Studio con risonanza magnetica del giro temporale superiore e delle sue sottoaree nella schizofrenia: rilevanza per le dimensioni neurolinguistiche

Background: I disturbi del linguaggio, e in particolare l\u2019impoverimento e la disorganizzazione, costituiscono un aspetto centrale della schizofrenia. Tali deficit sono stati descritti sia in termini di disturbi formali del pensiero (disordine nella forma ma non nel contenuto del pensiero), sia come alterazioni simili a quelle presenti nei disturbi di tipo afasico (es. creazione di neologismi). Inoltre, sono stati evidenziati deficit a livello fonologico, difficolt\ue0 nel recupero lessicale e una riduzione della complessit\ue0 sintattica, cos\uec come disturbi inerenti la pragmatica (comprensione delle espressioni figurate, prosodia linguistica e affettiva, theory of mind). Negli ultimi decenni, le ricerche condotte mediante tecniche di neuroimaging hanno indicato il giro temporale superiore (GTS) e le sue sottoaree, il giro di Heschl (HG) e il planum temporale (PT), come componenti essenziali del network fronto-temporale coinvolto nella produzione e comprensione del linguaggio. Inoltre, tali studi hanno evidenziato la presenza di anomalie strutturali in HG e GTS, cos\uec come un\u2019inversione della normale asimmetria del PT nei pazienti con schizofrenia rispetto ai controlli sani. Tali anomalie potrebbero costituire il substrato neurale dei disturbi del linguaggio descritti nella schizofrenia. Obiettivo dello studio: Valutare l\u2019esistenza di differenze strutturali (volumetriche) di GTS, HG e PT, dell\u2019indice di lateralizzazione del PT e relativamente ad alcuni indici linguistici/pragmatici in un gruppo di pazienti affetti da schizofrenia (DSM-IV) e in gruppo di controlli sani. Inoltre l\u2019obiettivo \ue8 di indagare la correlazione tra i volumi delle aree anatomiche di interesse e gli indici linguistici/pragmatici. Metodi: Cinquantotto pazienti con diagnosi di schizofrenia (et\ue0 media\ub1ds: 40.60\ub111.58; lunghezza di malattia: 13.92\ub110.79; 40 maschi, 18 femmine; destrimani; caucasici) e 59 controlli sani (et\ue0 media\ub1ds: 40.69\ub111.10; 32 maschi, 27 femmine; destrimani; caucasici) hanno eseguito una risonanza magnetica strutturale (sMRI) effettuata con uno scanner da 1.5 Tesla. Il giro temporale superiore, il giro di Heschl e il planum temporale sono stati tracciati manualmente e il rispettivo volume \ue8 stato calcolato mediante il software Brains2. Un task narrativo (descrizione di vignette) e una conversazione semi-strutturata sono stati utilizzati per la valutazione della produzione linguistica, mentre test di comprensione della sintassi e delle espressioni figurate sono stati utilizzati per gli aspetti relativi alla comprensione dell\u2019eloquio. Infine, \ue8 stata utilizzata una correlazione parziale per studiare la relazione tra i volumi ottenuti e gli indici linguistici risultati significativamente diversi nei due gruppi. Risultati: Per quanto riguarda il volume di GTS, HG e PT, non sono emerse differenze tra il gruppo dei pazienti e il gruppo dei controlli. Tuttavia, quando i gruppi sono stati stratificati in base al sesso, \ue8 emersa una riduzione del volume del PT sinistro e una riduzione della sua asimmetria nelle pazienti di sesso femminile rispetto ai controlli dello stesso sesso (volume PT: F=4.54, p= 0.04; indice di asimmetria del PT: F=4.69, p=0.04; ANOVA, et\ue0 e volume totale intracranico come covariate). Per quanto riguarda l\u2019assessment linguistico, i pazienti con schizofrenia hanno mostrato un deterioramento diffuso degli aspetti sia propriamente linguistici che pragmatici, in particolare riguardo la fluenza dell\u2019eloquio (numero di parole al minuto), la complessit\ue0 e diversit\ue0 sintattica, la diversit\ue0 lessicale, la comprensione delle regole della sintassi e delle espressioni figurate (idiomi e metafore) (p<0.01, MANOVA con et\ue0, sesso e livello di istruzione come covariate). Inoltre, dimensioni linguistiche distinte sono risultate correlate differentemente con i volumi di GTS-HG-PT nel gruppo dei pazienti e in quello dei controlli sani, in particolare riguardo la fluenza dell\u2019eloquio, gli indici relativi alla sintassi e la comprensione di espressioni idiomatiche e metaforiche. Conclusioni: Il presente studio ha evidenziato alterazioni strutturali del PT nelle pazienti affette da schizofrenia rispetto ai controlli dello stesso sesso. E\u2019 inoltre emersa la presenza di numerosi deficit linguistici nei soggetti con schizofrenia, quando confrontati con il gruppo di controllo. Inoltre, gli indici linguistici sono risultati correlare