using a two-tone auditory oddball paradigm that presents infrequent task-relevant target stimuli (which require a behavioural response) within a train of frequent task-irrelevant non-target (or standard) stimuli. The P3 amplitude reduction to target stimuli is present at the chronic and first-episode phases of schizophrenia, and may predict transition to psychosis among at-risk adolescents/young adults. We sought to characterise potential premorbid brain function abnormalities among at-risk children aged 9-12 years in detail, using an auditory novelty oddball task variant that dissociates an earlier, automatic frontocentral P3a subcomponent elicited by infrequent task-irrelevant salient novel stimuli from a later parietal P3b sub-component elicited by the infrequent task-relevant target stimuli. Methods: We examined brain function in two at-risk groups, including a group with family history of schizophrenia (FHx; n=20) and a group of children presenting a triad of replicated antecedents of schizophrenia (ASz; n=20), namely (i) psychotic-like experiences; (ii) a social, emotional, or behavioural problem; and (iii) a speech-and/or-motor developmental delay or abnormality. At-risk groups were compared with a group of typicallydeveloping (TD; n=28) peers who had no family history or antecedents of schizophrenia. Groups did not differ significantly on age, sex, ethnicity, socio-economic status, or handedness. Three group (FHx, ASz, TD) x three stimulus (targets, novels, non-targets) x five site (Fz, FCz, Cz, CPz, Pz) repeated-measures ANOVAs on peak P3 amplitude and latency data were conducted, and were repeated as ANCOVAs to control for poorer intellectual function (IQ) among the at-risk groups relative to TD children. Resu

Identification of markers of abnormal brain function in children at-risk of schizophrenia may inform early intervention and prevention programs. Individuals with schizophrenia are characterized by attenuation of MMN amplitude, which indexes automatic auditory sensory processing. The current aim was to examine whether children who may be at increased risk of schizophrenia due to their presenting multiple putative antecedents of schizophrenia (ASz) are similarly characterized by MMN abnormalities, relative to typically developing (TD) children. EEG was recorded from 22 ASz and 24 TD children aged 9 to 12 years (matched on age, sex, and IQ) during a passive auditory oddball task (15% duration deviant). ASz children were those presenting: (1) speech and/or motor development lags/problems; (2) internalizing, externalizing, and/or peer-relationship problems in the clinical range; and (3) psychotic-like experiences. TD children presented no antecedents. MMN amplitude, but not latency, was signifi cantly greater frontally in the ASz group than in the TD group. While MMN abnormalities were present in children at risk of schizophrenia, the nature of this abnormality differed from that observed in adults with schizophrenia. This may reflect developmental and disease effects in a pre-prodromal phase of psychosis onset. Longitudinal follow-up is necessary to establish the developmental trajectory of MMN in at-risk children.

There is increasing interest in the insula as a key region of neuropathology in schizophrenia. Several voxel-based meta-analyses of magnetic resonance imaging (MRI) studies have highlighted insula grey matter deficits in people with schizophrenia. However, volumetric studies targeting insula grey matter volume, to date, do not give a clear picture of insula morphometry. We undertook the first systematic review with meta- analysis of studies examining insula volume in schizophrenia compared to healthy controls.

Background: Subclinical psychotic-like experiences (PLEs) are common among the general population, particularly in children. Nevertheless, they confer elevated risk for later psychotic illness. This risk might be increased only in the context of additional psychosis risk markers, with recent research highlighting associations between depression/anxiety and the persistence of PLEs during adolescence. Yet, schizophrenia and related disorders are predicted by childhood externalising (EXT) as well as internalising (INT) psychopathology. Thus, the present study examined the latent structure underlying PLEs, EXT, and INT symptoms in a community sample of children aged 9-11 years. The study further examined whether longitudinal PLE trajectories over two years, particularly PLE persistence, predicted the presence of later INT and EXT problems. Methods: A community sample of 7,966 children (95% of eligible children; 51% male; mean age 10.4 years) completed questionnaires in class that assessed nine PLEs, EXT symptoms (conduct problems, hyperactivity and INT symptoms (emotional problems and peer relationship problems). A subsample of 547 children (46% male, mean age 12.2 years) completed reassessment after an average of two years, with their caregivers additionally reporting on children’s INT and EXT symptoms at both times (T0 and T1). Data in the longitudinal analysis were weighted to reflect the baseline population sample. Factor analysis of child-reported data in the large community sample (T0) was conducted to determine the latent structure underlying PLEs and other psychopathology in the general child population. In the longitudinal analysis, four PLE trajectories were defined using child-reported PLEs: persistent (PLEs at T0 and T1); remitting (PLEs at T0, but not at T1); incident (no PLEs at T0, but PLEs at T1); and none (no PLEs at T0 or T1). These trajectories were used to predict the presence of child-/parent-reportedINT and EXT problemsat T1. Analyses w

