Insular volume reduction in young male schizophrenia patients

Objective: Recent developments in neuroimaging have advanced the understanding of biological mechanisms underlying schizophrenia. Structural and functional abnormalities of the insular cortex have been reported in schizophrenia patients. Many studies have demonstrated that insula volume is lower in schizophrenia patients than healthy individuals. The present study aimed to compare insula volumes of young male schizophrenia patients with that of age-matched young healthy male subjects to eliminate age and gender bias. Methods: Twenty-three male schizophrenia patients meeting DSM-5 diagnostic criteria, who were at the age of 18-40 years, and age-matched 25 healthy male subjects were included into the study. All patients magnetic resonance imaging (MRI) procedure was completed. Insula volume of schizophrenia patients and healthy male volunteers was calculated using MRICloud method. Disease severity was assessed using Positive and Negative Symptom Scale (PANSS). Results: Volumes of both the left and the right insula were significantly lower in the patient group vs. the control group. Moreover, a positive correlation was determined between the right insula volume and the scores of positive symptom severity scale. Conclusion: Decreased insular volume is not a specific marker, but it may be a general marker regarding psychopathology. However, investigating whether the diagnostic specificity of insular cortex abnormalities in psychopathologies will be the focus of future studies.

Genç erkek şizofreni hastalarında insular hacim azalması

Amaç: Nörogörüntüleme alanındaki son gelişmeler şizofreninin altında yatan biyolojik mekanizmaların anlaşılmasını artırmıştır. Şizofreni hastalarında insular korteksin yapısal ve işlevsel anormallikleri bildirilmiştir. Çoğu çalışma şizofreni hastalarındaki insular hacimlerin sağlıklı insanlardan daha az olduğunu göstermiştir. Bu çalışmada yaş ve cinsiyet gibi değişkenlerin kontrol altına alınması amacı ile genç, erkek şizofreni hastalarında ve yaş olarak eşleştirilmiş sağlıklı genç erkek gönüllülerde insula hacimlerinin karşılaştırılması amaçlanmıştır. Yöntem: Şizofreni için DSM-5 tanı ölçütlerini karşılayan 18-45 yaşları arasındaki 23 erkek şizofreni hastası ve aynı yaş grubunda 25 sağlıklı gönüllü erkek çalışmaya alındı. Tüm hastalarda manyetik rezonans görüntüleme (MRG) işlemi tamamlandı. Şizofreni hastalarının ve sağlıklı erkek gönüllülerin insula hacmi MRICloud yöntemi kullanılarak hesaplandı. Hastalık şiddeti Pozitif ve Negatif Semptom Skalası (PANSS) ile belirlendi. Bulgular: Hem sağ, hem de sol insula hacmi hasta grubunda kontrol grubuna göre anlamlı düzeyde daha küçüktü. Ayrıca sağ insula hacmi ile pozitif semptom şiddeti ölçek puanları arasında pozitif korelasyon saptandı. Tartışma: Azalan insular hacim özgül bir hastalık belirteci değildir, ancak psikopatolojiye ilişkin genel bir belirteç olabilir. Bununla birlikte psikopatolojilerde insular korteks anormalliklerinin tanısal özgüllüğünün olup olmadığının araştırılması gelecekteki çalışmaların odak noktası olacaktır.

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1. Castillejos MC, Martín-Pérez C, Moreno-Küstner B. Incidence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses. Schizophr Res 2019; 204:458-459.

2. Vita A, De Peri L, Deste G, Sacchetti E. Progressive loss of cortical gray matter in schizophrenia: a meta-analysis and meta-regression of longitudinal MRI studies. Transl Psychiatry 2012; 20:2:e190.

3. Haijma SV, Van Haren N, Cahn W, Koolschijn PC, Hulshoff Pol HE, Kahn RS. Brain volumes in schizophrenia: a meta-analysis in over 18 000 subjects. Schizophr Bull 2013; 39(5):1129-1138.