in maniera differenziata tra i due gruppi con i volumi delle regioni anatomiche investigate. Tali risultati suggeriscono l\u2019importanza di condurre studi distinti per maschi e femmine (cos\uec come per destrimani e sinistrorsi) e inseriscono questo progetto di ricerca nel dibattito sulle differenze di genere nella schizofrenia. Studi futuri e con campioni pi\uf9 numerosi potranno chiarire se le differenze riscontrate tra i due sessi dal punto di vista anatomico possono risultare in una diversa competenza linguistica.Background: Language disturbances, such as impoverishment, disorganization and dysregulation, are prominent features of schizophrenia. These deficits have been described in patients both in term of thought disorders and schizophasia (dysphasia-like impairments such as neologism, clanging, unintelligible utterance). Moreover, phonetics, access to the lexicon and sometimes syntax are clearly impaired, along with pragmatic deficits (impaired affective/linguistic prosody, theory of mind, non literal expressions comprehension). In the last decades, researches carried out with neuroimaging techniques have suggested the superior temporal gyrus (STG) and its sub-areas, Heschl\u2019s gyrus (HG) and planum temporale (PT), as essential components of the fronto-temporal network involved in speech perception and production. Also, they have highlighted structural abnormalities in HG and STG (especially the left side) and an inversion of PT asymmetry in patients with schizophrenia compared to healthy controls. Such anatomical findings could be linked to language disturbances described in schizophrenia. Aim of the study: To compare STG, HG and PT volumes, PT lateralization index and linguistic/pragmatic dimensions in a sample of patients with a DSM-IV diagnosis of schizophrenia and healthy controls; to investigate correlations between volumes and linguistic/pragmatic indices. Methods: Fifty-eight patients with schizophrenia (mean age\ub1sd: 40.60\ub111.58; duration of illness: 13.92\ub110.79; 40 males, 18 females; all right-handed; all Caucasian) and 59 healthy controls (mean age\ub1sd: 40.69\ub111.10; 32 males, 27 females; all right-handed; all Caucasian) underwent 1.5 T structural magnetic resonance imaging (sMRI). Superior temporal gyrus, HG and PT were manually traced and volumes were calculated using the BRAINS2 software. Narrative, conversational and syntactic comprehension tasks were used to evaluate linguistic skills, while a pragmatic comprehension test was used to assess the ability to understand non literal aspects of language (metaphors and idioms). A partial correlation was used to investigate the link between volumes and linguistic/pragmatic indices. Results: As regards STG, HG and PT volumes, any differences was found between patients and healthy controls. When groups were stratified by sex, a left PT volume loss and a reduced right to left asymmetry was found only in the female patients compared to females controls (PT volume: F=4.54, p= 0.04; PT asymmetry index: F=4.69, p=0.04; ANOVA, age and intracranial volume as covariates). As regards language, patients with schizophrenia showed a widespread impairment of linguistic and pragmatic indices, especially regarding speech fluency, syntactic complexity and diversity, lexical diversity, syntactic rules understanding and non-literal expression comprehension (p<0.01, MANOVA with age, sex and educational level as covariates). Furthermore, distinct language dimensions differently correlated with STG-HG-PT volumes in patients with schizophrenia and controls, particularly with regard to speech fluency, syntactic measures and metaphor/idiom comprehension (p<0.01, partial correlation with age and duration of illness as covariates). Conclusion: This study has highlighted structural anomalies in the PT in females patients with schizophrenia compared to healthy females. Also, several linguistic and pragmatic deficits have been found in patients with schizophrenia compared to controls. Furthermore, distinct correlations between volumes and linguistic indices in patients with schizophrenia and healthy controls suggest a complex neuroanatomical substrate for language dimensions in healthy humans and in schizophrenia patients. In addition, such results suggest the importance to plan studies separately for males and females (and for left-handers/right-handers) in order to reduce the role of confounding variables. Further studies with larger samples should clarify whether these anatomical sex differences in language networks could result in different linguistic abilities

Language disturbances in ADHD.

