The UK NICE technology guidance “Structural Neuroimaging in First-Episode Psychosis” concludes that CT/MRI is not routinely recommended as an initial investigation for first-episode psychosis.

To evaluate the use of CT/MRI in a group of Early Intervention Service (EIS) patients with a first-episode psychosis aged 18–35 years at presentation.

To develop practice guidelines for use of neuroimaging in first-episode psychosis.

All 107 patients registered with the EIS in Hounslow, London, UK, were eligible for inclusion in this review. Data was collected from the medical records and the Picture Archiving and Communications System. Data was analysed using a microsoft excel data analysis tool. Additionally, comparisons were made between the group of patients with normal scans and that with abnormal scans. Statistical significance was determined using the chi-squared method with a significance of P < 0.05.

17 patients had documented neuroimaging results. 4 scans were abnormal. There was no significant difference between the group with normal and abnormal scans in terms of gender, abnormalities of physical/neurological health, blood tests and whether the patient had any additional medical conditions. Abnormal scan results did not influence treatment or outcome for any patient.

The abnormal scans were not correlated to clinical indices of history, examination and laboratory tests. Abnormal scans appear to have a low yield in terms of clinical effectiveness. The findings support selective use of neuroimaging in this cohort of patients. The indications for it usage would appear to rely on clinical judgement as well clinical findings.

Dysfunction in the basal ganglia has been related to impaired reward processing and anhedonia, a core symptom of Major Depressive Disorder (MDD). In particular, the ventral striatum including the nucleus accumbens is increasingly implicated in the pathophysiology of MDD, but evidence for a specific role during episodes of full remission is lacking so far.

To investigate functional connectivity patterns of resting-state activity in patients in the remitted phase of MDD (rMDD).

To determine whether rMDD is related to disruptions of functional coupling between the ventral striatum and cortical regions.

Forty-three remitted depressed patients and thirty-five healthy controls were recruited at Medical University of Vienna, Vienna, Austria, and performed a six minute resting-state fMRI scan. Seed time series were extracted from the preprocessed data using individual masks for ventral striatum and correlated with all nodes in a surface based analysis using FreeSurfer, AFNI and SUMA. The resulting correlation coefficients were then Fishertransformed, group results were determined by comparing group mean smoothed z-scores with a two-sample ttest.

Increased resting-state functional connectivity was revealed between ventral striatum (seed region) and anterior cingulate cortex as well as orbitofrontal cortex in the rMDD group compared to healthy controls.

Our preliminary data is in accordance with the idea that increased functional coupling between the ventral striatum and two major emotion processing regions, the anterior cingulate cortex and the orbitofrontal cortex, may represent a neural mechanism contributing to the maintenance of full remission of MDD.

White matter abnormalities play a prominent role in the pathogenesis of schizophrenia. Diffusion tensor imaging (DTI) studies showed a widespread decrease in fractional anisotropy (FA) in psychotic disorders.

To examine white and grey matter abnormalities in first episode psychosis (FEP).

We obtained T1-weighted and DTI magnetic resonance images (1.5 T) from 8 right-handed drug-naïve FEP patients and 8 healthy controls. The DTI data set was used to calculate FA maps; we carried-out optimized voxel-based morphometry (VBM) analysis of grey matter (GM) and FA maps using SPM2.

Patients were assessed with a neuropsychological battery comprising the Trail Making Test, the Stroop Colour Word Test, the Wisconsin Card Sorting Test and a test of Facial Affect recognition.

The voxelwise analysis showed decreased FA in the superior longitudinal and inferior fronto-occipital fasciculi, bilaterally, and in the left uncinate fasciculus. We observed reduced GM volume in the left frontal cortex (Brodmann areas [BA] 47, 13, 11, 10, and 9) and in right frontal (BA6), temporal (BA34) and occipital (BA 18, 19, and 30) cortex.

Neuropsychological assessment showed impaired executive function and deficit in facial affect recognition.

