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Background: Patients with psychotic disorders often show prominent cognitive impairment. Glutamate seems to play a prominent role, but its role in deep gray matter (DGM) regions is unclear. Aims: To evaluate glutamate levels within deep gray matter structures in patients with a psychotic disorder in relation to cognitive functioning, using advanced spectroscopic acquisition, reconstruction, and post-processing techniques. Methods: A 7-Tesla magnetic resonance imaging scanner combined with a lipid suppression coil and subject-specific water suppression pulses was used to acquire high-resolution magnetic resonance spectroscopic imaging data. Tissue fraction correction and registration to a standard brain were performed for group comparison in specifically delineated DGM regions. The brief assessment of cognition in schizophrenia was used to evaluate cognitive status. Results: Average glutamate levels across DGM structures (i.e. caudate, pallidum, putamen, and thalamus) in mostly medicated patients with a psychotic disorder ( n = 16, age = 33, 4 females) were lower compared to healthy controls ( n = 23, age = 24, 7 females; p = 0.005, d = 1.06). Stratified analyses showed lower glutamate levels in the caudate ( p = 0.046, d = 0.76) and putamen p = 0.013, d = 0.94). These findings were largely explained by age differences between groups. DGM glutamate levels were positively correlated with psychomotor speed ( r(30) = 0.49, p = 0.028), but not with other cognitive domains. Conclusions: We find reduced glutamate levels across DGM structures including the caudate and putamen in patients with a psychotic disorder that are linked to psychomotor speed. Despite limitations concerning age differences, these results underscore the potential role of detailed in vivo glutamate assessments to understand cognitive deficits in psychotic disorders.

Patients with psychotic disorders often show prominent cognitive impairment. Glutamate seems to play a prominent role, but knowledge on its role in deep gray matter regions is limited and previous studies have yielded heterogeneous results. The aim was to evaluate glutamate levels within deep gray matter structures in patients with a psychotic disorder in relation to cognitive functioning, using advanced spectroscopic acquisition, reconstruction and post-processing techniques. A 7 tesla MRI scanner combined with a unique lipid suppression coil and subject specific water signal suppression pulses were used to acquire high-resolution magnetic resonance spectroscopic imaging data. Anatomical scans were used to perform tissue fraction correction and registration to a standard brain for group comparison in specifically delineated brain regions. The brief assessment of cognition in schizophrenia was used to evaluate cognitive status. Average glutamate levels across deep gray matter structures (i.e. caudate, pallidum, putamen, and thalamus) in patients with a psychotic disorder (n=16, 4 females) were lower compared to healthy controls (n=23, 7 females). Stratified analyses showed lower glutamate levels in the caudate and putamen but not in the pallidum or thalamus. Average glutamate levels across deep gray matter structures were positively correlated with cognition, particularly to psychomotor speed. We find reduced glutamate levels across deep brain structures such as the caudate and putamen in patients with a psychotic disorder that are linked to psychomotor speed. Our results underscore the potential role of detailed in vivo glutamate assessments to understand cognitive deficits in patients with psychotic disorders.

Background: Delirium is frequently unrecognised. EEG shows slower frequencies (i.e. below 4 Hz) during delirium, which might be useful in improving delirium recognition. We studied the discriminative performance of a brief single-channel EEG recording for delirium detection in an independent cohort of patients. Methods: In this prospective, multicentre study, postoperative patients aged ≥60 yr were included (n=159). Before operation and during the first 3 postoperative days, patients underwent a 5-min EEG recording, followed by a video-recorded standardised cognitive assessment. Two or, in case of disagreement, three delirium experts classified each postoperative day based on the video and chart review. Relative delta power (1–4 Hz) was based on 1-min artifact-free EEG. The diagnostic value of the relative delta power was evaluated by the area under the receiver operating characteristic curve (AUROC), using the expert classification as the gold standard. Results: Experts classified 84 (23.3%) postoperative days as either delirium or possible delirium, and 276 (76.7%) non-delirium days. The AUROC of the relative EEG delta power was 0.75 [95% confidence interval (CI) 0.69–0.82]. Exploratory analysis showed that relative power from 1 to 6 Hz had significantly higher AUROC (0.78, 95% CI 0.72–0.84, P=0.014). Conclusions: Delirium/possible delirium can be detected in older postoperative patients based on a single-channel EEG recording that can be automatically analysed. This objective detection method with a continuous scale instead of a dichotomised outcome is a promising approach for routine detection of delirium. Clinical trial registration: NCT02404181.

