Developmental neurocognitive pathway of psychosis proneness and the impact of cannabis use

Cette thèse fait la promotion d’une nouvelle approche ciblant le risque de psychose qui consiste à identifier les enfants et les jeunes adolescents de la communauté appartenant à différentes trajectoires développementales d’expériences psychotiques. Une identification très précoce du risque de psychose chez des jeunes de la communauté pourrait ainsi diminuer la période où les symptômes cliniques ne sont pas traités, mais aurait également le potentiel de prévenir efficacement l’émergence de symptômes avérés, et ce, si les facteurs de risque sont identifiés. Étant donné que la consommation de cannabis s’avère un important facteur de risque de la psychose et le contexte actuel où les états en sont à réviser leurs politiques de réglementation du cannabis, il s’avère primordial de mieux comprendre comment la consommation peut mener à la psychose chez les individus vulnérables. Tout d’abord, j’ai investigué la séquence temporelle entre la consommation de cannabis et les expériences psychotiques chez une population de 4000 adolescents, suivis pendant 4 ans, au moment de l’adolescence où les deux phénomènes s’initient. Ensuite, j’ai examiné, chez des adolescents suivant une trajectoire de vulnérabilité, le rôle d’un moins bon fonctionnement cognitif ainsi que celui d’une exacerbation des symptômes anxieux et dépressifs comme médiateurs du lien entre cannabis et risque de psychose. Enfin, j’ai investigué la présence de marqueurs neurocognitifs précoces (fonctionnels et structurels) qui seraient associés à l’émergence de symptômes psychotiques chez des adolescents, et exploré si la consommation de cannabis pourrait modérer l’ampleur de ces marqueurs. Les données proviennent de deux cohortes longitudinales suivant des adolescents de la population générale, l’étude Co-Venture (n=4000, âgés de 12 ans, suivis annuellement pendant 4 ans) et l’étude de neuroimagerie IMAGEN (n=2200, âgés de 14 ans, suivis pendant 2 ans), ainsi qu’un sous-échantillon de l’étude Co-Venture ayant complété des mesures de neuroimagerie (n=151, âgés de 12 ans, suivis annuellement pendant 4 ans). Les résultats ont montré que la consommation de cannabis précédait systématiquement l’augmentation des expériences psychotiques, et non l’inverse. Chez les jeunes suivant une trajectoire de vulnérabilité, la relation entre la consommation de cannabis et le risque de psychose était davantage expliquée par une augmentation des symptômes de dépression et d’anxiété. Une réduction du volume de l’hippocampe et de l’amygdale en combinaison avec une hyperactivité de ces mêmes régions en réponse à des expressions neutres étaient tous associés à l’émergence de symptômes psychotiques. Or, la consommation de cannabis n’a pas exacerbé les altérations structurelles observées chez les adolescents rapportant des expériences psychotiques. Ces résultats ont mis en évidence le rôle primordial d’un hyperfonctionnement du système limbique pouvant mener à l’attribution aberrante d’une importance émotionnelle aux stimuli de l’environnement, et ce, chez des adolescents vulnérables. Il semble que le mécanisme par lequel la consommation de cannabis mène à l’émergence de symptômes cliniques passe par son influence sur les symptômes de dépression et d’anxiété ainsi que leurs mécanismes neuronaux sous-jacents d’une hypersensibilité au stress. Enfin, de par ces résultats, cette thèse permet de contribuer au développement de nouvelles interventions visant à réduire la demande de cannabis chez des adolescents vulnérables.Following the worldwide initiative on intervening early in clinical high-risk individuals for psychosis, this thesis promotes a novel approach to identify those at risk for psychosis by studying children and adolescents from the community who report different trajectories of subclinical psychosis symptoms (i.e., psychotic-like experiences) without the confounds of iatrogenic effects such as major social and cognitive impairments. Early identification from this approach may not only reduce harm by shortening the duration of untreated symptoms, but may also have the capacity to prevent the emergence of clinically validated symptoms, particularly if early risk factors can be identified. Considering the long-standing notion that cannabis misuse is an important risk factor for psychosis and that jurisdictions around the world are currently revising their cannabis regulatory policies, there is a need to better understand how cannabis use may lead to psychosis in vulnerable youths. This thesis examined different mechanisms that may explain the complex relationship between cannabis use and psychosis risk. I first explored the temporal sequence between cannabis use and self-reported psychotic-like experiences in a population-based sample of 4000 adolescents, over a 4-year period when both phenomena have their onset. Second, in vulnerable youths, I investigated the role of impaired cognitive functioning as well as increased affective and anxious symptoms as mediators of the cannabis-to-psychosis relationship. And third, I explored the presence of early neurocognitive markers (both functional and structural) associated with the emergence of psychotic symptoms, and how cannabis use moderates these markers. Two longitudinal cohorts from the general population, the Co-Venture Study (n=4000, aged 12 years old, followed annually for 4 years) and the neuroimaging IMAGEN Study (n=2200, aged 14 years old, followed for 2 years), as well as the neuroimaging subsample from the Co-Venture Study (n=151, aged 12 years old, followed annually for 4 years) were used. It was found that an increase in cannabis use always preceded an increase in reported psychotic-like experiences throughout adolescence, but an increase in psychotic-like experiences rarely predicted an increase in cannabis use. Then, in vulnerable adolescents, the cannabis-to-psychosis risk relationship was better explained by increases in depression and anxiety symptoms relative to changes in cognitive functioning. It was demonstrated that reduced hippocampus and amygdala volumes, combined with hyperactivity of the same regions during neutral cues processing were associated with the emergence of psychotic symptoms in young adolescents reporting psychotic-like experiences. However, cannabis use did not exacerbate the structural alterations observed in youths with psychotic-like experiences. These findings have improved our understanding of the relationship between cannabis use and vulnerability to psychosis. They have also highlighted the important role of an impaired limbic network leading to an aberrant emotional salience attribution in vulnerable adolescents. Although cannabis use did not exacerbate brain structural alterations observed in vulnerable youths, it appears that cannabis will more likely interfere with depression and/or anxiety symptoms and their associated brain mechanisms underlying vulnerability to stress in the path towards psychosis risk. This thesis may inform the development of new evidence-based interventions that reduce demand for cannabis among vulnerable youths