Our findings showed fronto-temporal disconnectivity in FEP and structural alterations in both cortical and subcortical regions.

Neuroanatomical findings are consistent with patients’ neuropsychological performance.

Further studies to establish a relationship between white and grey matter disarray on one hand and neuropsychological testing are needed.

Tardive dyskinesia is a serious side effect of antipsychotics’ activity. Imaging of the dopamine transporter could demonstrate the possible involvement of dopaminergic pathway in the appearance of tardive dyskinesia.

We report a case with paranoid schizophrenia and tardive dyskinesia symptoms. A first trial with quetiapine improved TD symptoms while an increase of its dose after a relapse of the underlying disease deteriorated the TD symptoms. Following that, sertindole was initiated which led to improvement of both psychotic and TD symptoms. A DAT scan showed physiologic distribution in the basal ganglia. Six months later after a serious cardiac syncope, sertindole was discontinued. Quetiapine was then started which led again to TD symptoms. A second DAT scan showed decreased dopamine transporter uptake in the area of basal ganglia.

We conclude that decreased dopamine transporter uptake seemed to associate with the deterioration of TD.

A significant amount of evidence from structural brain imaging studies provide new insights into the neuroanatomical basis of schizophrenia.

To investigate whole brain gray matter (GM) differences between schizophrenia patients grouped according to the number of psychotic episodes and normal controls (NC).

To determine regions of GM differences in schizophrenia patients grouped according to the number of psychotic episodes.

A group of 53 schizophrenia patients (23 with up to 3 psychotic episodes, 15 with 4 to 6 and 15 with 7 or more psychotic episodes) and 35 age and gender matched NC were included. Voxel-based morphometry (VBM) is an adaptation of the statistical parametric mapping technique that allows investigators to quantitatively examine brain structural changes. VBM data of schizophrenia patients divided into 3 groups: up to 3, 4 to 6 and 7 or more episodes were compared with NC.

Patients with up to 3 episodes had reduced gray matter volume (GMV) in the right claustrum, right Brodmann areas 6 and 13 and left Brodmann area 10, patients with 4 to 6 episodes in left Brodmann areas 25, 35 and 37 and in right Brodmann area 13, and those with 7 or more episodes showed decreased GMV in left substantia nigra and left Brodmann area 10 compared with NC.

GMV reduction in schizophrenia varies depending on the number of psychotic episodes. The affection of different brain areas indicates separated neurobiological mechanisms underlying the stage and the progression of illness.

Based on evidences in molecular neuroimaging, postmortem and genetic studies, impaired serotonergic neurotransmission has been implicated with affective disorders. Moreover, a growing number of evidences showed strong interrelations within the serotonergic system suggesting a common mechanism in the modulation of receptor and transporter densities.

Here we directly investigated the regional expression of the 5-HT1A, 5-HT2A and 5-HTT using PET and the three highly selective and specific radioligands [carbonyl-11C]WAY-100635, [18F]Altanserin and [11C]DASB in healthy subjects.

A total of 55 healthy subjects (5-HT1A: 36 subjects, 18 males, age = 26.0 ± 4.9; 5-HT2A: 19 subjects, 11 males, age = 28.2 ± 5.9; 5-HTT: 8 males, age = 28.12 ± 3.6) were included in this study. Binding potential (BPND) values were quantified according to the AAL parcellation scheme.

BPND values averaged over both hemispheres ranged from 0.40–6.35 for the 5-HT1A receptor; 0.01–2.01 for the 5-HT2A receptor and 0.09–2.05 for the 5-HTT, respectively. There was a specific topological pattern according to the ratio between the 5-HT1A, 5-HT2A receptors and 5-HTT (“fingerprints”).

Such information can be essential for detecting potential local alterations in the ratio between different binding proteins on a network level in pathological conditions.