Patients with psychotic disorders often show prominent cognitive impairment. Glutamate seems to play a prominent role, but knowledge on its role in deep gray matter regions is limited and previous studies have yielded heterogeneous results. The aim was to evaluate glutamate levels within deep gray matter structures in patients with a psychotic disorder in relation to cognitive functioning, using advanced spectroscopic acquisition, reconstruction and post-processing techniques. A 7 tesla MRI scanner combined with a unique lipid suppression coil and subject specific water signal suppression pulses were used to acquire high-resolution magnetic resonance spectroscopic imaging data. Anatomical scans were used to perform tissue fraction correction and registration to a standard brain for group comparison in specifically delineated brain regions. The brief assessment of cognition in schizophrenia was used to evaluate cognitive status. Average glutamate levels across deep gray matter structures (i.e. caudate, pallidum, putamen, and thalamus) in patients with a psychotic disorder (n=16, 4 females) were lower compared to healthy controls (n=23, 7 females). Stratified analyses showed lower glutamate levels in the caudate and putamen but not in the pallidum or thalamus. Average glutamate levels across deep gray matter structures were positively correlated with cognition, particularly to psychomotor speed. We find reduced glutamate levels across deep brain structures such as the caudate and putamen in patients with a psychotic disorder that are linked to psychomotor speed. Our results underscore the potential role of detailed in vivo glutamate assessments to understand cognitive deficits in patients with psychotic disorders.

Error-monitoring deficits in schizophrenia have been found, but results with respect to feedback processing and remedial action were unclear. The present study examined the role of emotion in feedback processing in medication-free patients with recent-onset schizophrenia. Patients and controls performed a time-estimation task, and brain activation was measured with functional magnetic resonance imaging (fMRI). Participants had to estimate a 1-s interval and received feedback about their performance in the form of words or facial expressions. Patients performed the task at the same level as the controls and used the feedback to improve performance. Brain activation following the feedback stimuli in the rostral cingulate zone differed between groups, but this effect depended on the modality of the feedback stimulus. Patients showed a differential response to verbal and facial feedback in the rostral cingulate zone, whereas healthy controls did not differ between modalities. Furthermore, activation in the rostral cingulate zone following facial feedback was negatively related to severity of the disease as expressed by the scores on positive symptom subscale of the Positive and Negative Syndrome Scale. Both findings point in the direction of a specific deficit in patients which is related to the emotional impact of external feedback.

Functional Magnetic Resonance Imaging (FMRI) is a non-invasive technique for brain mapping and mostly performed using changes of the blood-oxygen-level-dependent (BOLD)-signal. It has been widely used to investigate patients with schizophrenia. Most of the studies examine patients treated with antipsychotic drugs, although little is known about the effects of these drugs on the BOLDsignal. Here we examined studies of patients with schizophrenia treated with different antipsychotics to address the question whether and to what extent antipsychotic drugs in themselves produce BOLD-signal changes. We performed a PubMed-search for the period from 1999 until January 2012 with the search items "schizophrenia" and "Magnetic Resonance Imaging" and "Antipsychotic Agents; or "Magnetic Resonance Imaging" and "Antipsychotic Agents"; or "schizophrenia" and "Antipsychotic Agents" and "FMRI". We extracted articles that examined at least two patient groups with different treatments, or patients examined on different medications at different times and that provided information about drug effects. No common effect of antipsychotics on BOLD-signal was found. However, based on the results for different antipsychotics (haloperidol, olanzapine, quetiapine and risperidone) we found evidence that the affinity to the dopamine (DA) D(2)-receptor may influence BOLD-signal.

In previous functional magnetic resonance imaging (fMRI) studies concerning romantic love, several brain regions including the caudate and putamen have consistently been found to be more responsive to beloved-related than control stimuli. In those studies, infatuated individuals were typically instructed to passively view the stimuli or to think of the viewed person. In the current study, we examined how the instruction to attend to, or ignore the beloved modulates the response of these brain areas. Infatuated individuals performed an oddball task in which pictures of their beloved and friend served as targets and distractors. The dorsal striatum showed greater activation for the beloved than friend, but only when they were targets. The dorsal striatum actually tended to show less activation for the beloved than the friend when they were distractors. The longer the love and relationship duration, the smaller the response of the dorsal striatum to beloved-distractor stimuli was. We interpret our findings in terms of reinforcement learning. By virtue of using a cognitive task with a full factorial design, we show that the dorsal striatum is not activated by beloved-related information per se, but only by beloved-related information that is attended.