This article aims to review the studies exploring language abilities in attention deficit hyperactivity disorder (ADHD; with or without comorbid language impairment) focusing on oral speech discrimination, listening comprehension, verbal and spatial working memory as well as on discourse analysis and pragmatic aspects of communication and language comprehension

Childhood adversities and bipolar disorder: a neuroimaging focus

Early-life adverse events or childhood adversities (CAs) are stressors and harmful experiences severely impacting on a child's wellbeing and development. Examples of CAs include parental neglect, emotional and physical abuse and bullying. Even though the prevalence of CAs and their psychological effects in both healthy and psychiatric populations is established, only a paucity of studies have investigated the neurobiological firms associated with CAs in bipolar disorder (BD). In particular, the exact neural mechanisms and trajectories of biopsychosocial models integrating both environmental and genetic effects are still debated. Considering the potential impact of CAs on BD, including its clinical manifestations, we reviewed existing literature discussing the association between CAs and brain alterations in BD patients. Results showed that CAs are associated with volume alterations of several grey matter regions including the hippocampus, thalamus, amygdala and frontal cortex. A handful of studies suggest the presence of alterations in the corpus callosum and the pre-fronto-limbic connectivity at rest. Alterations in these regions of the brain of patients with BD are possibly due to the effect of stress produced by CAs, being hippocampus part of the hypothalamus-pituitary-adrenal axis and thalamus together with amygdala filtering sensory information and regulating emotional responses. However, results are mixed possibly due to the heterogeneity of methods and study design. Future neuroimaging studies disentangling between different types of CAs or differentiating between BD sub-types are needed in order to understand the link between CAs and BD

Neural correlates of cognitive behavioral therapy-based interventions for bipolar disorder: A scoping review

Cognitive Behavioral Therapy (CBT) is among the gold-standard psychotherapeutic interventions for the treatment of psychiatric disorders, including bipolar disorder (BD). While the clinical response of CBT in patients with BD has been widely investigated, its neural correlates remain poorly explored. Therefore, this scoping review aimed to discuss neuroimaging studies on CBT-based interventions in bipolar populations. Particular attention has been paid to similarities and differences between studies to inform future research. The literature search was conducted on PubMed, PsycINFO, and Web of Science databases in June 2023, identifying 307 de-duplicated records. Six studies fulfilled the inclusion criteria and were reviewed. All of them analyzed functional brain activity data. Four studies showed that the clinical response to CBT was associated with changes in the functional activity and/or connectivity of prefrontal and posterior cingulate cortices, temporal parietal junction, amygdala, precuneus, and insula. In two additional studies, a peculiar pattern of baseline activations in the prefrontal cortex, hippocampus, amygdala, and insula predicted post-treatment improvements in depressive symptoms, emotion dysregulation, and psychosocial functioning, although CBT-specific effects were not shown. These results suggest, at the very preliminary level, the potential of CBT-based interventions in modulating neural activity and connectivity of patients with BD, especially in regions ascribed to emotional processing. Nonetheless, the discrepancies between studies concerning aims, design, sample characteristics, and CBT and fMRI protocols do not allow conclusions to be drawn. Further research using multimodal imaging techniques, better-characterized BD samples, and standardized CBT-based interventions is needed

A critical overview of tools for assessing cognition in bipolar disorder

Cognitive deficits are prevalent in bipolar disorder even during the euthymic phase, having a negative impact on global functioning and quality of life. As such, more and more mental health professionals agree that neuropsychological assessment should be considered an essential component of the clinical management of bipolar patients. However, no gold standard tool has been established so far. According to bipolar disorder experts targeting cognition, appropriate cognitive tools should be brief, easy to administer, cost-effective and validated in the target population. In this commentary, we critically appraised the strengths and limitations of the tools most commonly used to assess cognitive functioning in bipolar patients, both for screening and diagnostic purposes