Moreover, these data might provide further insight in area-specific effects of frequently prescribed selective serotonin re-uptake inhibitors (SSRI):

1. 1) due to the distinct local receptor and transporter availability;

2. 2) SSRI application alters the postsynaptic receptor expression and thus;

3. 3) leads to a modified interaction of inhibitory and exhibitory receptors.

Fluid intelligence expresses the capacity for interpretation of novel stimuli and flexible behavioral adaptation to such cues. Phasic dopamine firing closely matches a temporal difference prediction error (PE) signal important for learning and rapid behavioral adaptation. Both fluid intelligence and dopaminergic neurotransmission decline with age. So far, no study investigated the relationship between fluid IQ, PE signal and direct measures of dopaminergic neurotransmission. Here we used a multimodal imaging approach that combines positron emission tomography and functional magnetic resonance imaging.

A group of healthy controls was investigated with both 6-[18F]FluoroDOPA PET and functional MRI with a probabilistic reversal task. The task required a constant behavioral adaptation to changes in reward contingencies, while choosing between two abstract stimuli. A reinforcement learning algorithm was used to compute a trial-by-trial prediction error, which was the used as a regressor in the fMRI data analysis with SPM8.

The prediction error signal was associated with functional activation in the basal ganglia including the ventral striatum and putamen. Fluid intelligence was associated with the PE signal in the ventral striatum, which correlated with age-related changes in dopamine synthesis capacity in the prefrontal cortex.

These findings provide insight into the role of age-related changes in dopaminergic neurotransmission on behavioral adaptation. The multimodal imaging approach allows the characterization of interactions between dopamine metabolism and learning-related neuronal activation and may thus be a useful tool to clarify mechanisms underlying learning and plasticity in old age, which are crucial to our understanding of successful aging.

Several studies have independently suggested that schizophrenia patients are more likely to have an enlarged cavum septum pellucidum (CSP). However, neither finding has been consistently replicated.

We recruited the relatively homogeneity population: treatment resistant schizophrenia (TRS) and treatment resistant depression (TRD).To investigate whether CSP was present more frequently in TRS or TRD patients than controls and the difference of CSP morphological characteristic between groups.

1.5-Tesla MRI was used to evaluate the prevalence of CSP and morphology changes in 42 TRS, 45 TRD patients and 30 healthy controls. The CSP length, width and volume were measured using MRIcro and Analyze™ 8.1 software. A CSP equal to or greater than 6 mm in length was defined as big CSP.

TRS Patients had a significantly higher prevalence (6%) of the big CSP than TRD patients (0%) or controls (3.3%) while no significant difference on the prevalence of all CSP (TRS: 64.3%, TRD: 48.9%, controls: 50.0%) or small CSP between groups. Compared with controls or TRD patients, the values of CSP maximum width in patients with TRS were significant lower and CSP length were higher. There was no significant difference in the CSP volume between groups.

The incidence in Big CSP in TRS patients was higher than that of TRS patients or controls. The small CSP may be a kind of normal variant. There were different CSP developmental characteristics between TRS and TRD patients based on the MRI study.

Despite strong evidence that the pathophysiology of tic disorders (TD) involves structural and functional disturbances of the basal ganglia, inconsistent findings from several TD imaging studies have supported contradictory conclusions.

To find brain structural differences between children with of TD and the health children and verify the pathogenesis hypothesis of that basal ganglia play an important role in this disorder.

The right handedness, first-episode TD children were chosen. Yale global tic severity scale (YGTSS) was used to assess the tic severity. MRI scan was performed on TD children and the controls. The volumes of caudate nucleus, putamen, globus pallidus and total intracranial volume were measured on high resolution MR images. We compared the volumes, relative volumes and asymmetry index, AI between groups.

Totally 11 patients finished this study with two excluded for the unclear image caused by tic and 18 subjects (9 TD patients and 9 controls) were finally analyzed. The right globus pallidus is significantly larger in TD patients. The volumes of left caudate increased significantly in both TD patients and controls. There was no significant difference in asymmetry index between two groups, relative volumes did not correlate significantly with the severity of tic and the course of disease.