L’impulsivité en toxicomanie : un regard sur les mécanismes neuronaux de la rechute à la nicotine

Contexte : Jusqu’à 90% des fumeurs qui tentent d’arrêter de fumer vont rechuter dans l’année suivant la date d’arrêt. L’impulsivité, au même titre que le « craving », a démontré être un bon facteur de prédiction de la rechute tabagique. Ainsi, la présente étude visait à évaluer, à l’aide de la neuroimagerie fonctionnelle, l’influence de l’impulsivité sur les mécanismes neuronaux du « craving » de la cigarette. Parmi les régions cérébrales impliquées dans le « craving » de la nicotine, les cortex préfrontal dorsolatéral, orbitofrontal et cingulaire sont d’importantes structures dans les processus de contrôle de soi. Méthodes : 31 fumeurs chroniques ont passé une session de neuroimagerie durant laquelle ils devaient regarder des images appétitives de cigarettes et des images neutres. Ils ont ensuite dû inscrire le « craving » ressenti à la vue des images et répondre à un questionnaire portant sur les traits de personnalité de l’impulsivité (BIS-11). Résultats : Tel qu’attendu, le score d’impulsivité était positivement corrélé au « craving » rapporté par les participants à la vue d’images de cigarettes. Au niveau cérébral, plus les fumeurs présentaient de forts traits d’impulsivité, moins grande était l’activité du cortex cingulaire postérieur (CCP) durant le « craving ». Enfin, l’activité du CCP présentait une connectivité fonctionnelle négative avec l’insula, le cortex préfrontal dorsolatéral et le cortex cingulaire antérieur. Conclusions : Comme le CCP est le siège des processus de mentalisation et de référence à soi, nous suggérons que plus les fumeurs étaient impulsifs, moins ils prenaient conscience de leur état et moins ils en exerçaient un contrôle, donc plus ils ressentaient de forts « cravings ». En poussant plus loin, nos résultats mettent l’accent sur l’aspect identitaire (le soi, les mémoires autobiographiques) et l’aspect d’introspection en toxicomanie : deux avenues à explorer.Background: 90% of cigarette smokers attempting to quit smoking relapse by one-year following their quit date. Impulsivity, as well as cue-induced cravings, have been shown to be good predictors of relapse for tobacco smoking; however, no study to date has examined their interaction and its neural substrates. The goal of this study was to determine the neural influence of trait impulsivity during functional imaging of cue-induced cigarette cravings. Among the brain regions involved in nicotine craving, the dorsolateral prefrontal cortex, the orbitofrontal as well as the cingulate cortex all play a significant role in self-control processes. Methods: Thirty-one chronic smokers passively viewed appetitive smoking-related and neutral images while being scanned. Participants also reported their level of craving and completed the BIS-11, a measure of trait impulsivity. Results: As hypothesized, we observed a significant positive relationship between impulsivity scores and reported craving. Impulsivity scores were negatively correlated with activity in the posterior cingulate cortex (PCC). The insula, dorsal anterior cingulate cortex and dorsolateral prefrontal cortex presented a negative connectivity with the PCC. Conclusions: Given that the PCC is involved in mentalization and self-relevant processing, it is possible that greater trait impulsivity in smokers is associated to a lower tendency to understand and use one’s mental and physical state to guide behavior. This may weaken their capacity for self-control and consequently, promotes more automatic and stronger cue-elicited smoking urges. Furthermore, our results highlight the important but undervalued role of identity (the self and autobiographic memories) and mindfulness in addiction

