Overactivation of Emotional Brain Systems Predicts Severity of Positive Symptoms and Global Functioning in Prodromal and First-Episode Psychosis

Presentation First Author: 
Gemma Modinos

Background: Overactivation of corticolimbic brain areas to irrelevant or non-emotional stimuli has been proposed as a key pathogenic process in schizophrenia, leading to the increased subjective emotionality, and the development of psychotic symptoms and functional impairments that are characteristic of the disorder. Neural and subjective responses to neutral stimuli have not been examined in groups at risk, and their impact on levels of psychotic symptoms and global functioning is unknown. Methods: We measured neural response to emotional and neutral scenes in 18 patients with a first-episode of psychosis (FEP), 18 individuals at ultra-high risk of psychosis (UHR), and 22 healthy controls during fMRI. Subjective ratings of emotional arousal were recorded. The impact of neural abnormalities on psychotic symptoms and global functioning was assessed with regression analyses. Results: Both FEP and UHR participants were more likely to rate neutral photos as more emotionally arousing than controls did. FEP and UHR subjects showed decreased activation in dorsomedial prefrontal cortex, the left and right inferior frontal gyrus/insula, and bilateral amygdala to emotional scenes, but increased activation to neutral scenes, compared with controls. The degree of activation to neutral scenes predicted severity of positive symptoms and poorer functioning. Conclusions: Individuals at UHR of psychosis and FEP patients show increased subjective arousal and overactivation of corticolimbic brain systems to otherwise neutral information. These abnormalities predicted positive psychotic symptoms and poor functioning, supporting the hypothesis that disruption of emotional brain systems may represent an important biological substrate for the pathophysiology of psychosis.

Conference Name: 
Presentation Date: 
January, 2015
Additional Authors: 
Huai-Hsuan Tseng - Irina Falkenberg - Carly Samson - Philip McGuire - Paul Allen
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