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Professor Xiao-Jing Wang, New York University & NYU Shanghai, USA & China, shared developments in the computational modeling of GABA microcircuitry and cognitive deficits in schizophrenia.
Professor Wang seeks to understand the dynamic behaviour and function of neural circuits. He investigates neural mechanisms and computational principles of cognitive processes - such as decision making and working memory - using theoretical and modeling approaches. Neural network modeling is a valuable tool to bridge the gaps between levels of investigation that would be difficult to achieve experimentally. Accurate microcircuit models may direct our approach to treating mental disorders, including schizophrenia.
Neural network modeling allows us to bridge the gaps between levels of investigation that would be difficult to achieve experimentally.
Mental disorders mainly involve cognitive-type brain systems, such as the prefrontal cortex (PFC) - often called "the CEO of the brain". Professor Wang has investigated the microcircuit properties that enable a cortical area, such as the PFC, to carry out cognitive functions. Wang proposed that the cognitive function of cortical areas is due to an interplay between slow reverberating excitation and competitive synaptic inhibition.
Working memory is a key cognitive function that is impaired in mental disorders. Using computational circuit modeling of the PFC, Professor Wang has shown that working memory deficits in schizophrenia arise from an inability to filter out distractors that are behaviourally irrelevant - rather than problems with working memory storage. This interesting finding was confirmed by human study.
The prefrontal cortex is often called "the CEO of the brain".
Resistance against distractors in a working memory circuit depends on several subtypes of interneurons, soma-, dendrite-, and interneuron-targeting interneurons, which are all modulated differently by dopamine.
Professor Wang suggested a novel perspective on GABA signaling impairment in mental disorders. The GABA system consists of several inhibitory cell types. Different types of interneurons can set up a gating mechanism that is used by the brain to flexibly route information flow to the right place at the right time - based on behavioural demands. Diverse GABAergic cell types are found throughout the brain. Their functions need to be fully investigated - both experimentally and theoretically - using large-scale, cross-level, brain circuit modeling.
A novel perspective on GABA signaling impairment in mental disorders.
Professor Thomas Klausberger, Medical University Vienna, Austria, discussed the contribution of distinct types of GABAergic interneurons to working memory and decision making.
The cerebral cortex is made up of highly diverse neuronal types, including excitatory pyramidal cells, and GABAergic inhibitory interneurons - which control the activity and timing of pyramidal cells. Professor Klausberger is investigating how distinct types of neurons support the executive functions of the PFC.
Freely-moving rats performed a delayed cue-matching-to-place task, which involves working memory and decision making. The rats were given a stimulus - either chocolate or cherry - and after a six second delay they ran either down the left path (chocolate) or the right path (cherry). A reward was at the end of the road for those rats that made the right choice - based on the initial stimulus.
During this task, GABAergic interneurons and pyramidal cells in the PFC were recorded using the juxtacellular recording and labelling technique - and their contribution to network oscillations investigated.
Two groups of pyramidal neurons showed task-related firing patterns - neurons that represented the future goal and those that fired during distinct periods of the task. Distinct types of interneurons modulated these firing patterns.
Distinct types of GABAergic interneurons contribute to working memory and decision making.
By recording identified neurons, Professor Klausberger has shown how distinct types of neurons contribute to prefrontal network operations and executive behaviour. These results indicate that GABAergic interneurons release GABA at distinct times to different domains of pyramidal cells - like percussions in music.
GABAergic interneurons release GABA at distinct times - like percussions in music.
Professor John Krystal, Yale University, USA, and CINP President Elect, spoke about GABA-related dysfunctional cortical activity in schizophrenia.
Molecular and cellular changes have been observed in post-mortem tissue from patients who had schizophrenia. But we don’t yet know how these alterations cause schizophrenia’s characteristic symptoms and cognitive impairment.
Professor Krystal and colleagues analyzed healthy subjects and patients with schizophrenia using functional MRI (fMRI) and electroencephalography (EEG). They also looked at healthy subjects given the N-methyl-D-aspartate receptor (NMDA-R) antagonist, ketamine - which causes similar symptoms to and is a pharmacological model of schizophrenia. The results were interpreted alongside relevant computational neuroscience models of the behaviour of cortical micro- and macro-circuits.