Faces are multidimensional stimuli that convey information for complex social and emotional functions. Separate neural systems have been implicated in the recognition of facial identity (mainly extrastriate visual cortex) and emotional expression (limbic areas and the superior temporal sulcus). Working-memory (WM) studies with faces have shown different but partly overlapping activation patterns in comparison to spatial WM in parietal and prefrontal areas. However, little is known about the neural representations of the different facial dimensions during WM. In the present study 22 subjects performed a face-identity or face-emotion WM task at different load levels during functional magnetic resonance imaging. We found a fronto-parietal-visual WM-network for both tasks during maintenance, including fusiform gyrus. Limbic areas in the amygdala and parahippocampal gyrus demonstrated a stronger activation for the identity than the emotion condition. One explanation for this finding is that the repetitive presentation of faces with different identities but the same emotional expression during the identity-task is responsible for the stronger increase in BOLD signal in the amygdala. These results raise the question how different emotional expressions are coded in WM. Our findings suggest that emotional expressions are re-coded in an abstract representation that is supported at the neural level by the canonical fronto-parietal WM network. (C) 2010 Elsevier Ltd. All rights reserved.

The present study examined the role of the rostral cingulate zone (RCZ) in feedback processing, and especially focused on effects of modality of the feedback stimulus and remedial action. Participants performed a time-estimation task in which they had to estimate a 1-second interval. After the estimation participants received verbal (correct/false) or facial (fearful face/happy face) feedback. Percentage of positive and negative feedback was kept at 50% by dynamically adjusting the interval in which estimations were labeled correct. Contrary to predictions of the reinforcement learning theory, which predicts more RCZ activation when the outcome of behavior is worse than expected, we found that the RCZ was more active after positive feedback than after negative feedback, independent of the modality of the feedback stimulus. More in line with the suggested role of the RCZ in reinforcement learning was the finding that the RCZ was more active after negative feedback that was followed by a correct adjustment as compared to negative feedback followed by an incorrect adjustment. Both findings can be explained in terms of the RCZ being involved in facilitating remedial action as opposed to the suggested signaling function (outcome is worse than expected) proposed by the reinforcement learning theory. (C) 2010 Elsevier Inc. All rights reserved.

Aims: It has been suggested that schizophrenic patients are more vulnerable to stress than healthy persons, and that stressors can trigger a psychotic episode or worsen symptoms. The biological system often studied in relation to stress is the hypothalamic–pituitary–adrenal (HPA) axis, which controls the release of cortisol. We investigated whether the diurnal basal activity of the HPA axis differed between young male patients with schizophrenia and healthy controls. Methods: Twenty-seven male patients (mean age 22 ± 5 years) and 38 healthy male control subjects (mean age 22 ± 3 years) were included in the present study. Saliva was sampled at five time points during the day: directly after awakening, 30 min thereafter, and at 12.00 hours, 16.00 hours and 22.00 hours. Results: The cortisol concentration decreased significantly more during the day in the patient group thanin the control group. Patients also showed a significantly decreased area under the curve with respect to the increase, again indicating that the cortisol concentrations decreased more during the day in patients than in controls. Both the morning increase and the area under the curve with respect to the increase were significantly negatively correlated with negative symptom severity. Conclusions: Patients with schizophrenia showed a different daytime sensitivity of the HPA axis. Our findings further suggest that an increase in negative symptom severity is related to a decreased HPA axis sensitivity.

Abstract This study aimed to investigate the effects of treatment with haloperidol, olanzapine and risperidone on cardiovascular variability in patients with recent-onset schizophrenia by means of spectral analysis. Unmedicated patients ( n = 18) had a higher mean heart rate and a tendency for a lower high-frequency power of heart rate variability than healthy control subjects ( n = 57), indicating a decreased cardiac vagal control in unmedicated patients with schizophrenia. Patients treated with haloperidol ( n = 10) showed significantly lower low-frequency power of heart rate and systolic blood pressure variability compared with olanzapine-treated patients, suggesting that haloperidol attenuated sympathetic functioning. On the contrary, olanzapine-treated patients ( n = 10) showed the highest power in the low-frequency range of heart rate and systolic blood pressure variability, suggesting an increased sympathetic cardiac functioning. No significant effects of risperidone ( n = 13) were found. None of the antipsychotic agents differed in their parasympathetic cardiovascular effects. We conclude that young, unmedicated patients with schizophrenia differed from controls in their parasympathetic functioning, but the antipsychotic agents haloperidol, risperidone and olanzapine induced only minor cardiovascular side effects.

