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Background and Hypothesis Psychotic Like Experiences (PLEs) are widely prevalent in children and adolescents and increase the risk of developing psychosis. Cortical gyrification characterizes brain development from in utero till about the first 2 years of life and can be measured in later years as static gyrification changes demonstrating neurodevelopment and dynamic gyrification changes reflecting brain maturation during adolescence. We hypothesized that PLEs would be associated with static cortical gyrification changes reflecting a neurodevelopmental abnormality. Study Design We studied 1252 adolescents recruited in the IMAGEN consortium. We used a longitudinal study design, with Magnetic Resonance Imaging measurements at age 14 years and age 19 years; measurement of PLEs using the Community Assessment of Psychic Experiences (CAPE) questionnaire at age 19 years; and clinical diagnoses at age 23 years. Study Results Our results show static gyrification changes in adolescents with elevated PLEs on 3 items of the CAPE—voice hearing, unusual experiences of receiving messages, and persecutory ideas—with lower cortical gyrification in fronto-temporal regions in the left hemisphere. This group also demonstrated dynamic gyrification changes with higher cortical gyrification in right parietal cortex in late adolescence; a finding that we replicated in an independent sample of patients with first-episode psychosis. Adolescents with high PLEs were also 5.6 times more likely to transition to psychosis in adulthood by age 23 years. Conclusions This is the largest study in adolescents that demonstrates fronto-temporal abnormality of cortical gyrification as a potential biomarker for vulnerability to PLEs and transition to psychosis.

SummaryThe National Health Service (NHS) was created 70 years ago to provide universal healthcare to the UK, and over the years it has relied upon international medical graduates (IMGs) to be able to meet its needs. Despite the benefits these professionals bring to the NHS, they often face barriers that hinder their well-being and performance. In this editorial, we discuss some of the most common challenges and the adverse effects these have on IMGs’ lives and careers. However, we also propose practical measures to improve IMGs’ experiences of working in psychiatry.

Perhaps identifying those who are clinically vulnerable has been one of the kindest endeavours this year.1 Letters of support and guidance from the NHS and the NHS Volunteer Responder Scheme, and guidance from NHS Employers for working from home2 and supporting staff with childcare responsibilities,3 are compassionate initiatives that recognise the importance of …

In 2018 a research paper and linked editorial discussed the challenges and discrimination faced by physician mothers.12 Physician mothers who have children with complex needs do not find their voices in the literature, hear their stories of resilience, or know of avenues where their insights could enrich healthcare delivery and leadership. In the NHS workforce, clinicians with children with complex needs …

Nelson discusses the positive effects of this pandemic.1 Covid-19 has opened up the vulnerabilities in society. Many healthcare workers are identified by the NHS as either being “clinically vulnerable” or taking care of someone who is clinically vulnerable. Health education boards and the NHS have allowed for remote arrangements for those who are shielding. The Royal Colleges of Psychiatrists and General Practitioners are engaging remotely and developing alternative arrangements for exams such as clinical skills assessment. …

Bipolar disorder and schizophrenia share phenotypic and genotypic features, but might differ in aspects of abnormal neurodevelopmental trajectories. We studied gyrification, a marker of early developmental pathology, in high-resolution MRI scans of 34 patients with schizophrenia, 17 euthymic bipolar I disorder patients with previous psychotic symptoms, and 34 matched healthy controls in order to test the hypothesis of overlapping and diverging prefrontal gyrification abnormalities. We applied a novel, validated method for measuring local gyrification in each vertex point of the reconstructed cortical surface. Psychotic bipolar I patients had higher gyrification in dorsal anterior and infragenual cingulate cortex compared to either schizophrenia or healthy controls, while schizophrenia patients had higher gyrification than controls in anterior medial (BA 10) and orbitofrontal areas, altogether indicating disease-specific alterations in the prefrontal cortex. Our findings indicate gyrification changes in a specific subgroup of bipolar I disorder to affect an area relevant to emotion regulation, and distinct from changes seen in schizophrenia.