Professor Krystal described different types of network disinhibition seen in these studies.
One of those is pathological hyperconnectivity - a feature of early course (high-risk, first episode) schizophrenia that is associated with symptoms of psychosis. Long-term hyperconnectivity produces volume loss in schizophrenia. In first episode schizophrenia, hippocampal hypermetabolic regions predict volume loss in chronic psychosis.
The signal properties of cortical functional connectivity change as schizophrenia progresses. This finding opens the door for phase-specific pharmacotherapy - treating schizophrenia differently at different stages of the illness.
Schizophrenia has a dynamic neurobiology that changes over the course of the illness.
Schizophrenia is associated with heterogeneous pathophysiologies - a finding which has not been adequately addressed by treatment efforts.
Professor Krystal drew attention to the time-dependent neurobiological evolution of schizophrenia. Based on the idea that schizophrenia has a dynamic neurobiology that changes over the course of the illness, he proposed phase-specific pharmacotherapy. The disinhibitory phase - early course of the illness - can be targeted with treatments that restore inhibition. But in the atrophic, chronic phase, inhibitory treatments may worsen deficits in synaptic connectivity.
The developmental neurobiology of schizophrenia needs to be characterized further - to enable us to treat patients better. Such studies should use our knowledge of the genetics and epigenetics of schizophrenia.
It is hoped that neurodevelopmental and homeostatic processes may allow us to identify time-dependent sources of cortical network dysfunction that correspond with the clinical phases of schizophrenia.
Professor Etienne Sibille, Centre for Addiction and Mental Health, Canada, changed the direction of the symposium as he presented findings on GABA-related cellular and molecular pathology in depression.
Somatostatin (SST) is a selective marker for GABA neurons that regulates pyramidal cell dendrites. SST is reduced in major depressive disorder (MDD). In fact, low SST is also reported in schizophrenia, bipolar disorder, Alzheimer’s disease, epilepsy and other conditions. SST may be a vulnerable biological module in the brain.
The important questions are, does low SST contribute to psychiatric symptoms, particularly mood disorders? And does targeting low SST have antidepressant potential?
Exploring new drug targets in depression.
Professor Sibille described human postmortem molecular studies and animal genetic and pharmacological studies as he addressed these questions.
Genetic studies in mice suggested that low SST and reduced SST-positive GABA neurons have a role in causing mood symptoms, and may be targets for novel antidepressants.
The function of SST-positive GABA neurons is mediated by post-synaptic GABA-A receptors that contain the alpha5 subunit. These receptors are found mostly in the hippocampus and cortex. Boosting alpha5-mediated GABA function (through positive allosteric modulation) has antidepressant activity in mice.
Professor Sibille also described another potential new drug target - based on the idea that altered eukaryotic initiation factor 2 (EIF2) signaling may be linked to dysregulation of SST expression and high emotionality. He and colleagues have shown that activating EIF2 signaling through EIF2 kinase inhibition diminished stress-induced behavioural emotionality in mice.
CINP symposia bring together the latest advances in basic, clinical and translational neuropsychopharmacology relevant to mental illness and treatment.
Artificial intelligence is a term that conjures up images of robots and machines capable of intelligent thought. In the field of psychiatry, artificial intelligence principles and practices are being used to take neuroimaging data and develop biomarkers that could support a clinical diagnosis and quantify and describe that diagnosis.
Dr Mitsuo Kawato of the ATR Computational Neuroscience Laboratories in Kyoto, Japan, has been involved in research that for the first time defines the biological dimension – an imaging dimension – of a psychiatric diagnosis. Research published by Dr Kawato and colleagues in Nature Communications in 2016 ranked among the top 1% of viewed scientific papers published in same period. Dr Kawato believes this is because the paper dealt with an artificial intelligence application that could define autism spectrum disorder (ASD) using neuroimaging-based classifiers – or biomarkers. The research team are using the application to define and create neuroimaging biomarkers for major depressive disorder (MDD), schizophrenia, obsessive compulsive disorder (OCD) and chronic pain syndromes.
