Psychomotor symptoms of schizophrenia map on the cerebral motor circuit

Walther, Sebastian

doi:10.1016/j.pscychresns.2015.06.010

Cited by 90 publications

(67 citation statements)

References 70 publications

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“…This prospect is supported by studies showing that, coinciding with the assumptions of the SyNoPsis project, there is a link of catatonia symptoms with alterations in the cerebral motor system [63]. In particular, we demonstrated resting-state hyperperfusion in the supplementary motor area (SMA) of subjects with current catatonia in schizophrenia [124].…”

Section: Mapping Symptoms Onto Brain Systems: Empirical Evidence For mentioning

confidence: 56%

“…In particular, the observed hypokinesia, i.e., reduction of motor activity, is associated with an aberrant coupling of cortical and subcortical motor areas. This association has been corroborated by data on gray matter density, gray matter perfusion, and WM properties [63, 121]. …”

Section: Mapping Symptoms Onto Brain Systems: Empirical Evidence For mentioning

confidence: 59%

“…Such parameters have been successfully linked to brain structures and functions and to clinical features [63, 64]. The approach is consistent with the intention of the DSM-5 to relaunch research on catatonia, disengaging it from schizophrenia [104].…”

Section: Mapping Symptoms Onto Brain Systems: Empirical Evidence For mentioning

confidence: 83%

“…Most perspicuous is the attribution of characteristic catatonic symptoms to the motor system [63]. This is true especially for hyperkinesia, hypokinesia, and parakinetic symptoms like grimacing or tic-like movement abnormalities, but also for bizarre gestures and postures.…”

Section: Translational Psychopathology: Matching Psychotic Symptoms Wmentioning

confidence: 99%

“…In fact, in several studies the motor abnormalities related to schizophrenia or its subtypes have been found to map onto the cerebral motor circuit [63, 74, 118-120]. In particular, the observed hypokinesia, i.e., reduction of motor activity, is associated with an aberrant coupling of cortical and subcortical motor areas.…”

Section: Mapping Symptoms Onto Brain Systems: Empirical Evidence For mentioning

confidence: 99%

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Systems Neuroscience of Psychosis: Mapping Schizophrenia Symptoms onto Brain Systems

et al. 2017

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Schizophrenia research has been in a deadlock for many decades. Despite important advances in clinical treatment, there are still major concerns regarding long-term psychosocial reintegration and disease management, biological heterogeneity, unsatisfactory predictors of individual course and treatment strategies, and a confusing variety of controversial theories about its etiology and pathophysiological mechanisms. In the present perspective on schizophrenia research, we first discuss a methodological pitfall in contemporary schizophrenia research inherent in the attempt to link mental phenomena with the brain: we claim that the time-honored phenomenological method of defining mental symptoms should not be contaminated with the naturalistic approach of modern neuroscience. We then describe our Systems Neuroscience of Psychosis (SyNoPsis) project, which aims to overcome this intrinsic problem of psychiatric research. Considering schizophrenia primarily as a disorder of interindividual communication, we developed a neurobiologically informed semiotics of psychotic disorders, as well as an operational clinical rating scale. The novel psychopathology allows disentangling the clinical manifestations of schizophrenia into behavioral domains matching the functions of three well-described higher-order corticobasal brain systems involved in interindividual human communication, namely, the limbic, associative, and motor loops, including their corticocortical sensorimotor connections. The results of several empirical studies support the hypothesis that the proposed three-dimensional symptom structure, segregated into the affective, the language, and the motor domain, can be specifically mapped onto structural and functional abnormalities of the respective brain systems. New pathophysiological hypotheses derived from this brain system-oriented approach have helped to develop and improve novel treatment strategies with noninvasive brain stimulation and practicable clinical parameters. In clinical practice, the novel psychopathology allows confining the communication deficits of the individual patient, shifting attention from the symptoms to the intact resources. We have studied this approach and observed important advantages for therapeutic alliances, personalized treatment, and de-escalation strategies. Future studies will further conjoin clinical definitions of psychotic symptoms with brain structures and functions, and disentangle structural and functional deficit patterns within these systems to identify neurobiologically distinct subsyndromes. Neurobiologically homogeneous patient groups may provide new momentum for treatment research. Finally, lessons learned from schizophrenia research may contribute to developing a comprehensive perspective on human experience and behavior that integrates methodologically distinct, but internally consistent, insights from humanities and neuroscience.