Neuroimaging studies exploring the neural basis of social isolation

According to the social brain hypothesis, the human brain includes a network designed for the processing of social information. This network includes several brain regions that elaborate social cues, interactions and contexts, i.e. prefrontal paracingulate and parietal cortices, amygdala, temporal lobes and the posterior superior temporal sulcus. While current literature suggests the importance of this network from both a psychological and evolutionary perspective, little is known about its neurobiological bases. Specifically, only a paucity of studies explored the neural underpinnings of constructs that are ascribed to the social brain network functioning, i.e. objective social isolation and perceived loneliness. As such, this review aimed to overview neuroimaging studies that investigated social isolation in healthy subjects. Social isolation correlated with both structural and functional alterations within the social brain network and in other regions that seem to support mentalising and social processes (i.e. hippocampus, insula, ventral striatum and cerebellum). However, results are mixed possibly due to the heterogeneity of methods and study design. Future neuroimaging studies with longitudinal designs are needed to measure the effect of social isolation in experimental v. control groups and to explore its relationship with perceived loneliness, ultimately helping to clarify the neural correlates of the social brain

A critical overview of emotion processing assessment in non-affective and affective psychoses

Aims: Patients with affective and non-affective psychoses show impairments in both the identification and discrimination of facial affect, which can significantly reduce their quality of life. The aim of this commentary is to present the strengths and weaknesses of the available instruments for a more careful evaluation of different stages of emotion processing in clinical and experimental studies on patients with non-affective and affective psychoses. Methods: We reviewed the existing literature to identify different tests used to assess the ability to recognise (e.g. Ekman 60-Faces Test, Facial Emotion Identification Test and Penn Emotion Recognition Test) and to discriminate emotions (e.g. Face Emotion Discrimination Test and Emotion Differentiation Task). Results: The current literature revealed that few studies combine instruments to differentiate between different levels of emotion processing disorders. The lack of comprehensive instruments that integrate emotion recognition and discrimination assessments prevents a full understanding of patients' conditions. Conclusions: This commentary underlines the need for a detailed evaluation of emotion processing ability in patients with non-affective and affective psychoses, to characterise the disorder at early phases from the onset of the disease and to design rehabilitation treatments

Language disturbances in ADHD

This article aims to review the studies exploring language abilities in attention deficit hyperactivity disorder (ADHD; with or without comorbid language impairment) focusing on oral speech discrimination, listening comprehension, verbal and spatial working memory as well as on discourse analysis and pragmatic aspects of communication and language comprehension

e-Health interventions targeting pain-related psychological variables in fibromyalgia: a systematic review

There is growing evidence to support the potential benefit of e-Health interventions targeting psychosocial outcomes and/or pain-related psychological variables for chronic pain conditions, including fibromyalgia syndrome (FMS). This systematic review aims at providing an in-depth description of the available e-Health psychological and/or multicomponent interventions for patients with FMS. Searches were made in PubMed, Cochrane, Web of Science, and PsycINFO up to 15 May 2023, finally including twenty-six articles. The quality of the included articles was medium–high (average quality assessment score of 77.1%). 50% of studies were randomized controlled trials (RCTs) (n = 13), and the majority of them focused exclusively on adult patients with FMS (n = 23) who were predominantly female. Four categories of e-Health modalities were identified: web-based (n = 19), mobile application (m-Health) (n = 3), virtual reality (VR) (n = 2), and video consulting (n = 2). Interventions were mainly based on the cognitive behavioral therapy (CBT) approach (n = 14) and mostly involved contact with a healthcare professional through different digital tools. Overall, a growing number of psychological and multicomponent interventions have been created and delivered using digital tools in the context of FMS, showing their potentiality for improving psychosocial outcomes and pain-related psychological variables. However, some digital tools resulted as underrepresented, and the literature on this topic appears highly heterogeneous precluding robust conclusions

Default mode network activity in bipolar disorder

Since its discovery in 1997, the default mode network (DMN) and its components have been extensively studied in both healthy individuals and psychiatric patients. Several studies have investigated possible DMN alterations in specific mental conditions such as bipolar disorder (BD). In this review, we describe current evidence from resting-state functional magnetic resonance imaging studies with the aim to understand possible changes in the functioning of the DMN in BD. Overall, several types of analyses including seed-based and independent component have been conducted on heterogeneous groups of patients highlighting different results. Despite the differences, findings seem to indicate that BD is associated with alterations in both frontal and posterior DMN structures, mainly in the prefrontal, posterior cingulate and inferior parietal cortices. We conclude this review by suggesting possible future research directions