In spite of relative success in the treatment of psychotic disorders, we know very little about the underlying processes which, when disrupted, lead to psychosis. This lack of understanding is particularly evident in the fact that current pharmacologic therapies still leave approximately 50 % of schizophrenic/schizoaffective patients with persistent symptoms. Better understanding of the pathophysiological processes underlying psychosis, and particularly those in patients who remain symptomatic despite treatment, will be critical to improving treatment outcomes. This in turn requires an improved understanding of the functions normally carried out by relevant brain networks. Significant findings have begun to point to a neurobiology relevant to psychosis. Examining this work, it appears that psychosis may involve a dysfunction in limbic brain regions that normally evaluate the emotional salience of stimuli, and this dysfunction likely entails abnormal interaction of limbic/emotional areas with prefrontal/cognitive areas. The establishment of emotional salience and the further processing it generates appear to involve sublenticular/basal forebrain areas, amygda.la, medial prefrontal cortex and orbitofrontal cortex. These regions receive rich doparninergic innervation and appear critical to the treatment of schizophrenia and schizoaffective disorder. We hypothesize that positive symptoms of psychosis involve the inappropriate attribution of salience, such as delusions of reference, while negative symptoms involve a failure to respond to emotional stimuli. We propose to use functional magnetic resonance imaging (fMRT) to map responses to emotionally salient stimuli in treated patients with schizophrenia/schizoaffective disorder who remain actively symptomatic, and we will test the following hypotheses:
(Aim 1) Patients with treatment-resistant positive symptoms will exhibit abnormal activation of the amygdala and medial prefrontal cortex;
(Aim 2) Patients with defict/primary negative symptoms will fail to activate the orbitofrontal cortex. Establishing the involvement of these regions in treatment resistant symptoms should provide an important piece of the much larger puzzle of psychosis, eventually leading us to new and better treatment strategies for psychotic disorders.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH064148-04
Application #
6920069
Study Section
Special Emphasis Panel (ZRG1-BDCN-6 (01))
Program Officer
Meinecke, Douglas L
Project Start
2002-08-06
Project End
2007-07-31
Budget Start
2005-08-01
Budget End
2006-07-31
Support Year
4
Fiscal Year
2005
Total Cost
$344,250
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Psychiatry
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
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Taylor, Stephan F; Chen, Ashley C; Tso, Ivy F et al. (2011) Social appraisal in chronic psychosis: role of medial frontal and occipital networks. J Psychiatr Res 45:526-38
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Tso, Ivy F; Grove, Tyler B; Taylor, Stephan F (2010) Emotional experience predicts social adjustment independent of neurocognition and social cognition in schizophrenia. Schizophr Res 122:156-63
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Waugh, Christian E; Wager, Tor D; Fredrickson, Barbara L et al. (2008) The neural correlates of trait resilience when anticipating and recovering from threat. Soc Cogn Affect Neurosci 3:322-32

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