N-acetyl aspartate concentration in the anterior cingulate cortex in patients with schizophrenia: A study of clinical and neuropsychological correlates and preliminary exploration of cognitive behaviour therapy effects

Premkumar, Preethi; Parbhakar, Vivek A.; Fannon, Dominic; Lythgoe, David J.; Williams, Steven; Kuipers, Elizabeth; Kumari, Veena

doi:10.1016/j.pscychresns.2010.02.008

Cited by 25 publications

(21 citation statements)

References 66 publications

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“…The search was run on 12th May 2017 with no time range specified for the date of publication. Our search revealed 9 papers in total [24][25][26][27][28][29][30][31][32], all published within the last 10 years (see Table 1 for greater details).…”

Section: Literature Searchmentioning

confidence: 99%

“…So far four reports [24][25][26][27][28], all published within the last 7 years and with overlapping samples from the same research group, have focused on pre-vs post-CBTp brain changes in psychosis. Of these, one study [24] used spectroscopic imaging, two studies used functional magnetic resonance imaging (fMRI) [25][26], and one study used structural magnetic resonance imaging (MRI) [27].…”

Section: Pre-vs Post-cbtp Changesmentioning

confidence: 99%

“…Of these, one study [24] used spectroscopic imaging, two studies used functional magnetic resonance imaging (fMRI) [25][26], and one study used structural magnetic resonance imaging (MRI) [27]. The findings of each of these are described and discussed below.…”

Section: Pre-vs Post-cbtp Changesmentioning

confidence: 99%

“…Premkumar and colleagues [24] used spectroscopic imaging to investigate the changes following CBTp. Their study provided preliminary evidence for N-acetyl aspartate (NAA) concentration in the anterior cingulate cortex (ACC) to increase following 6-8 months of NICE (National Institute for Clinical Excellence, UK)-compliant CBTp [17], adjunct to treatmentas-usual, in a small group of medication-resistant schizophrenia patients.…”

Section: Spectroscopic Imagingmentioning

confidence: 99%

“…A formal pre-therapy assessment of relevant cognitive functions followed by targeted cognitive remediation therapies [81] may be helpful. There are promising data showing that cognitive remediation therapies can normalise activity in many brain areas, including the prefrontal and cingulate regions that commonly show activation deficits during working memory and affect processing paradigms in schizophrenia [82] and also found predict CBTp response [24][25][26][27][28][29][30][31][32].…”

Section: Implications: Future Research and Therapeutic Avenuesmentioning

confidence: 99%

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Cognitive Behaviour Therapy for Psychosis: Insights from Neuroimaging

Kumari¹,

Terca²

2017

J Neuroimaging Psychiatry Neurol

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Up to 40% of schizophrenia patients continue to suffer from distressing symptoms despite remaining compliant with their prescribed antipsychotic medication. Additional symptom reduction following cognitive behaviour therapy for psychosis (CBTp) has been shown, but only in about 50% of such patients. A clear understanding of the neural changes following CBTp (potential mediators of improvement in target outcomes) as well as neural predictors of CBTp-led improvement (possible moderators) may help to refine or develop it further and increase its effectiveness. We provide a review of studies published to date (9 in total) examining the neural effects and/or predictors of CBTp. The studies analysed comprised of one spectroscopic imaging study on pre-vs post-CBTp changes, five functional magnetic resonance imaging studies [two analysing prevs post-CBTp changes, two analysing pre-therapy brain properties as predictors of symptom reduction following CBTp, and one analysing pre-vs post-CBTp changes in functional connectivity as the predictors of long term (over 7 years) outcome following CBTp], and three structural magnetic resonance imaging studies [two on pre-therapy brain properties as predictors of symptom change following CBTp, and one analysing pre-vs post-CBTp changes]. The findings from pre-vs post-CBTp brain activation studies demonstrate that CBTp reduces fronto-limbic activation to social threat and normalises cortico-limbic functional connectivity, indicating improved affect regulation through top-down control after CBTp. Additionally, CBTp was found to reduce pituitary volume, potentially by lowering of symptom-related distress. The findings from studies analysing pre-therapy brain properties as predictors of symptom reduction following CBTp indicate that functional and structural properties of multiple brain areas that are implicated in a range of cognitive functions, particularly the dorsolateral (cognitive flexibility), medial (self-awareness) and inferior (verbal skills) frontal cortices, hippocampus (memory) and precuneus (self-awareness), predict symptom reduction following CBTp. These results suggest a role for cognitive enhancement in the context of CBTp.