4. Makris N, Goldstein JM, Kennedy D, Hodge SM, Caviness VS, Faraone SV, et al. Decreased volume of left and total anterior insular lobule in schizophrenia. Schizophr Res 2006; 83:155-171.

5. Yamada M, Hirao K, Namiki C, Hanakawa T, Fukuyama H, Hayashi T, et al. Social cognition and frontal lobe pathology in schizophrenia: a voxel-based morphometric study. Neuroimage 2007; 35(1):292-298.

6. Saze T, Hirao K, Namiki C, Fukuyama H, Hayashi T, Murai T. Insular volume reduction in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2007; 257(8):473-479.

7. Crespo-Facorro B, Roiz-Santiáñez R, Quintero C, Pérez-Iglesias R, Tordesillas-Gutiérrez D, Mata I, et al. Insular cortex morphometry in first-episode schizophrenia-spectrum patients: Diagnostic specificity and clinical correlations. J Psychiatr Res 2010; 44(5):314-320.

8. Sakamoto R, Marano C, Miller MI, Lyketsos CG, Li Y, Mori S, et al. Cloud-based brain magnetic resonance image segmentation and parcellation system for individualized prediction of cognitive worsening. J Health Eng 2019; 9507193.

9. Djamanakova A, Tang X, Li X, Faria AV, Ceritoglu C, Oishi K, et al. Tools for multiple granularity analysis of brain MRI data for individualized image analysis. Neuroimage 2014; 101:168-176.

10. Artaechevarria X, Munoz-Barrutia A, Ortiz-deSolorzano C. Combination strategies in multi-atlas image segmentation: application to brain MR data. IEEE Trans Med Imaging 2009; 28:1266-1277.

11. Commowick O, Warfield SK. Incorporating priors on expert performance parameters for segmentation validation and label fusion: a maximum a posteriori STAPLE. Med Image Comput Comput Assist Interv 2010; 13:25-32.

12. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders [electronic resource]: DSM-5. American Psychiatric Association, Arlington, VA, 2013, c2013.

13. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13(2):261-276.

14. Uddin LQ, Nomi JS, Hébert-Seropian B, Ghaziri J, Boucher O. Structure and Function of the Human Insula. J Clin Neurophysiol 2017; 34(4):300-306.

15. Namkung H, Kim SH, Sawa A. The insula: an underestimated brain area in clinical neuroscience, psychiatry, and neurology: (Trends in Neuroscience 2017; 40:200-207). Trends Neurosci 2018; 41(8):551-554.

16. Cauda F, D’Agata F, Sacco K, Duca S, Geminiani G, Vercelli A. Functional connectivity of the insula in the resting brain. Neuroimage 2011; 55(1):8-23.

17. Nagai M, Kishi K, Kato S. Insular cortex and neuropsychiatric disorders: a review of recent literature. Eur Psychiatry 2007; 22(6):387-394.

18. Matsuo K, Kopecek M, Nicoletti MA, Hatch JP, Watanabe Y, Nery FG, et al. New structural brain imaging endophenotype in bipolar disorder. Mol Psychiatry 2012; 17(4):412-420.

19. Cui L, Li M, Deng W, Guo W, Ma X, Huang C, et al. Overlapping clusters of gray matter deficits in paranoid schizophrenia and psychotic bipolar mania with family history. Neurosci Lett 2011; 489(2):94-98.

20. Uwatoko T, Yoshizumi M, Miyata J, Ubukata S, Fujiwara H, Kawada R, et al. Insular gray matter volume and objective quality of life in schizophrenia. PLoS One 2015; 10(11):e0142018.

21. Shepherd AM, Matheson SL, Laurens KR, Carr VJ, Green MJ. Systematic meta-analysis of insula volume in schizophrenia. Biol Psychiatry 2012; 72(9):775-784.

22. Takahashi T, Wood SJ, Yung AR, Phillips LJ, Soulsby B, McGorry PD, et al. Insular cortex gray matter changes in individuals at ultra-high-risk of developing psychosis. Schizophr Res 2009; 111:94-102.