The right globus pallidus may be the primary pathological change of TD. Asymmetry indexes between the two groups are not significantly different. The relative volume of any structure of basal ganglia has no significant correlation with the severity of tic and the course of disease.

Antisocial personality disorder (ASPD) and psychopathy involve significant interpersonal and behavioural impairments. However, little is known about white matter (WM) abnormalities in tracts linking grey matter regions. A previous diffusion tensor imaging (DT-MRI) tractography study in ASPD and psychopathy revealed abnormalities in the right uncinate fasciculus, indicating fronto-limbic disconnectivity.

It is not clear whether WM abnormalities are restricted to only this tract or are more widespread. Therefore, we planned to use whole brain DT-MRI voxel-based analyses.

To clarify if WM abnormalities extend beyond the frontal lobe.

We used whole brain DT-MRI to compare WM fractional anisotropy (FA) of 15 adults with ASPD and healthy age, handedness and IQ-matched controls. Also, within ASPD subjects, we related differences in FA to severity of psychopathy measures.

Significant WM FA reductions were found in ASPD subjects relative to controls. These were found bilaterally in the anterior corpus callosum. Right hemisphere FA reduction was found in the anterior corona radiata, uncinate fasciculus, inferior fronto-occipital fasciculus and internal capsule. Left hemisphere, FA deficits encompassed the inferior longitudinal fasciculus, inferior fronto-occipital fasciculus and internal capsule. There was a significant negative correlation between WM FA in the right uncinate fasciculus and corpus callosum and measures of psychopathy.

We report FA reduction in the uncinate fasciculus and anterior corpus callosum which may be associated with frontal and inter-hemispheric disconnectivity in ASPD, in addition to abnormalities in other tracts which directly or indirectly connect to prefrontal regions.

Irony is a form of speech used to convey feelings in an indirect way. Schizophrenic patients usually demonstrate impaired irony processing, associated with poor theory of mind.

We used fMRI to examine neural circuitry underlying deficits in understanding irony in schizophrenia.

21 schizophrenic patients and 24 healthy subjects were studied. Short scenarios and three conditions were used: irony condition (IC), irony with linguistic help condition (IHC), and control condition (CC). We used event-related design. Scenarios started with a contextual part, followed by a 2–4s ISI. The ironic sentence appeared next, and a question followed. Between trials an ITI of 5–7s were used.

Patients performed significantly worse in the conditions (IC:p = 0.0003;IHC:p = 0.0034;CC:p = 0.0036). In the IC: patients activated the left insula, left anterior cingulum, right and left superior frontal gyrus (SFG), right middle frontal gyrus (MFG) during the contextual part, and activated the left inferior frontal gyrus (IFG), left middle temporal gyrus (MTG) and right superior temporal gyrus during the statement. In the IHC: patients activated the left precuneus, left IFG, left SFG, left and right MFG, right cuneus and left MTG during the context, and activated right SFG and left posterior cingulum during the statement.

Patients probably have an abnormal contextual processing and a missing activation of the theory of mind network during the interpretation of ironic statements. The given linguistic help proved to be efficient help for many patients in processing the context correctly, and in understanding ironic situations more successfully.

Diffusion tensor imaging (DTI) is a magnetic resonance imaging technique that have increasingly being used for the non-invasive evaluation of brain white matter (WM) abnormalities. Several studies suggest that the normal integration of cerebral function may be compromised in schizophrenia. Abnormalities in WM tracts may be directly relevant for the neuropathology of schizophrenia.

The purpose of this review was to discuss recent DTI findings in schizophrenia and a methodologic analysis.

The literature search was performed with the search engine PubMed of the U.S. National Library of Medicine. Search strategy used was based on the Cochrane review technique, limited to the period between 1998 (first report on DTI and schizophrenia) and May 2010. And limited to ‘Title/Abstract’. The reference lists of these studies were used to identify additional studies.