Hippocampal pathology has been shown to be central to the pathophysiology of schizophrenia and a putative risk marker for developing psychosis. We applied both (1)H MRS (proton magnetic resonance spectroscopy) at 3Tesla and voxel-based morphometry (VBM) of high-resolution brain structural images in order to study the association of the metabolites glutamate (Glu) and N-acetyl-aspartate (NAA) in the hippocampus with whole-brain morphometry in 31 persons at ultra-high-risk for psychosis (UHR), 18 first-episode schizophrenia patients (Sz), and 42 healthy controls (all subjects being neuroleptic-naïve). Significantly diverging associations emerged for UHR subjects hippocampal glutamate showed positive correlation with the left superior frontal cortex, not seen in Sz or controls, while in first-episode schizophrenia patients a negative correlation was significant between glutamate and a left prefrontal area. For NAA, we observed different associations for left prefrontal and caudate clusters bilaterally for both high-risk and first-episode schizophrenia subjects, diverging from the pattern seen in healthy subjects. Our results suggest that associations of hippocampal metabolites in key areas of schizophrenia might vary due to liability to or onset of the disorder.

While schizophrenia and bipolar disorder have been assumed to share phenotypic and genotypic features, there is also evidence for overlapping brain structural correlates, although it is unclear whether these relate to shared psychotic features. In this study, we used voxel-based morphometry (VBM8) in 34 schizophrenia patients, 17 euthymic bipolar I disorder patients (with a history of psychotic symptoms), and 34 healthy controls. Our results indicate that compared to healthy controls schizophrenia patients show grey matter deficits (p

This study investigates the morphometry of Heschl's gyrus and its included primary auditory cortex (PAC) in hearing impaired (HI) and normal hearing (NH) infants. Fourty-two infants, age 8–19 months, with NH (n = 26) or hearing impairment (n = 16) were studied using high-resolution 3D magnetic resonance imaging. Gray matter (GM) and white matter (WM) volumes were obtained using software for automatic brain imaging segmentation to estimate the volume of each tissue within manually defined regions for the anterior portion of Heschl's gyrus (aHG) in each individual subject, transformed to an infant brain template space. Interactions among group (HI, NH), tissue type (GM, WM), and hemisphere (left, right) were examined using analysis of variance. Whole-brain voxel-based morphometry was utilized to explore volume differences between groups across the entire brain. The HI group showed increased GM and decreased WM in aHG compared with the NH group; likely effects of auditory deprivation. The HI group did not exhibit their typical L > R asymmetry pattern that the NH group showed. Increased GM in aHG in HI infants may represent abnormal cortical development in PAC as seen in animal models of sensory deprivation. Lower WM volume is consistent with studies with deaf adults.

Probabilistic independent component analysis was applied to identify the default mode network (DMN) in resting state data obtained with functional magnetic resonance imaging from 25 DSM-IV schizophrenia and 25 matched healthy subjects. Power spectrum analysis showed a significant diagnosis × frequency interaction and higher power in one frequency band, indicating an alteration of DMN frequency spectrum in schizophrenia.

BackgroundGenetic variation in the gene encoding ZNF804A, a risk gene for schizophrenia, has been shown to affect brain functional endophenotypes of the disorder, while studies of white matter structure have been inconclusive.MethodWe analysed effects of ZNF804A single nucleotide polymorphism rs1344706 on grey and white matter using voxel-based morphometry (VBM) in high-resolution T1-weighted magnetic resonance imaging scans of 62 schizophrenia patients and 54 matched healthy controls.ResultsWe found a significant (p p ConclusionsOur findings demonstrate effects of ZNF804A genetic variation on brain structure, with diverging regional effects in schizophrenia patients and healthy controls in frontal and temporal brain areas. These effects, however, might be dependent on the impact of other (genetic or non-genetic) disease factors.

Common genetic variation in the promoter region of the glutamate receptor delta 1 (GRID1) gene has recently been shown to confer increased risk for schizophrenia in several independent large samples. We analysed high-resolution magnetic resonance imaging (MRI) data from 62 patients with schizophrenia and 54 healthy controls using voxel-based morphometry (VBM) to assess the effect of single nucleotide polymorphism rs3814614 (located in the GRID1 promoter region), of which the T allele was identified as a risk factor in a previous association study. There were no effects of genotype or groupgenotype interactions on total brain grey matter or white matter, but on regional grey matter. In healthy subjects, we identified a significant effect of rs3814614 genotype in the anterior thalamus (bilaterally), superior prefrontal cortex, and orbitofrontal cortex e in all cases with the homozygous risk genotype TT resulting in higher grey matter density. We did not find this association within the schizophrenia sample, where rs3814614 variation was only associated with grey matter reduction in TT homozygous subjects in medial parietal cortex and increased grey matter in right medial cerebellum. For white matter, we did not find significant genotype effects in healthy controls, and only minor effects within schizophrenia patients in the posterior temporal lobe white matter. Our data indicate that GRID1 rs3814614 genotype is related to grey matter variation in prefrontal and anterior thalamic brain areas in healthy subjects, but not in patients indicating a potential role of this schizophrenia candidate gene in thalamo-cortical functioning. 2012 Elsevier Ltd. All rights reserved.