Effects of delaying binge drinking on adolescent brain development : a longitudinal neuroimaging study

Background: Onset of alcohol use by 14 relative to 21 years of age strongly predicts elevated risk for severe alcohol use problems, with 27% versus 4% of individuals exhibiting alcohol dependence within 10 years of onset. What remains unclear is whether this early alcohol use (i) is a marker for later problems, reflected as a pre-existing developmental predisposition, (ii) causes global neural atrophy or (iii) specifically disturbs neuro-maturational processes implicated in addiction, such as executive functions or reward processing. Since our group has demonstrated that a novel intervention program targeting personality traits associated with adolescent alcohol use can prevent the uptake of drinking and binge drinking by 40 to 60%, a crucial question is whether prevention of early onset alcohol misuse will protect adolescent neurodevelopment and which domains of neurodevelopment can be protected. Methods: A subsample of 120 youth at high risk for substance misuse and 30 low-risk youth will be recruited from the Co-Venture trial (Montreal, Canada) to take part in this 5-year follow-up neuroimaging study. The Co-Venture trial is a community-based cluster-randomised trial evaluating the effectiveness of school-based personality-targeted interventions on substance use and cognitive outcomes involving approximately 3800 Grade 7 youths. Half of the 120 high-risk participants will have received the preventative intervention program. Cognitive tasks and structural and functional neuroimaging scans will be conducted at baseline, and at 24- and 48-month follow-up. Two functional paradigms will be used: the Stop-Signal Task to measure motor inhibitory control and a modified version of the Monetary Incentive Delay Task to evaluate reward processing. Discussion: The expected results should help identify biological vulnerability factors, and quantify the consequences of early alcohol abuse as well as the benefits of early intervention using brain metrics

Functional neuroimaging predictors of self-reported psychotic symptoms in adolescents

OBJECTIVE: This study aimed to investigate the neural correlates of psychotic-like experiences in youth on measures of inhibitory control, reward anticipation and emotion processing. A secondary aim was to test whether these neuro-functional correlates of risk were predictive of psychotic symptoms 2 years later. METHOD: Functional imaging response to three paradigms: the Stop-Signal, Monetary Incentive Delay, and Faces tasks was collected in youth at age 14, as part of the IMAGEN study. At baseline, youth from London and Dublin sites were assessed on psychotic-like experiences and those reporting significant experiences were compared with matched controls. Significant brain activity differences between the groups were used to predict, with cross-validation, the presence of psychotic symptoms in the context of mood fluctuation at age 16, assessed in the full sample. These prediction analyses were conducted with the London-Dublin subsample (N=246) and the full sample (N=1196). RESULTS: Youth reporting psychotic-like experiences showed increased hippocampus/amygdala activity during neutral faces processing and reduced dorsolateral prefrontal activity during failed inhibition relative to controls. The most prominent region for classifying 16-year olds with mood fluctuation and psychotic symptoms relative to the control groups (those with mood fluctuations but no psychotic symptoms and those with no mood symptoms) included hyperactivation of the hippocampus/amygdala, when controlling for baseline psychotic-like experiences and cannabis use. CONCLUSIONS: The results stress the importance of the limbic network’s increased response to neutral facial stimuli as a marker of the extended psychosis phenotype. These findings might help to guide early intervention strategies for at-risk youth

Subcortical volumes across the lifespan: Data from 18,605 healthy individuals aged 3–90 years

Age has a major effect on brain volume. However, the normative studies available are constrained by small sample sizes, restricted age coverage and significant methodological variability. These limitations introduce inconsistencies and may obscure or distort the lifespan trajectories of brain morphometry. In response, we capitalized on the resources of the Enhancing Neuroimaging Genetics through Meta‐Analysis (ENIGMA) Consortium to examine age‐related trajectories inferred from cross‐sectional measures of the ventricles, the basal ganglia (caudate, putamen, pallidum, and nucleus accumbens), the thalamus, hippocampus and amygdala using magnetic resonance imaging data obtained from 18,605 individuals aged 3–90 years. All subcortical structure volumes were at their maximum value early in life. The volume of the basal ganglia showed a monotonic negative association with age thereafter; there was no significant association between age and the volumes of the thalamus, amygdala and the hippocampus (with some degree of decline in thalamus) until the sixth decade of life after which they also showed a steep negative association with age. The lateral ventricles showed continuous enlargement throughout the lifespan. Age was positively associated with inter‐individual variability in the hippocampus and amygdala and the lateral ventricles. These results were robust to potential confounders and could be used to examine the functional significance of deviations from typical age‐related morphometric patterns