It is assumed that the procedures of functional magnetic resonance imaging (fMRI) are able to provoke significant dissociative responses. Trait and state dissociation of 32 healthy subjects undergoing fMRI have been recorded. At least one-third of the subjects showed dissociative responses of very large effect size (d = 4.10). The contributing causal factors for that dissociative response could not yet identified clearly. Considering the impact of dissociation on mental functions, we recommend controlling subjects undergoing fMRI studies for dissociative responses. Further studies on the actual phenomenological experience of subjects undergoing fMRI procedures are warranted.

Background: Depersonalization (DP) is characterized by persistent or recurrent episodes of detachment from one’s self with reduced pain perception being a common feature. Alterations in the body schema similar to the cortico-limbic disconnection syndrome of pain asymbolia are suggested to be responsible for DP. In this study we used hypnosis to induce DP in healthy subjects and to examine neural patterns of pain perception in the state of DP by means of functional magnetic resonance imaging (fMRI). Methods: Pain perception was investigated in 7 healthy subjects with high susceptibility to hypnosis in three different mental states: waking state (N-W), hypnotic relaxation (H-R) and hypnotic DP (H-DP). Pain was induced with electrical stimulation to the median nerve at the right wrist. fMRI measurements were performed during all states. Results: Nociceptive stimuli led to an activation of the well described pain network including somatosensory and insular regions and the cerebellum. Activation was markedly reduced in the contralateral somatosensory cortex, parietal cortex (Brodmann area 40, BA40), prefrontal cortex (BA9), putamen and the ipsilateral amygdala during H-DP. Subjects also reported a significant decrease in pain intensity from N-W to H-DP. Conclusion: Pain response during H-DP was reduced in sensory and affective pain-related areas, reflecting the diminished intensity of the perceived pain. Moreover, a network of cortical and subcortical areas that have been implicated in the perception of the own body was less responsive during DP, which might point to a specific neural mechanism underlying the ‘out-of-body’ experience. Although the small number of subjects does not allow a generalization of our findings, H-DP seems to be a promising tool for the investigation of psychological and biological mechanisms of self-inflicted injuries as well as the mind-body interplay within the realm of psychosomatic disorders.

Depersonalisation (DP) und Derealisation (DR) werden in der klinischen Routine zu wenig beachtet. Da Patienten von sich aus selten spontan uber ihr Erleben von DP/DR sprechen, ist eine gezielte Exploration fur die sichere Erfassung der DP/DR wichtig. Bei 143 Neuaufnahmen einer psychosomatischen Akutstation wurde die Einmonatspravalenz von DP/DR mit dem Strukturierten Klinischen Interview fur DSM-IV Dissoziative Storungen erhoben. Zusatzlich wurden Fragebogen zur Erfassung der DP/DR (Fragebogen zu dissoziativen Symptomen, Cambridge Depersonalisation Scale), der allgemeinen Psychopathologie (SCL-90-R) und der interpersonalen Probleme (IIP) eingesetzt. In der Stichprobe fand sich bei 23,1% ( n =33) ein primares Depersonalisations-Derealisationssyndrom (ICD-10 F48.1) und bei 7% ( n =10) sekundare pathologische DP/DR. DP/DR jeglicher Schwere wurde von 62,9% der Patienten berichtet. Bei Patienten mit pathologischer DP/DR lagen besonders oft Angststorungen vor. Auserdem zeigten sie generell eine hohere Symptombelastung als die ubrigen Patienten und waren insbesondere durch Introversion gekennzeichnet. Eine weitergehende Berucksichtigung der DP/DR bei der Routinediagnostik, der Behandlung, klinischen Studien und der Grundlagenforschung erscheint angesichts der hohen Pravalenz geboten.

We used psychotherapeutic measures and functional magnetic resonance imaging (fMRI) to assess the effect of a combined psychodynamic and cognitive behavioral treatment of a patient suffering from a severe obsessive compulsive disorder (OCD). The clinical outcome was controlled by a detailed case description and psychometric test instruments. Intensive exploration of the patient made possible the creation of an idiosyncratic imagination paradigm suitable for fMRI. The patient shows at the end of treatment a decrease in symptoms as assessed by clinical as well as psychometric instruments. Especially recapitulation and cleaning obsessions decreased, but the cognitive avoidance strategies remained almost unchanged. fMRI showed no orbito-fronto-striatothalamic activation corresponding to obsessive compulsive symptoms, but an increased activation of the medial prefrontal (MFC) and anterior cingulate cortex (ACC). The lack of activation of the orbito-fronto-striatothalamic circuits and at the same time the occurrence of the increased activation of the MFC and ACC reflects the cognitive avoidance strategies still triggered by the symptom provoking stimulus.