Alterations in brain function in schizophrenia and other neuropsychiatric disorders are evident not only during specific cognitive challenges, but also from functional MRI data obtained during a resting state. Here we apply probabilistic independent component analysis (pICA) to resting state fMRI series in 25 schizophrenia patients and 25 matched healthy controls. We use an automated algorithm to extract the ICA component representing the default mode network (DMN) as defined by a DMN-specific set of 14 brain regions, resulting in z-scores for each voxel of the (whole-brain) statistical map. While goodness of fit was found to be similar between the groups, the region of interest (ROI) as well as voxel-wise analysis of the DMN showed significant differences between groups. Healthy controls revealed stronger effects of pICA-derived connectivity measures in right and left dorsolateral prefrontal cortices, bilateral medial frontal cortex, left precuneus and left posterior lateral parietal cortex, while stronger effects in schizophrenia patients were found in the right amygdala, left orbitofrontal cortex, right anterior cingulate and bilateral inferior temporal cortices. In patients, we also found an inverse correlation of negative symptoms with right anterior prefrontal cortex activity at rest and negative symptoms. These findings suggest that aberrant default mode network connectivity contributes to regional functional pathology in schizophrenia and bears significance for core symptoms.

IntroductionWorking memory deficits are considered a core feature of disturbed cognition in schizophrenia. Recent neuropsychological studies in twins suggest that there are shared genetic factors between schizophrenia and executive processes.AimWe used a co-twin control design to test the hypothesis that prefrontal activation during a working memory task is seen both in affected as well as unaffected twins discordant for schizophrenia, thus reflecting genetic load on this putative endophenotype.MethodsAs part of EUTwinsS, a multi-centre collaborative study on twins with schizophrenia, we obtained functional MRI scans during a Sternberg working memory task (with one maintenance and one manipulation variations) of twins discordant for schizophrenia (5 monozygotic pairs, 7 dizygotic pairs) and compared them to 10/4 healthy MZ/DZ twins, matched for age and gender.ResultsComparing the overall task-related effects (p < 0.001, uncorrected), we found stronger activation in control twins compared to either Sz-affected or unaffected twins in the right middle frontal gyrus and medial fronto-orbital cortex, and compared to Sz-affected twins also in the left cerebellum and right inferior occipital cortex. Comparing the manipulation vs. maintenance trials, healthy controls showed stronger activation than Sz-affected twins in the left hippocampus, but smaller in right caudate and anterior cingulate, while unaffected co-twins showed diminished right middle and left superior and middle frontal gyri compared to either group.ConclusionsWhile diminished prefrontal activation in unaffected co-twins might indicate compensatory processes during executive control, the overall activation deficits are consistent with a genetic effect on prefrontal cortical efficiency.

Background:Measures of cortical folding have increasingly been used to assess morphological properties previously not measured in highresolution MRI scans. Assumed to be under genetic influence and relatively stable over the (adult) life-span, the local gyrification index can be measured in 3D across the entire cortical surface. Here we present initial results fromthe STARconsortiumandEUTwinsSnetwork assessing differences in cortical gyrification inmonozygotic (MZ) twins discordant for schizophrenia and healthy controls to assess the impact of disease manifestation on cortical folding. This design is chosen to match for genetic Background (quasi-identical in MZ twins) to study disease effects, especially for the prefrontal cortex, where alterations in gyrification have been described in singletons with schizophrenia. Methods: We analysed samples from two network sites: 7 MZ twin pairs discordant for schizophrenia and 7 MZ healthy control twin pairs (Heidelberg sample) and 8 MZ twin pairs disocrdant for schizophrenia and 8 MZ healthy control pairs (London sample). Cortical surfaces were extracted using FreeSurfer software from high-resolution MRI scans (1.5 T) and local gyrification was then calculated using local curvature based measures developed inhouse (Luders et al., NeuroImage 2006). Results: Comparing the affected MZ twin to his/her co-twin, we found altered gyrification in frontal areas in both samples, albeit at somewhat different locations: in the right medial prefrontal area for the Heidelberg sample and more anterior in the right frontopolar cortex in the London sample. Discussion: If replicated in our on-going extension of these samples, these findings would suggest that disturbed prefrontal gyrification in schizophrenia is not purelyan effect of geneticmechanisms, as it differes betweenmonozygotic twins. Rather, itmight (at least inpart) reflect the expression of the disease phenotype or even progressive changes.