Pattern of neural responses to verbal fluency shows diagnostic specificity for schizophrenia and bipolar disorder

Article


Costafreda, Sergi G, Fu, C., Picchioni, Marco, Toulopoulou, Timothea, McDonald, Colm, Kravariti, Eugenia, Walshe, Muriel, Prata, Diana, Murray, Robin M and McGuire, Philip K 2011. Pattern of neural responses to verbal fluency shows diagnostic specificity for schizophrenia and bipolar disorder. BMC Psychiatry. 11 (1), p. 18.
AuthorsCostafreda, Sergi G, Fu, C., Picchioni, Marco, Toulopoulou, Timothea, McDonald, Colm, Kravariti, Eugenia, Walshe, Muriel, Prata, Diana, Murray, Robin M and McGuire, Philip K
Abstract

Background: Impairments in executive function and language processing are characteristic of both schizophrenia
and bipolar disorder. Their functional neuroanatomy demonstrate features that are shared as well as specific to
each disorder. Determining the distinct pattern of neural responses in schizophrenia and bipolar disorder may
provide biomarkers for their diagnoses.
Methods: 104 participants underwent functional magnetic resonance imaging (fMRI) scans while performing a
phonological verbal fluency task. Subjects were 32 patients with schizophrenia in remission, 32 patients with
bipolar disorder in an euthymic state, and 40 healthy volunteers. Neural responses to verbal fluency were
examined in each group, and the diagnostic potential of the pattern of the neural responses was assessed with
machine learning analysis.
Results: During the verbal fluency task, both patient groups showed increased activation in the anterior cingulate,
left dorsolateral prefrontal cortex and right putamen as compared to healthy controls, as well as reduced
deactivation of precuneus and posterior cingulate. The magnitude of activation was greatest in patients with
schizophrenia, followed by patients with bipolar disorder and then healthy individuals. Additional recruitment in
the right inferior frontal and right dorsolateral prefrontal cortices was observed in schizophrenia relative to both
bipolar disorder and healthy subjects. The pattern of neural responses correctly identified individual patients with
schizophrenia with an accuracy of 92%, and those with bipolar disorder with an accuracy of 79% in which misclassification
was typically of bipolar subjects as healthy controls.
Conclusions: In summary, both schizophrenia and bipolar disorder are associated with altered function in
prefrontal, striatal and default mode networks, but the magnitude of this dysfunction is particularly marked in
schizophrenia. The pattern of response to verbal fluency is highly diagnostic for schizophrenia and distinct from
bipolar disorder. Pattern classification of functional MRI measurements of language processing is a potential
diagnostic marker of schizophrenia.

JournalBMC Psychiatry
Journal citation11 (1), p. 18
ISSN1471-244X
Year2011
PublisherBioMed Central
Publisher's version
License
CC BY
Web address (URL)http://dx.doi.org/10.1186/1471-244X-11-18
Publication dates
Print28 Jan 2011
Publication process dates
Deposited05 Aug 2014
FunderNational Institute for Health Research (NIHR)
Copyright information© 2011 Costafreda et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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