Taking data from 200 patient samples, and looking at 10,000 neuroimaged connections and 140 brain lesions, Dr Kawato said it had been possible, using sophisticated artificial intelligence algorithms, to select the 16 functional connections that are specific for and discriminate ASD from normal (typically developed) brains. He explained that this type of computational neuroscience allows the description of one scale – one dimension – that plots the Gaussian distribution for typically developed individuals and another that plots the distribution for, in this case, ASD. This biomarker tool therefore also allows for a quantitative assessment – or score for the diagnosis.
What is more, Dr Kawato explained that these neuroimaging biomarkers being developed not only define and describe a specific diagnosis, but highlight distinctions between diagnoses and similarities and closeness of certain diagnoses. For example he said that the ASD neuroimaging biomarker could not distinguish MDD patients from their controls, but showed some ability to discriminate between patients with schizophrenia and controls. According to Dr Kawato, this closeness between ASD and schizophrenia is in keeping with historical views that these conditions shared some commonality and with genetic studies indicating common loci for schizophrenia and ASD.
Dr Kawato believes that neuroimaging biomarkers will be a valuable support to clinical diagnosis and will become a reality of practice and diagnosis in the near future. He told Progress in Mind: “In other disciplines of medicine like cardiovascular medicine and oncology for example, it is common to examine biomarkers – be they blood biomarkers or imaging scans (fMRI and PET). But in psychiatry, we haven’t had that kind of quantitative measurement to support the clinical diagnosis.”
“We had two objectives. The first was to provide objective scales to support clinical diagnosis with neuroimaginging based biomarkers.” Dr Kawato then said that if these biomarkers prove to be really reliable, it may be possible to use these tools to explore and describe the neurocircuits and brain regions with correlates for predicting certain diagnosis.
Dr Kawato described how the neuroimaging biomarker looks at resting state fMRI, with a 5-10 minute scan providing the data to allow a quantitative diagnosis. He said that in the future it might be possible, not just to diagnose one condition, but to use all the available biomarker scales to see if, in the case of ASD for example, a person has a condition more predominantly located between ASD and schizophrenia – or located closer to the normal healthy position.
These developments in neuroimaging biomarker research might also have applications in the management of psychiatric disorders. Dr Kawato said that real-time feedback based on imaging biomarkers might have therapeutic applications in some diagnoses. He explained: “We can define “ASDness” and then in realtime we can feed this back to our patient as a score. It’s something a bit like cognitive behavioural therapy or psychotherapy, although a little bit more high tech.” Dr Kawato said that pilot studies in ASD, MDD and chronic pain conditions, have been looking at this real-time feedback. According to Dr Kawato, outcomes may depend on the learning capability of a given patient and some conditions may be more amenable to reinforcement conditioning than others.
For the future, Dr Kawato said that neuroimaging biomarkers may soon become a clinical reality and he hoped that machine learning algorithms based on biomarkers might also find a place as another modality in the management of psychiatric disorders.
Computational neuropsychiatry is a new discipline, exciting huge interest for its potential in diagnosis and possibly even management.
Management and study of depression – with its strong focus on affect, mood and emotion – has for a long time underplayed the importance of cognitive dysfunction as a core feature of depression. At a 2016 CINP scientific session, the need for discovery, development and translation in the domain of cognitive dysfunction in depression was stressed by co-chair and presenter Professor Barbara Sahakian, Professor of Clinical Neuropsychology at the Department of Psychiatry, University of Cambridge, UK.
Professor Sahakian reminded delegates that cognitive deficits often persist in remitted patients, impacting on their ability to return to work, education and normal function. She spoke of the importance of better and earlier detection and treatment of depression and the fact that untreated or undertreated depression leads to poorer response rates, more relapse and greater disease chronicity.