In schizophrenia and Parkinson's disease, cortical and subcortical motor organization is influenced by primary disease conditions and neuroleptic treatment. Using functional magnetic resonance imaging patients with schizophrenia were compared, according to Diagnostic and Statistical Manual of Mental Disorders (4th edn), under stable treatment with olanzapine (n = 7; OL) or haloperidol (n = 7; HA) to healthy controls (n = 7; HC), patients with schizophrenia without any neuroleptic treatment (n = 7; UN) and to patients with left (n = 7; LHP)- and right (n = 7; RHP)-sided hemiparkinsonism. All subjects performed a unilateral left-handed fingertapping task. All groups had significant activation in the contralateral motor cortex and the putamen (P < 0.001). Different activation patterns between groups within cortical and subcortical regions of interest were revealed. In particular, different subcortical activation patterns were found between OL- and HA-treated patients with schizophrenia. Activation of the contralateral putamen was increased in right-sided hemiparkinsonism. Significant thalamus activation was found in patients under neuroleptic treatment as well as in hemiparkinsonism, whereas the thalamus was not activated in untreated patients with schizophrenia and in healthy controls. Comparing dopaminergic depletion in hemiparkinsonism and dopaminergic blockade in HA-treated patients, an increase in activation was found within the contralateral primary motorcortex, in the ipsilateral putamen and the contralateral thalamus in hemiparkinsonism. In contrast, activation of the contralateral putamen differed between OL and HA, LHP and RHP. These findings confirm that cortical and subcortical motor-related brain loop functions are influenced by both primary neuropsychiatric conditions as well as by treatment effects. It is hypothesized that dopaminergic depletion in hemiparkinsonism and dopaminergic blockade under neuroleptic agents influence basal ganglia activity in a different way; in particular regarding functional connectivity. Basal ganglia and thalamic interaction seems to have a key role in cortical-subcortical interaction.

Background Neurobiology of psychopathy is important for our understanding of current neuropsychiatric questions. Despite a growing interest in biological research in psychopathy, its neural underpinning remains obscure. Methods We used functional magnetic resonance imaging to study the influence of affective contents on brain activation in psychopaths. Series containing positive and negative pictures from the International Affective Picture System were shown to six male psychopaths and six male control subjects while 100 whole-brain echo-planar-imaging measurements were acquired. Differences in brain activation were evaluated using BrainVoyager software 4.6. Results In psychopaths, increased activation through negative contents was found right-sided in prefrontal regions and amygdala. Activation was reduced right-sided in the subgenual cingulate and the temporal gyrus, and left-sided in the dorsal cingulate and the parahippocampal gyrus. Increased activation through positive contents was found left-sided in the orbitofrontal regions. Activation was reduced in right medial frontal and medial temporal regions. Conclusions These findings underline the hypotheses that psychopathy is neurobiologically reflected by dysregulation and disturbed functional connectivity of emotion-related brain regions. These findings may be interpreted within a framework including prefrontal regions that provide top-down control to and regulate bottom-up signals from limbic areas. Because of the small sample size, the results of this study have to be regarded as preliminary.

Functional magnetic resonance imaging (fMRI) is a well established, non-invasive technique for mapping the working brain. Yet imaging of subcortical regions has proven to be difficult. We studied 40 subjects performing an unilateral self-paced finger-tapping task. Patients with schizophrenia according to DSM-IV treated with olanzapine (n =10) or haloperidol (n=10) were compared to healthy controls (n =10) and untreated patients (n=10). Brainvoyager software was used for data-analyzing. All subjects showed highly significant activation in the contralateral sensorimotor area, the supplementary motor area and the ipsilateral cerebellum. In every investigated subject contralateral subcortical regions were also significantly activated (P < 0.001). Activation in ipsilateral pallidum was significantly higher in untreated patients compared with the other groups indicating an increase in subcortical coactivation. In addition, significant correlations were revealed within groups. This study emphasizes the possibility of investigating subcortical brain activation in patients with schizophrenia. The results of the present study outline the importance of further fMRI studies to investigate interindividual activation differences under different conditions especially focusing on basal ganglia.

