Resonancia Magnetica Funcional con Paradigma Auditivo Emocional en Pacientes con un Primer Episodio Psicótico

Neuroimaging studies of emotional response in patients with Psychosis have mainly used visual stimuli, i.e., still photographs of emotional faces paradigms and shown globally reduced brain activity. Much less is known about the mechanisms underlying emotion recognition deficits within the auditory modality. Our principal aim is to evaluate the emotional response of First-Episode Psychotic (FEP) patients to neutral and emotional words. An auditory emotional paradigm based on the most frequent words heard by psychotic patients with auditory hallucinations was designed. This paradigm was applied to evaluate cerebral activation with functional magnetic resonance imaging (fMRI) in 59 FEP patients and 50 healthy subjects. We found a clear enhanced activity of the frontal lobe, temporal cortex, cingulate and mainly hippocampus and amygdala in patients when hearing emotional words in comparison with controls. Our findings are consistent with other studies suggesting a significant role for emotional response, revealing that alterations in limbic system are present in the early stages of psychosis, and these alterations are correlated with the severity of the illness

First-Episode Psychotic Patients Showed Longitudinal Brain Changes Using fMRI With an Emotional Auditory Paradigm

Most previous longitudinal studies of functional magnetic resonance imaging (fMRI) in first-episode psychosis (FEP) using cognitive paradigm task found an increased activation after antipsychotic medications. We designed an emotional auditory paradigm to explore brain activation during emotional and nonemotional word processing. This study aimed to analyze if longitudinal changes in brain fMRI BOLD activation is present in patients vs. healthy controls. A group of FEP patients (n = 34) received clinical assessment and had a fMRI scan at baseline and follow-up (average, 25-month interval). During the fMRI scan, both emotional and nonemotional words were presented as a block design. Results were compared with a pair of healthy control group (n = 13). Patients showed a decreased activation at follow-up fMRI in amygdala (F = 4.69; p = 0.04) and hippocampus (F = 5.03; p = 0.03) compared with controls. Middle frontal gyrus was the only area that showed a substantial increased activation in patients (F = 4.53; p = 0.04). A great heterogeneity in individual activation patterns was also found. These results support the relevance of the type of paradigm in neuroimaging for psychosis. This is, as far as we know, the first longitudinal study with an emotional auditory paradigm in FEP. Our results suggested that the amygdala and hippocampus play a key role in psychotic disease. More studies are needed to understand the heterogeneity of response at individual level