Cortical thickness across the lifespan: Data from 17,075 healthy individuals aged 3-90 years

Delineating the association of age and cortical thickness in healthy individuals is critical given the association of cortical thickness with cognition and behavior. Previous research has shown that robust estimates of the association between age and brain morphometry require large‐scale studies. In response, we used cross‐sectional data from 17,075 individuals aged 3–90 years from the Enhancing Neuroimaging Genetics through Meta‐Analysis (ENIGMA) Consortium to infer age‐related changes in cortical thickness. We used fractional polynomial (FP) regression to quantify the association between age and cortical thickness, and we computed normalized growth centiles using the parametric Lambda, Mu, and Sigma method. Interindividual variability was estimated using meta‐analysis and one‐way analysis of variance. For most regions, their highest cortical thickness value was observed in childhood. Age and cortical thickness showed a negative association; the slope was steeper up to the third decade of life and more gradual thereafter; notable exceptions to this general pattern were entorhinal, temporopolar, and anterior cingulate cortices. Interindividual variability was largest in temporal and frontal regions across the lifespan. Age and its FP combinations explained up to 59% variance in cortical thickness. These results may form the basis of further investigation on normative deviation in cortical thickness and its significance for behavioral and cognitive outcomes

Neural Circuitry of Impulsivity in a Cigarette Craving Paradigm

Impulsivity has been shown to play a pivotal role in the onset, pattern of consumption, relapse and, most notably, craving of illicit and licit drugs such as cigarette smoking. The goal of this study was to examine the neurobiological influence of trait impulsivity during cue-induced cigarette craving. Thirty-one chronic smokers passively viewed appetitive smoking-related and neutral images while being scanned and reported their feelings of craving. They completed the Barratt Impulsiveness Scale, a measure of trait impulsivity. We conducted functional connectivity analyses using the psycho-physiological interaction method. During the processing of smoking stimuli, participants presented increased activations in the cingulate and prefrontal cortices. We observed a significant positive relationship between impulsivity scores and reported craving. A negative correlation was observed between the impulsivity score and activity in the posterior cingulate cortex (PCC). The insula, dorsal anterior cingulate cortex (dACC) as well as the dorsolateral prefrontal cortex (DLPFC) presented a negative connectivity with the PCC. Consistent with the view that the PCC is related to the ability to resist cigarette craving, our results suggest that high impulsive smokers have greater difficulty in controlling their cravings, and that this weakness may be mediated by lower PCC activity. Moreover, we argue that the less PCC activity, the greater the probability of a stronger emotional, physiological, and biased attentional response to smoking cues mediated by insula, dACC, and DLPFC activity. This is the first study on this topic, and so, results will need to be replicated in both licit and illicit drug abusers. Our findings also highlight a need for more emphasis on the PCC in drug addiction research, as it is one of the most consistently activated regions in functional magnetic resonance imaging studies examining the neural correlates of cue-induced alcohol, drug, and tobacco cravings

Altered brain connectivity in patients with schizophrenia is consistent across cognitive contexts

BACKGROUND: Schizophrenia has been defined as a dysconnection syndrome characterized by aberrant functional brain connectivity. Using task-based fMRI, we assessed to what extent the nature of the cognitive context may further modulate abnormal functional brain connectivity. METHODS: We analyzed data matched for motion in patients with schizophrenia and healthy controls who performed 3 different tasks. Tasks 1 and 2 both involved emotional processing and only slighlty differed (incidental encoding v. memory recognition), whereas task 3 was a much different mental rotation task. We conducted a connectome-wide general linear model analysis aimed at identifying context-dependent and independent functional brain connectivity alterations in patients with schizophrenia. RESULTS: After matching for motion, we included 30 patients with schizophrenia and 30 healthy controls in our study. Abnormal connectivity in patients with schizophrenia followed similar patterns regardless of the degree of similarity between cognitive tasks. Decreased connectivity was most notable in the medial prefrontal cortex, the anterior and posterior cingulate, the temporal lobe, the lobule IX of the cerebellum and the premotor cortex. LIMITATIONS: A more circumscribed yet significant context-dependent effect might be detected with larger sample sizes or cognitive domains other than emotional and visuomotor processing. CONCLUSION: The context-independence of functional brain dysconnectivity in patients with schizophrenia provides a good justification for pooling data from multiple experiments in order to identify connectivity biomarkers of this mental illness