There is a striking amount of heterogeneity in findings, probably by methodologic problems. Brain regions such as the cingulate bundle, corpus callosum, and regions within frontal and temporal WM have a proportionally larger number of positive findings across the studies. In addition, WM tracts as The superior longitudinal fasciculus, fronto-occipital longitudinal fasciculi, uncinate fasciculi, frontal longitudinal fasciculus and the arcuate fasciculus have also positive findings in patients with schizophrenia. Other brain structures as the cerebellar peduncles, the fornix, the hippocampus and parahippocampal gyrus, the thalamic and optic radiations have been evaluated and shown positive findings. However, these findings are not present in all studies. DTI abnormalities in first-episode patients are less robust than in chronic patients.

Recent DTI findings further support the hypothesis of structural dysconnectivity in schizophrenia.

Major depression is associated with altered neural function in frontal and limbic areas.

The findings have been inconsistent, especially those derived from cerebral blood flow (CBF) measures.

To identify differences in regional CBF between patients and controls using arterial spin labeling (ASL) at rest.

20 patients with major depression and 20 matched healthy controls were scanned in the morning with a pCASL-sequence at a 3 T Siemens scanner. Mean Hamilton Depression Score (21 item version) was 26.2 ± 5.7 for patients, mean Beck Depression Inventory scores were 28.9 ± 8.9. Mean age did not differ between groups (39.6 vs. 44.4 years). Whole brain voxelwise T-Tests were correct for multiple comparisons using a False Discovery Rate of q < 0.05.

Mean global resting CBF was not different between groups (66.1 vs. 63.0 ml/100 mg/min, T = 0.95, p = 0.35). FDR correction at q < 0.05 led to a T-value threshold of 3.71 (p < 0.001) for group comparison. Hypoperfusion in patients was detected in left middle temporal gyrus, left middle frontal gyrus, right precentral gyrus. Hyperperfusion in patients was seen in the right superior temporal gyrus.

ASL revealed frontotemporal hypoperfusion in patients with major depression. This is in line with previous work and the current concept of depression. However, we were unable to replicate hyperperfusion in limibic areas.

Obsessive compulsive disorder (OCD) with religious contents is more prevalent among religious populations. The aim of this study was to evaluate efficacy of religious cognitive-behavioral therapy (RCBT) on OCD with religious content and co-morbidities.

This is a randomized controlled clinical trial. Our intervention consists of 10 weekly RCBT 90 minutes sessions supervised by both clergyman and psychiatrist.

Randomly 50 patients with 17 and more Yale Brown scores and religious content obsessive symptoms were selected and divided into two intervention and control groups. Yale Brown, SCL-90, and Hamilton depression questionnaires were used in this study. Data were analyzed by ANOVA/ANCOVA repeated measure tests using SPSS ver. 13.

Mean age of patients was 32.9 ± 8.86 years. 94% (n = 47) were female. Yale Brown scores in three stages (before intervention, after fifth and tenth session) in both groups decreased specially in intervention group but showed no significant difference (p = 0.294). However there were significant difference between mean scores of two groups (p = 0.047). Comparison of obsession subscale and compulsion subscale of Yale Brown scale showed decrease in three stages of the study. Decreasing trend in obsession subscale is not statistically significant (f (2, 42) = 0.94, p-value = 0.398), but decreasing trend in compulsive subscale is statistically significant (f(2,43) = 36.008, p value < 0.001).

In obsessive compulsive disorder with religious contents, religious CBT not only could significantly increase clinical responses, especially in compulsive behavior but also improve co-morbid symptoms such as depression as well as global severity index and decrease symptoms.

An increasing amount of outcome research supports the efficacy of Short Term Psychodynamic Psychotherapy (STPP) for a wide range of psychological disorders, reporting effect sizes in meta-analyses between 0.50 and 1.40 (for review see Shedler, 2010). Mapping mechanisms of change in the STPP process can be considered the major challenge of STPP for the decades to come.