Although patients with schizophrenia have severe memory impairments and emotional deficits, studies investigating emotional memory modulation (EMM) in schizophrenia show contradictory results, possibly due to methodological differences and small group size. We investigated whether impaired EMM is already present in First Episode Psychosis (FEP) and whether impairments in EMM are task or stimulus dependent Forty-five FEP and thirty-seven Healthy Control (HC) male participants matched for age performed visual and verbal short-term (immediate recall) and long-term (after 24 h recognition) memory tasks with neutral, negative and positive stimuli. On all tasks overall memory performance for FEP was significantly below that of HC. Although EMM varied by task and type of stimulus, none of the tasks showed a difference in EMM between FEP and HC. There were no differences between FEP and HC in the way emotion modulates different memory domains. This could mean that EMM is spared in the early course of schizophrenia. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

This study examined the proposed automatic and involuntary nature of synesthetic experiences in graphemecolor synesthetes by comparing behavioral and blood-oxygen level dependent (BOLD) responses in a synesthetic and a standard version of the Stroop task. Clear interference effects in terms of slower reaction times and stronger BOLD responses in the rostral cingulate zone (RCZ) were found in synesthetes performing the synesthetic version of the Stroop task. Surprisingly, less interference was found in synesthetes compared with controls performing the standard Stroop task. This smaller interference effect, expressed as the difference in reaction time between incongruent and neutral stimuli, was explained in terms of experienced interference during the neutral condition of the Stroop task in synesthetes. This was confirmed by stronger BOLD responses in the RCZ for synesthetes specifically in the neutral condition. To the best of our knowledge, this is the first study to show different performance of synesthetes in a standard Stroop task and the presented data can be seen as strong evidence for the automatic and involuntary nature of synesthetic experiences. (C) 2013 IBRO. Published by Elsevier Ltd. All rights reserved.

Background Recent studies have suggested that deregulated AKT1 signaling is associated with schizophrenia. We hypothesized that if this is indeed the case, we should observe both decreased AKT1 expression as well as deregulation of AKT1 regulated pathways in Peripheral Blood Mononuclear Cells (PBMCs) of schizophrenia patients. Objectives To examine PBMC expression levels of AKT1 in schizophrenia patients versus controls, and to examine whether functional biological processes in which AKT1 plays an important role are deregulated in schizophrenia patients. Methods/Results A case-control study, investigating whole-genome PBMC gene expression in male, recent onset (

Previous research investigating the emotion recognition ability in patients with schizophrenia has mainly focused on the recognition of facial expressions. To broaden our understanding of emotional processes in patients with schizophrenia, this study aimed to investigate whether these patients experience and process other emotionally evocative stimuli differently from healthy participants. To investigate this, we measured the cardiac and subjective responses of 33 male patients (9 with and 24 without antipsychotic medication) and 40 male control subjects to emotion-eliciting pictures. Cardiac responses were chosen as an outcome measure because previous research has indicated that these are linked with attentional and emotional processes and provide a more objective measure than self-report measures alone. The differences in cardiac responses between patients and controls were limited to medicated patients: only the medicated patients showed significantly decreased cardiac orienting responses compared with control subjects, regardless of picture contents. These results indicate that medicated patients directed less attention towards emotion-eliciting pictures than controls. Decreased attentional resources while processing emotional evocative stimuli could lead to incorrect appraisals of the environment and may have detrimental emotional and social consequences, contributing to chronic stress levels and an increased risk for cardiovascular disease.

Background: Body image distortion is a key symptom of eating disorders. In behavioral research two components of body image have been defined: attitudes towards the body and body size estimation. Only few fMRI-studies investigated the neural correlates of body image in bulimia; those are constrained by the lack of a direct distinction between these different body image components. Methods: The present study investigates the neural correlates of two aspects of the body image using fMRI: satisfaction rating and size estimation of distorted own body photographs in bulimia nervosa patients (15) and controls (16). Results: Patients were less satisfied with their current body shape than controls and preferred to be thinner. The amount of insula activity reflects the pattern of the satisfaction rating for patients and controls. Patients also overestimated their own body size. For control subjects, an activated cluster in lateral occipital cortex was sensitive for body size distortions, whereas bulimic patients did not demonstrate such a modulation. Furthermore, bulimic subjects did not recruit the middle frontal gyrus (MFG) in contrast to controls during the body size estimation task, maybe indicating a reduced spatial manipulation capacity. Therefore, this activation pattern of lateral occipital cortex and MFG might be responsible for body size overestimation in bulimia. Conclusions: The present results show that bulimic patients exhibit two distinct deficits in body image representations similar to anorectic patients and that specifically associated neuronal correlates can be identified. Concludingly, our study support psychotherapeutic strategies specifically targeting these two aspects of body image distortions. (C) 2011 Elsevier Inc. All rights reserved.

