The Neural Basis of an Affective Pathway to Psychosis a Study Combining Functional MRI and Experience Sampling Methodology

Abstract

Affective reactivity to daily stressors are increased in individuals in the early stages of psychosis. Studies in psychosis patients and healthy individuals at increased psychosis risk show altered neural reactivity to stress in limbic (i.e., hippocampus [HC] and amygdala), prelimbic (i.e., ventromedial prefrontal cortex [vmPFC] and ventral anterior cingulate cortex [vACC]), and salience areas (i.e., anterior insula [AI]). We investigated whether a similar pattern of neural reactivity is present in early psychosis individuals and if brain activity in these regions is associated with daily-life stress reactivity.

Twenty-nine early psychosis individuals (11 clinical high risk and 18 first-episode psychosis) completed a stress task in conjunction with functional MRI. All participants also provided experience sampling methodology (ESM) data on momentary affect and stressful activities in their everyday environment. Multilevel regression models were used to estimate if daily-life stress reactivity was moderated by activity in (pre)limbic and salience areas.

Task-induced stress was associated with increased activation of the right AI and decreased activation in the vmPFC, vACC, and HC. Task-induced changes in vmPFC and vACC activity were associated with affective stress reactivity, whereas changes in HC and amygdala activity were associated with higher overall stress levels.

These preliminary results suggest region-specific roles in affective and psychotic daily-life stress reactivity in early psychosis. The observed pattern suggests that chronic stress plays a role in neural stress reactivity. Direct comparison with a control group should elucidate whether these findings reflect a neural basis for an affective pathway to psychosis.

Note:
Clinical Trial Registration Details: The study was part of a large-scale randomized controlled trial (RCT) on the efficacy of an acceptance and commitment therapy (ACT)-based ecological momentary intervention for early psychosis individuals (INTERACT: NTR4252 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4252)

Funding Information: TV was funded by a postdoctoral fellowship grant from FWO (1243620N). UH was supported by a NWO VENI grant (451-13-022) and a DFG Heisenberg professorship (389624707). JAW was supported by an R01 grant (MH115031) from the National Institutes of Health of the United States. IMG was supported by an FWO Odysseus grant (GOF8416N).

Declaration of Interests: None.

Ethics Approval Statement: The study was approved by the medical-ethical committee of the academic hospital in Leuven, Belgium (reference: B322201629214; study number: s59127, Interact), and in accordance with the Helsinki Declaration (2013)

Keywords: stress reactivity, experience sampling method, functional magnetic resonance imaging, Early Psychosis, affect