This study focuses on STPP with Obsessive-Compulsive (OC) patients and tests the hypothesis that the progressive elimination of OC symptoms throughout an STPP process is correlated to a parallel process of change at the level of interpersonal characteristics.

Mixed quantitative-qualitative analyses of data of Short Term Psychodynamic Therapies with four OC patients are presented. Repeated Measures analyses are performed to study intra-subject associations between intensity of OC symptoms (measured by General Health Questionnaire, GHQ-12, and Obsessive-Compulsive Inventory, OCI-R) and interpersonal characteristics (measured by Inventory of Interpersonal Problems, IIP-32).

Observed associations between evolutions in general interpersonal characteristics and general complaints were significant yet inconsistent across the patients. Qualitative analyses, however, revealed similarities on the level of specific interpersonal characteristics, in this respect that all patients struggled to escape the suffocating impact of parental figures and/or romantic partners.

Rather than elaborating a general interpersonal style (cfr. Desmet et al., 2008), the results suggest that a progressive elaboration of parent-child and partner relationships is a crucial characteristic of the STPP process with OC patients. Limitations of the study are the small sample size and the absence of contrast- and control groups.

Several neuroimaging studies in obsessive-compulsive disorders (OCD) have shown a dysfunction in the orbito-fronto-striato-thalamamic neural circuitry as the fundamental neuropathological correlate, consistent across all symptom subtypes.

Therefore, the neurobiological differentiation of the various obsessive-compulsive symptoms is attracting increasing interest in neuroimaging as this clinical picture becomes increasingly subclassified.

A systematic literature survey was used to search for original papers that studied the neurobiological correlates of the various symptom dimensions of OCD (symmetry, forbidden thoughts, washing, hoarding).

It was possible to include a total of 15 original papers in the assessment. The “forbidden thoughts” factor, which also includes compulsion to control, is associated mainly with activations in brain structures of the cognitive control system, i.e. the basal ganglia and parts of the anterior cingulate cortex (ACC). Therefore, the neural representation pattern of “forbidden thoughts” differs clearly from that of “washing”, in which cerebral regions of emotional control seem to be particularly involved, i.e. the orbito-frontal cortex (OFC), ACC, the amygdala and insula. On the other hand, the “hoarding and collecting” dimension is primarily associated with brain areas involved in decision-making, i.e. the ventro-medial OFC, the dorsal ACC and the dorso-lateral prefrontal cortex (DLPC).

The results confirm the hypothesis that all dimensions of OCD are based on different neuronal networks, which underlines the neurobiological heterogeneity of the clinical picture of OCD, thus pointing the way for future research strategies.

Obsessive-compulsive patients have many problems in their processing.

They have a local processing than global processing. They focoused on the local aspect of world.

The purpose of this study was to examine cerebral lateralization of global-local visual processing in obsessive-compulsive patients.

All participants were right handed. Participants completed Edinburgh, the padua, Beck Depression and the Anxiety Inventories and computer task. The repeated measure design of 2(2×3×2) was used to analyze the reaction time data, and the repeated measure design of 2(2×2) was used to analyze the interference data.

Results indicated that OC patients were generally faster in local stimuli processing than global stimuli processing. Also in patient’s group, global stimuli (incongruent) processing contrary to local stimuli (incongruent) processing in the right hemisphere was faster than that of the left hemisphere, a result consistent with previous literature for normal people. In patient’s group, global-to-local interference contrary to local-to-global interference in the right hemisphere was greater than that of the left hemisphere, but in normal’s group, interference pattern in two hemispheres showed no significant differences. In addition, local to global interference in the left hemisphere of normal’s group was greater than that of the patient’s group, but these differences was not significant. Also results showed similar global-to-local interference in normal and patient’s group.

In general, the results of this study show that OC patients are faster in processing of local stimuli than global stimuli. However, this can not be attributed to a dysfunctional hemisphere.