In the last decade, functional Magnetic Resonance Imaging (FMRI) has been increasingly used to investigate the neurobiology of schizophrenia. This technique relies on changes in the blood-oxygen-level-dependent (BOLD) – signal, which changes in response to neural activity. Many FMRI studies on schizophrenia have examined medicated patients, but little is known about the effects of antipsychotic medication on the BOLD – signal. In this review we investigated to what extent studies in patients with schizophrenia (SC), who were treated with different antipsychotics, could give insight in the effects of antipsychotics on the BOLD-signal. A PubMed search was performed using the search items “schizophrenia”, “FMRI”, “antipsychotics” and “schizophrenia”, “BOLD”, “antipsychotics”. Only articles in which there were at least two groups of patients with different treatments or in which patients were scanned twice with different treatments were selected. 18 articles, published between 1999 and 2009, fulfilled these criteria. Paradigms and results of these studies were compared regarding differences induced by the administered antipsychotics. This analysis showed no general effect of antipsychotics on the BOLD-signal. However, there is some evidence that the extent of blockade of the dopamine (DA) D2 receptor does influence the BOLD-signal. Higher affinity to the dopamine D2 receptor, as expressed by a higher/lower inhibition constant (Ki) seems to cause a decrease in BOLD-signal.

textabstractIn recent years, special interest has been focused on impairments of executive functions in patients with obstructive sleep apnoea syndrome (OSAS). However, the majority of studies have not clearly separated deficits in executive functions from impairments in other cognitive processes involved in task solving. In the present study, working memory (WM) functions of 20 patients with OSAS were compared with those of 10 age-, sex- and education-matched healthy subjects. Cognitive functions were measured four times a day; each of these measurements was accompanied by an assessment of subjective and objective daytime sleepiness. To separate dysfunctions of WM from those of additionally involved processes, n-back tasks were applied embedded in a reaction-time- decomposition approach. Deficits in n-back tasks could be observed in OSAS patients in accuracy and reaction times. However, the slowing could already be observed in simple reaction time tasks. The drop in 1-back accuracy in the morning was related to daytime sleepiness. During the afternoon, accuracy of OSAS patients dropped in 2-back tasks, an effect which correlated neither with sleepiness nor with the extent of sleep apnoea or oxygen desaturation. In conclusion, our data reflect a complex perspective upon cognitive deficits in OSAS. Cross-group differences in processing time on the higher level WM task appeared to be attributable to slowing at a more elementary cognitive processing level. In contrast, reduced accuracy during the WM task in the OSAS group could not be explained by deficits in more elementary cognitive processes.

Functional magnetic resonance imaging (fMRI) studies can provide insight into the neural correlates of hallucinations. Commonly, such studies require self-reports about the timing of the hallucination events. While many studies have found activity in higher-order sensory cortical areas, only a few have demonstrated activity of the primary auditory cortex during auditory verbal hallucinations. In this case, using self-reports as a model of brain activity may not be sensitive enough to capture all neurophysiological signals related to hallucinations. We used spatial independent component analysis (sICA) to extract the activity patterns associated with auditory verbal hallucinations in six schizophrenia patients. SICA decomposes the functional data set into a set of spatial maps without the use of any input function. The resulting activity patterns from auditory and sensorimotor components were further analyzed in a single-subject fashion using a visualization tool that allows for easy inspection of the variability of regional brain responses. We found bilateral auditory cortex activity, including Heschl's gyrus, during hallucinations of one patient, and unilateral auditory cortex activity in two more patients. The associated time courses showed a large variability in the shape, amplitude, and time of onset relative to the self-reports. However, the average of the time courses during hallucinations showed a clear association with this clinical phenomenon. We suggest that detection of this activity may be facilitated by examining hallucination epochs of sufficient length, in combination with a data-driven approach.

We used psychotherapeutic measures and functional magnetic resonance imaging (fMRI) to assess the effect of a combined psychodynamic and cognitive behavioral treatment of a patient suffering from a severe obsessive compulsive disorder (OCD). The clinical outcome was controlled by a detailed case description and psychometric test instruments. Intensive exploration of the patient made possible the creation of an idiosyncratic imagination paradigm suitable for fMRI. The patient shows at the end of treatment a decrease in symptoms as assessed by clinical as well as psychometric instruments. Especially recapitulation and cleaning obsessions decreased, but the cognitive avoidance strategies remained almost unchanged. fMRI showed no orbito-fronto-striatothalamic activation corresponding to obsessive compulsive symptoms, but an increased activation of the medial prefrontal (MFC) and anterior cingulate cortex (ACC). The lack of activation of the orbito-fronto-striatothalamic circuits and at the same time the occurrence of the increased activation of the MFC and ACC reflects the cognitive avoidance strategies still triggered by the symptom provoking stimulus.