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Section: Mapping Symptoms Onto Brain Systems: Empirical Evidence For mentioning

confidence: 56%

Section: Mapping Symptoms Onto Brain Systems: Empirical Evidence For mentioning

confidence: 59%

Section: Mapping Symptoms Onto Brain Systems: Empirical Evidence For mentioning

confidence: 83%

Section: Translational Psychopathology: Matching Psychotic Symptoms Wmentioning

confidence: 99%

Section: Mapping Symptoms Onto Brain Systems: Empirical Evidence For mentioning

confidence: 99%

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Systems Neuroscience of Psychosis: Mapping Schizophrenia Symptoms onto Brain Systems

et al. 2017

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Psychomotor Slowing in Psychosis and Inhibitory Repetitive Transcranial Magnetic Stimulation

Walther,

Alexaki,

Weiss

et al. 2024

JAMA Psychiatry

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ImportancePsychomotor slowing is a frequent symptom of psychosis, impairing gross and fine motor behavior. It is associated with poor outcomes and functioning, and no treatment is available.ObjectiveTo investigate whether 15 sessions of inhibitory repetitive transcranial magnetic stimulation (rTMS) may reduce psychomotor slowing.Design, Setting, and ParticipantsThis was a 4-arm, double-blind, randomized, sham-controlled trial at a university hospital in Switzerland. Enrollment took place from March 2019 to August 2022. Adults aged 18 to 60 years with schizophrenia spectrum disorders and severe psychomotor slowing were eligible. All patients continued existing medications, including antipsychotics and benzodiazepines. Those with substance misuse (other than nicotine), conditions associated with impaired or aberrant movement, convulsions, history of hearing problems, other conditions typically excluded from magnetic resonance imaging or TMS, any TMS treatment in the past 3 months, or those who were pregnant or breastfeeding were excluded. Of 615 patients screened for eligibility, 103 were randomized and 88 received at least 1 session of rTMS: 22 were assigned to 1-Hz rTMS, 22 to iTBS, 22 to sham, and 22 to the waiting group. Follow-up was conducted at 6 weeks and 24 weeks following the week 3 assessments including clinical, functional, and motor measures.InterventionsFifteen sessions of rTMS in 3 weeks over the supplementary motor area: 1-Hz rTMS, iTBS, sham, or no treatment (waiting). After 3 weeks, the waiting group received 15 sessions of 1-Hz rTMS over the supplementary motor area.Main Outcomes and MeasuresThe main outcome was the proportion of responders at week 3 in the Salpêtrière Retardation Rating Scale (SRRS) defined as a 30% or greater reduction from baseline (last-observation-carried-forward). The SRRS has 15 items and a maximum total score of 60.ResultsOf the 88 participants analyzed, 45 were men and 43 were women. The mean (SD) age was 36.3 (12.4) years and the mean (SD) SRRS score was 24.0 (5.9). A total of 69 participants completed the study. At week 3, response rates differed between groups: 15 of 22 (68%) in the 1-Hz rTMS group, 8 of 22 (36%) in the iTBS group, 7 of 22 (32%) in the sham group, and 4 of 22 (18%) in the waiting group (χ23 = 12.1; P = .007). The 1-Hz rTMS group had more responders than sham (odds ratio [OR], 0.13; 95% CI, 0.02-0.65; P = .03), iTBS (OR, 0.12; 95% CI, 0.02-0.61; P = .02), and waiting (OR, 0.04; 95% CI, 0.01-0.22; P = .003). In the waiting group, 10 of 16 participants (63%) responded after receiving 15 sessions of 1-Hz rTMS. No serious adverse events occurred.Conclusions and RelevanceIn this study, inhibitory add-on rTMS safely alleviated psychomotor slowing in psychosis compared with iTBS, sham, and no treatment. The treatment was also effective with delayed onset. Future studies need to explore the neural changes associated with supplementary motor area rTMS in psychosis.Trial RegistrationClinicalTrials.gov Identifier: NCT03921450

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White matter microstructure variations contribute to neurological soft signs in healthy adults

Hirjak

Thomann

Kubera

et al. 2017

Human Brain Mapping

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Psychomotor symptoms of schizophrenia map on the cerebral motor circuit

Cited by 90 publications

References 70 publications

Systems Neuroscience of Psychosis: Mapping Schizophrenia Symptoms onto Brain Systems

Systems Neuroscience of Psychosis: Mapping Schizophrenia Symptoms onto Brain Systems

Psychomotor Slowing in Psychosis and Inhibitory Repetitive Transcranial Magnetic Stimulation

White matter microstructure variations contribute to neurological soft signs in healthy adults

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