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Section: Literature Searchmentioning

confidence: 99%

Section: Pre-vs Post-cbtp Changesmentioning

confidence: 99%

Section: Pre-vs Post-cbtp Changesmentioning

confidence: 99%

Section: Spectroscopic Imagingmentioning

confidence: 99%

Section: Implications: Future Research and Therapeutic Avenuesmentioning

confidence: 99%

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Cognitive Behaviour Therapy for Psychosis: Insights from Neuroimaging

Kumari¹,

Terca²

2017

J Neuroimaging Psychiatry Neurol

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Can cognitive behaviour therapy beneficially influence arousal mechanisms in psychosis?

Howells

Baldwin

Kingdon

2015

Hum. Psychopharmacol Clin Exp

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Cognitive behavioural therapy for psychosis (CBTp) is an approved adjunct therapy for patients with psychotic disorders; however, we do not fully understand the neurobiological effects that this therapy may exert. Arousal, as measured by electroencephalography (EEG), provides a useful electrophysiological marker for assessing psychotic disorders. EEG studies may therefore serve as a useful measure for assessing the underlying effects of CBTp in psychotic disorders.

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MR Spectroscopic Studies of the Brain in Psychiatric Disorders

Maddock

Buonocore

2011

Current Topics in Behavioral Neurosciences

226

196

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The measurement of brain metabolites with magnetic resonance spectroscopy (MRS) provides a unique perspective on the brain bases of neuropsychiatric disorders. As a context for interpreting MRS studies of neuropsychiatric disorders, we review the characteristic MRS signals, the metabolic dynamics,and the neurobiological significance of the major brain metabolites that can be measured using clinical MRS systems. These metabolites include N-acetylaspartate(NAA), creatine, choline-containing compounds, myo-inositol, glutamate and glutamine, lactate, and gamma-amino butyric acid (GABA). For the major adult neuropsychiatric disorders (schizophrenia, bipolar disorder, major depression, and the anxiety disorders), we highlight the most consistent MRS findings, with an emphasis on those with potential clinical or translational significance. Reduced NAA in specific brain regions in schizophrenia, bipolar disorder, post-traumatic stress disorder, and obsessive–compulsive disorder corroborate findings of reduced brain volumes in the same regions. Future MRS studies may help determine the extent to which the neuronal dysfunction suggested by these findings is reversible in these disorders. Elevated glutamate and glutamine (Glx) in patients with bipolar disorder and reduced Glx in patients with unipolar major depression support models of increased and decreased glutamatergic function, respectively, in those conditions. Reduced phosphomonoesters and intracellular pH in bipolar disorder and elevated dynamic lactate responses in panic disorder are consistent with metabolic models of pathogenesis in those disorders. Preliminary findings of an increased glutamine/glutamate ratio and decreased GABA in patients with schizophrenia are consistent with a model of NMDA hypofunction in that disorder. As MRS methods continue to improve, future studies may further advance our understanding of the natural history of psychiatric illnesses, improve our ability to test translational models of pathogenesis, clarify therapeutic mechanisms of action,and allow clinical monitoring of the effects of interventions on brain metabolicmarkers

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N-acetyl aspartate concentration in the anterior cingulate cortex in patients with schizophrenia: A study of clinical and neuropsychological correlates and preliminary exploration of cognitive behaviour therapy effects

Cited by 25 publications

References 66 publications

Cognitive Behaviour Therapy for Psychosis: Insights from Neuroimaging

Cognitive Behaviour Therapy for Psychosis: Insights from Neuroimaging

Can cognitive behaviour therapy beneficially influence arousal mechanisms in psychosis?

MR Spectroscopic Studies of the Brain in Psychiatric Disorders

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