In schizophrenia and Parkinson's disease, cortical and subcortical motor organization is influenced by primary disease conditions and neuroleptic treatment. Using functional magnetic resonance imaging patients with schizophrenia were compared, according to Diagnostic and Statistical Manual of Mental Disorders (4th edn), under stable treatment with olanzapine (n = 7; OL) or haloperidol (n = 7; HA) to healthy controls (n = 7; HC), patients with schizophrenia without any neuroleptic treatment (n = 7; UN) and to patients with left (n = 7; LHP)- and right (n = 7; RHP)-sided hemiparkinsonism. All subjects performed a unilateral left-handed fingertapping task. All groups had significant activation in the contralateral motor cortex and the putamen (P0.001). Different activation patterns between groups within cortical and subcortical regions of interest were revealed. In particular, different subcortical activation patterns were found between OL- and HA-treated patients with schizophrenia. Activation of the contralateral putamen was increased in right-sided hemiparkinsonism. Significant thalamus activation was found in patients under neuroleptic treatment as well as in hemiparkinsonism, whereas the thalamus was not activated in untreated patients with schizophrenia and in healthy controls. Comparing dopaminergic depletion in hemiparkinsonism and dopaminergic blockade in HA-treated patients, an increase in activation was found within the contralateral primary motorcortex, in the ipsilateral putamen and the contralateral thalamus in hemiparkinsonism. In contrast, activation of the contralateral putamen differed between OL and HA, LHP and RHP. These findings confirm that cortical and subcortical motor-related brain loop functions are influenced by both primary neuropsychiatric conditions as well as by treatment effects. It is hypothesized that dopaminergic depletion in hemiparkinsonism and dopaminergic blockade under neuroleptic agents influence basal ganglia activity in a different way; in particular regarding functional connectivity. Basal ganglia and thalamic interaction seems to have a key role in cortical-subcortical interaction.

Neurobiology of psychopathy is important for our understanding of current neuropsychiatric questions. Despite a growing interest in biological research in psychopathy, its neural underpinning remains obscure.We used functional magnetic resonance imaging to study the influence of affective contents on brain activation in psychopaths. Series containing positive and negative pictures from the International Affective Picture System were shown to six male psychopaths and six male control subjects while 100 whole-brain echo-planar-imaging measurements were acquired. Differences in brain activation were evaluated using BrainVoyager software 4.6.In psychopaths, increased activation through negative contents was found right-sided in prefrontal regions and amygdala. Activation was reduced right-sided in the subgenual cingulate and the temporal gyrus, and left-sided in the dorsal cingulate and the parahippocampal gyrus. Increased activation through positive contents was found left-sided in the orbitofrontal regions. Activation was reduced in right medial frontal and medial temporal regions.These findings underline the hypotheses that psychopathy is neurobiologically reflected by dysregulation and disturbed functional connectivity of emotion-related brain regions. These findings may be interpreted within a framework including prefrontal regions that provide top-down control to and regulate bottom-up signals from limbic areas. Because of the small sample size, the results of this study have to be regarded as preliminary.

Motor symptoms including neurological soft signs have been found to be more prevalent in schizophrenic patients. In addition, catatonic symptoms and neuroleptic treatment as well may influence cortical and subcortical motor organization in schizophrenia. The results of previous neuroimaging studies exploring motor function in patients with schizophrenia are inhomogenous reporting on a decreased activity in cortical motor regions in some studies and normal activity in others. Using fMRI, we studied 40 subjects performing a unilateral self-paced fingertapping task. Analyzing a general linear model of four groups, we compared patients with schizophrenia according to DSM-IV treated with olanzapine (OL; 10) or haloperidol (HA; 10) to healthy controls (HC; 10) and untreated patients (UN; 10). Brainvoyager software was used for data analyzing. In all groups, the contralateral motor cortex was significantly activated. Significant activation of the ipsilateral cerebellum was found in the UN group, the control group and the OL group. The contralateral basal ganglia were activated in UN and in controls. Motor-induced cortical and subcortical brain activation in HC was significantly higher than in patients with schizophrenia. UN with schizophrenia showed a significant overactivation than the other groups. In conclusion, we revealed a diminished activation in the patient group treated with neuroleptic drugs. This study outlines the importance of further fMRI studies to investigate interindividual activation differences under different conditions especially focusing on basal ganglia.