Background: The impact of environmental risk factors and the presence of antecedents of schizophrenia remain unclear. This meta-review aims to summarize and quality assess the available evidence from systematic reviews with meta-analysis in this area to compare effect sizes and identify gaps in the evidence in this area. Methods: Medline, CINAHL, Current Contents and PsycINFO were searched, supplemented by hand-searching. Included are systematic reviews with meta-analysis, reporting results separately for schizophrenia spectrum disorders. Reviews published prior to 2000, treatment guidelines, overviews, and reviews with a high possibility of reporting bias (as per PRISMA) were excluded. All included reviews’ reporting was quality assessed using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, and data quality was assessed using GRADE guidelines for consistency, precision and directness. Data extraction and quality assessment were completed by two independent reviewers. Results: The searches identified 451 results (less duplicates) of which 13 meet inclusion criteria. A further seven reviews have been identified via hand-searching and other sources. Results are currently being collated and will be presenting in order of magnitude of risk. Conclusions: There appears to be a paucity of evidence in this area from well-conducted systematic reviews, particularly relating to antecedents of schizophrenia.

Belgium has become one of the few countries in the world where euthanasia is legally allowed within a specific juridical framework. Even more unique is the inclusion of grounds for requesting euthanasia on the basis of mental suffering. Further refinement of the legal, medical and psychiatric approach to the issue is required in order to clear up essential practical and ethical matters. Psychiatrists and their professional organisations need to play a greater role in this ongoing debate and contribute from a clinical, scientific and ethical point of view.

Healthy subjects show increased activation in left temporal lobe regions in response to speech sounds compared to complex nonspeech sounds. Abnormal lateralization of speech-processing regions in the temporal lobes has been posited to be a cardinal feature of schizophrenia. Event-related fMRI was used to test the hypothesis that schizophrenic patients would show an abnormal pattern of hemispheric lateralization when detecting speech compared with complex nonspeech sounds in an auditory oddball target-detection task. We predicted that differential activation for speech in the vicinity of the superior temporal sulcus would be greater in schizophrenic patients than in healthy subjects in the right hemisphere, but less in patients than in healthy subjects in the left hemisphere. Fourteen patients with schizophrenia (selected from an outpatient population, 2 females, 12 males, mean age 35.1 years) and 29 healthy subjects (8 females, 21 males, mean age 29.3 years) were scanned while they performed an auditory oddball task in which the oddball stimuli were either speech sounds or complex nonspeech sounds. Compared to controls, individuals with schizophrenia showed greater differential activation between speech and nonspeech in right temporal cortex, left superior frontal cortex, and the left temporal-parietal junction. The magnitude of the difference in the left temporal parietal junction was significantly correlated with severity of disorganized thinking. This study supports the hypothesis that aberrant functional lateralization of speech processing is an underlying feature of schizophrenia and suggests the magnitude of the disturbance in speech-processing circuits may be associated with severity of disorganized thinking.

Converging evidence from studies of event-related potentials (ERPs) and functional magnetic resonance imaging (fMRI) suggest that criminal psycho- pathy is associated with abnormalities in limbic and paralimbic brain regions during a variety of cognitive and affective tasks. These results have led to the hypothesis that the paralimbic system is dysfunctional in criminal psychopathy. In the affective realm, ERP and fMRI studies utilizing emotional lexical decision tasks, affective verbal memory and emotional word discrimination tasks reveal evidence supporting this hypothesis. However, these latter studies all employed linguistic stimuli raising the possibility that some or all of the observed abnormalities in criminal psychopaths may be related to primary difficulties in language processing. To address this issue, we designed an affective picture processing task which contained no explicit demands on linguistic processing. Participants were presented with alternating blocks of affective or neutral picture stimuli and were required to make a living/nonliving discrimination for each stimulus presented. We hypothesized that affective pictures, relative to neutral pictures, would elicit greater limbic and paralimbic hemodynamic activity in nonpsychopaths than in psychopaths. Consistent with predictions, psychopaths showed less affect related activity than nonpsychopaths in left amygdala, rostral and caudal anterior cingulate and posterior cingulate. These findings replicate and extend the results of affective processing studies employing linguistic stimuli and support the hypotheses that psychopathy is associated with a dysfunctional paralimbic system.

