Abstract
Stress is implicated in many aspects of schizophrenia, including heightened distress intolerance. We examined how affect and microstructure of major brain tracts involved in regulating affect may contribute to distress intolerance in schizophrenia. Patients with schizophrenia spectrum disorders (n = 78) and community controls (n = 95) completed diffusion weighted imaging and performed psychological stress tasks. Subjective affect was collected pre and post stressors. Individuals who did not persist during one or both stress tasks were considered distress intolerant (DI), and otherwise distress tolerant (DT). Fractional anisotropy (FA) of the dorsal cingulum showed a significant diagnosis x DT/DI phenotype interaction (p = 0.003). Post-hoc tests showed dorsal cingulum FA was significantly lower in DI patients compared with DI controls (p < 0.001), but not different between DT groups (p = 0.27). Regarding affect responses to stress, irritability showed the largest stress-related change (p < 0.001), but irritability changes were significantly reduced in DI patients compared to DI controls (p = 0.006). The relationship between irritability change and performance errors also differed among patients (ρ = −0.29, p = 0.011) and controls (ρ = 0.21, p = 0.042). Further modeling highlighted the explanatory power of dorsal cingulum for predicting DI even after performance and irritability were taken into account. Distress intolerance during psychological stress exposure is related to microstructural properties of the dorsal cingulum, a key structure for cognitive control and emotion regulation. In schizophrenia, the affective response to psychological stressors is abnormal, and distress intolerant patients had significantly reduced dorsal cingulum FA compared to distress intolerant controls. The findings provide new insight regarding distress intolerance in schizophrenia.
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Abbreviations
- DI:
-
distress intolerant
- DT:
-
distress tolerant
- BPRS:
-
Brief Psychiatric Rating Scale
- BNSS:
-
Brief Negative Symptom Scale
- CPZ:
-
chlorpromazine equivalents
- PASAT:
-
Paced Auditory Serial Addition Task
- MTPT:
-
Mirror-Tracing Persistence Task
- PANAS:
-
Positive and Negative Affect Schedule
- DWI:
-
diffusion weighted imaging
- FA:
-
fractional anisotropy
- RD:
-
radial diffusivity
- AD:
-
axial diffusivity
- dcg:
-
dorsal cingulum
- vcg:
-
ventral cingulum
- fx:
-
fornix
- unc:
-
uncinate fasciculus
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Funding
Support was received from National Institutes of Health grants MH112180, MH103222, MH108148, MH067533, a State of Maryland contract (M00B6400091), and a National Alliance for Research in Schizophrenia and Affective Disorders (NARSAD) Award from the Brain and Behavior Research Foundation.
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Dr. Hong has received or is planning to receive research funding or consulting fees from Mitsubishi, Your Energy Systems LLC, Neuralstem, Taisho Pharmaceutical, Heptares, Pfizer, Takeda and Regeneron. All other authors declare no financial interests that could represent a conflict of interest.
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Supplemental Figure 1
Voxel-wise differences in factional anisotropy between patients and controls along the entire white matter skeleton; widespread reductions in FA were observed in patients relative to controls. (PDF 511 kb)
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Wisner, K.M., Chiappelli, J., Savransky, A. et al. Cingulum and abnormal psychological stress response in schizophrenia. Brain Imaging and Behavior 14, 548–561 (2020). https://doi.org/10.1007/s11682-019-00120-9
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DOI: https://doi.org/10.1007/s11682-019-00120-9