Visual system assessment for predicting a transition to psychosis

Abstract

The field of psychiatry is far from perfect in predicting which individuals will transition to a psychotic disorder. Here, we argue that visual system assessment can help in this regard. Such assessments have generated medium-to-large group differences with individuals prior to or near the first psychotic episode or have shown little influence of illness duration in larger samples of more chronic patients. For example, self-reported visual perceptual distortions—so-called visual basic symptoms—occur in up to 2/3rds of those with non-affective psychosis and have already longitudinally predicted an impending onset of schizophrenia. Possibly predictive psychophysical markers include enhanced contrast sensitivity, prolonged backward masking, muted collinear facilitation, reduced stereoscopic depth perception, impaired contour and shape integration, and spatially restricted exploratory eye movements. Promising brain-based markers include visual thalamo-cortical hyperconnectivity, decreased occipital gamma band power during visual detection (MEG), and reduced visually evoked occipital P1 amplitudes (EEG). Potentially predictive retinal markers include diminished cone a- and b-wave amplitudes and an attenuated photopic flicker response during electroretinography. The foregoing assessments are often well-described mechanistically, implying that their findings could readily shed light on the underlying pathophysiological changes that precede or accompany a transition to psychosis. The retinal and psychophysical assessments in particular are inexpensive, well-tolerated, easy to administer, and brief, with few inclusion/exclusion criteria. Therefore, across all major levels of analysis—from phenomenology to behavior to brain and retinal functioning—visual system assessment could complement and improve upon existing methods for predicting which individuals go on to develop a psychotic disorder.

The magnitude and variability of neurocognitive performance in first-episode psychosis: a systematic review and meta-analysis of longitudinal studies

“…Notably, no enhancements were seen in visual memory tasks, suggesting a more stable deficit in this area. The visual system has been related to the transition to psychosis [ 45 ], and although the exact mechanism is unknown, many studies indicate that visual pathways could be related to psychosis onset [ 46 , 47 ]. Similarly, none of the motor functioning tasks showed improvement at follow-up, which aligns with the fact that the FEP group presented a better performance than the HC group on some of these tasks (e.g., Grooved Pegboard Test).…”

Retinal electrophysiology in central nervous system disorders. A review of human and mouse studies

“…In conclusion, the application of visual electrophysiology to assist with classification and understanding the underlying neurobiology of psychiatric conditions is a promising new field ( Silverstein and Thompson, 2020 ; Diamond et al, 2022 ; Silverstein et al, 2022 ; Mahroo, 2023 ). The limitations are because of the large heterogeneity in these clinical populations who have common and overlapping phenotypes and genotypes.…”

“…Several reviews and commentaries covering the findings and applications of visual electrophysiology in central nervous system (CNS) disorders have been published in the last decade advocating the retina as a “window to the brain” ( London et al, 2013 ; Lavoie et al, 2014b , c ; Gagné et al, 2015 ; Nguyen et al, 2017 ; Youssef et al, 2019 ; Silverstein and Thompson, 2020 ; Diamond et al, 2022 ; Silverstein et al, 2022 ; Schwitzer et al, 2022b , c ; Alves et al, 2023 ; Mahroo, 2023 ; Tursini et al, 2023 ) and on using the electroretinogram (ERG) to differentiate schizophrenia and bipolar disorder ( Lavoie et al, 2014b ; Hébert et al, 2015 , 2020 ; Hosak et al, 2018 ; Almonte et al, 2020 ; Peredo et al, 2020 , 2022 ; Silverstein et al, 2020 , 2022 ; Maziade et al, 2022 ; Moreau et al, 2022 ; Tursini et al, 2022 ). To understand the landscape of potential retinal biomarkers in CNS disorders, here we review studies encompassing schizophrenia, bipolar disorder, autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), seasonal affective disorder, major depressive disorder, Parkinson’s disease (PD) and Alzheimer’s disease (AD).…”

Dorsal attention network activity during perceptual organization is distinct in schizophrenia and predictive of cognitive disorganization

“…A goal for future research will be to determine to what extent abnormal DAN activity emerges across these and other visual tasks in SZ. Because DAN differences were so large and because they were found relative to both healthy controls and bipolar disorder patients (AUCs > .85; sensitivities > .72; specificities > .72), such differences might yield a candidate biomarker for differential diagnosis or predicting future psychosis onset (Diamond et al, 2022). More highly powered studies with early‐stage or high‐risk patients are needed to confirm these possibilities.…”