Cognitive deficits and dysfunction, she said, contribute greatly to the financial losses associated with depression, where both absenteeism and presenteeism contribute to loss of productivity. Professor Sahakian spoke about the importance of considering both mental well-being and mental capital – where a person’s ‘mental capital’ encompasses their cognitive and emotional resources and resilience in the face of stress. The term ‘capital’ rightly associated with ideas of financial capital as well as the ‘capital’ of the mind.
Professor Sahakian said that cognitive dysfunction is not simply a residual domain in depression but a core aspect of depression and possibly an early biomarker for depression. She said researchers in Cambridge are looking for cognitive biomarkers for in adolescents – for example looking at oversensitivity to negative feedback and negative attentional bias as potential predictors for the later development of depression.
Professor Sahakian asked the audience how familiar they were with the concepts of hot and cold cognition, explaining that cold cognition is the term used to describe broadly non-emotional cognitive functions, while hot cognition includes emotional, often time-limited cognitive functions where there may be a conflict between risk and reward. Hot cognition includes negative attentional bias and responses to negative feedback.
Depression affects both hot and cold cognition and Professor Sahakian reminded delegates again that cognitive dysfunction in depression is the biggest barrier to rehabilitation. Forgetfulness, difficulty focussing – cold cognitive impairments, and sensitivity to negative feedback – hot cognitive impairments, are features of cognitive dysfunction that can make return to work or education very difficult. Professor Sahakian said that cognitive deficits in remitted depression are also associated with higher depression relapse rates.
Other speakers in the session reported on clinical studies looking at the impact of antidepressant agents on cognitive dysfunction in depression and remitted depression, and described some of the challenges and new methods and ideas that will be needed for continued drug discovery and exploration of this domain of depression.
Cognitive dysfunction is a core feature of depression that often persists in ‘remitted’ patients.
In a world of seemingly endless ways and means to keep abreast of the latest research, and countless virtual channels through which to forge networks and relationships, it seems the traditional congress is still very much alive.
At a closed workshop held during CINP 2016, a number of the recipients of the Young Investigator travel award* were brimming with ideas about ways to enhance the congress experience, yet were unanimous that the tried-and-tested elements of the congress concept still hold great appeal for young scientists and clinicians.
Attending talks by experts, networking with peers, hearing the latest research-thinking and taking time out from the rigors of their everyday research work and clinical practice – to reflect on the broader aspects of neuroscience and psychiatry – are enriching experiences. According to the young investigators at CINP, there is no substitute for face-to-face meetings and being part of the community engendered by a congress.
But that’s not to say that meeting and congress organizers should be complacent, or that there aren’t opportunities to make the congress experience better.
The Millennial app- and twitter-savvy generation want congress plans at their finger-tips, and sharing on social media is a given. Young investigators appreciate that congress data may be new and embargoed information, yet can see that high quality facts, opinions and concepts are worthy of wider dissemination. During the workshop, young investigators used the example of TEDx talks – ‘ideas worth spreading’ – which keep conversations going long after an event as an approach congresses could adopt, and during the congress, they would be more than happy to use and share handles and hashtags to communicate congress ideas and messages. They just want presenters to realise that when a delegate appears to be on their ‘phone – it probably means they are tweeting pearls of wisdom from the talk!
Young investigators appreciate that short of a major culture change, their older peers may not all rush to embrace twitter, but they suggested that facebook and facebook pages have broader generational appeal and they think that medical societies could work, for example, with student helpers willing to be their social media whizzes (officers) who establish and run social media campaigns.
During a congress, young investigators find plenary lectures by thought leaders and poster sessions to be excellent learning and idea-generating experiences. Soaking up ideas and being able to meet and talk with other scientists and clinicians is something the CINP young investigators think should be a regular event in their calendars. While not averse to e-learning opportunities and catching up on missed congress events via post-congress webcasts, the up-coming generation would prefer a concentrated dose of real-time interaction with their colleagues.
* Jee Hyun Kim, Australia; Jiamei Lian, Australia; Daniel Quintana, Australia; Saddichha Sahoo, Australia; Giulia Treccani, Italy (currently working in Denmark)
Young investigators, attending CINP 2016 through the Rafaelsen travel award scheme, shared their thoughts on what they like about coming to meetings.