We used event-related functional magnetic resonance imaging (erf MRI) techniques to examine the cerebral sites involved with target detection and novelty processing of auditory stimuli. Consistent with the results from a recent erf MRI study in the visual modality, target processing was associated with activation bilaterally in the anterior superior temporal gyrus, inferior and middle frontal gyrus, inferior and superior parietal lobules, anterior and posterior cingulate, thalamus, caudate, and the amygdala/hippocampal complex. Analyses of the novel stimuli revealed activation bilaterally in the inferior frontal gyrus, insula, inferior parietal lobule, and in the inferior, middle, and superior temporal gyri. These data suggest that the scalp recorded event-related potentials (e.g., N2 and P3) elicited during similar tasks reflect an ensemble of neural generators located in spatially remote cortical areas.

Schizophrenia is a diffuse brain disease that affects many facets of cognitive function. One of the most replicated findings in the neurobiology of schizophrenia is that the event-related potentials to auditory oddball stimuli are abnormal, suggesting abnormalities in attention and memory processes. Recently, we have used event-related fMRI to elucidate the abnormal neural architecture underlying target detection in chronic patients with schizophrenia. Compared with control participants, selective deficits were observed in the lateral frontal cortex, thalamus, superior temporal gyms, cingulate, and parietal lobes. Here we present the results of a similar study from a group of first-episode psychotic patients. Consistent with the results observed with chronic medicated patients, diffuse hemodynamic abnormalities were observed in the first episode patients in multiple cortical and subcortical sites. The first episode patients were also tested six weeks after treatment with atypical neuroleptics. Improvements in neural function, manifest as significantly larger hemodynamic responses to target stimuli, were observed in bilateral amygdala, hippocampus, dorsolateral prefrontal cortex, and supramarginal gyms and in the posterior cingulate. These data are consistent with the hypothesis that schizophrenia is characterized by a widespread pathological process affecting many cerebral areas. The data also suggest atypical neuroleptics improve neural function at diverse cerebral sites.

Introduction Psychopathy is a personality disorder characterised by disturbance in affective, interpersonal, and behavioural domains. Typically, it is the behavioural disturbances, including impulsivity, poor behavioural controls, and persistent contravention of societal norms, that brings the psychopath to the attention of society. The psychopaths’ behavioural disturbance has been conceptualized as arising from impaired response inhibition. Event-related potential research (Kiehl et al., 2000, Biological Psychiatry, 48) suggests that psychopathy is associated with abnormal neural activity during suppression of inappropriate responses. We used event-related fMRI to elucidate the neurobiological correlates of response inhibition during performance of a Go/NoGo task. Using this task in healthy controls Liddle et al. (2001, Human Brain Mapping, 12) demonstrated the importance of lateral frontal cortex in response inhibition. We hypothesised that psychopaths would show less activation in lateral frontal cortex during processing of NoGo stimuli than would healthy controls. Methods Fourteen psychopaths were recruited from a maximum-security prison and compared with fourteen healthy control participants selected from the general population. Psychopathy was assessed using the Hare Psychopathy Checklist-Revised (PCL-R) (Hare, 1991). Groups were matched for age, parental socioeconomic status, and IQ. All participants were right-handed, native English speakers, without history of head injury or psychotic illness. Task procedures are as described in Liddle et al. (2001). The visual stimuli for the Go and NoGo trials were the letters ‘X’ and ‘A’ respectively, presented for a period of 250 msecs each. Each trial commenced with a descending count of asterisks in order to increase motor response preparation. Twenty-four Go and 24 NoGo trials were randomly presented in a single scanning session. Imaging was performed using a General Electric 1.5 T whole body system fit