title: Modulation of motivational salience processing during the early stages of psychosis.
abstract: BACKGROUND
  Deficits in motivational salience processing have been related to psychotic symptoms and disturbances in dopaminergic neurotransmission. We aimed at exploring changes in salience processing and brain activity during different stages of psychosis and antipsychotic medication effect.
  
  
  METHODS
  We used fMRI during the Salience Attribution Task to investigate hemodynamic differences between 19 healthy controls (HCs), 34 at-risk mental state (ARMS) individuals and 29 individuals with first-episode psychosis (FEP), including a subgroup of 17 FEP without antipsychotic medication (FEP-UM) and 12 FEP with antipsychotic medication (FEP-M). Motivational salience processing was operationalized by brain activity in response to high-probability rewarding cues (adaptive salience) and in response to low-probability rewarding cues (aberrant salience).
  
  
  RESULTS
  Behaviorally, adaptive salience response was not accelerated in FEP, although they correctly distinguished between trials with low and high reward probability. In comparison to HC, ARMS exhibited a lower hemodynamic response during adaptive salience in the right inferior parietal lobule and FEP-UM in the left dorsal cingulate gyrus. The FEP-M group exhibited a lower adaptive salience response than HC in the right insula and than ARMS in the anterior cingulate gyrus. In unmedicated individuals, the severity of hallucinations and delusions correlated negatively with the insular- and anterior cingulate hemodynamic response during adaptive salience. We found no differences in aberrant salience processing associated with behavior or medication.
  
  
  CONCLUSIONS
  The changes in adaptive motivational salience processing during psychosis development reveal neurofunctional abnormalities in the somatosensory and premotor cortex. Antipsychotic medication seems to modify hemodynamic responses in the anterior cingulate and insula.
authors.affiliation: Psychiatric University Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, Basel, Switzerland; Medical Image Analysis Center, University Hospital Basel, Switzerland.
authors.forename: Renata
authors.initials: R
authors.lastname: Smieskova
authors.affiliation: Institute of Cognitive Neuroscience, University College London, UK.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Roiser
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Chaddock
authors.affiliation: Psychiatric University Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, Basel, Switzerland; Medical Image Analysis Center, University Hospital Basel, Switzerland.
authors.forename: André
authors.initials: A
authors.lastname: Schmidt
authors.affiliation: Psychiatric University Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, Basel, Switzerland; Medical Image Analysis Center, University Hospital Basel, Switzerland.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Harrisberger
authors.affiliation: Medical Image Analysis Center, University Hospital Basel, Switzerland.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Bendfeldt
authors.affiliation: Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, Bruderholz, Switzerland.
authors.forename: Andor
authors.initials: A
authors.lastname: Simon
authors.affiliation: Psychiatric University Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, Basel, Switzerland.
authors.forename: Anna
authors.initials: A
authors.lastname: Walter
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fusar-Poli
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK.
authors.forename: Philip K
authors.initials: PK
authors.lastname: McGuire
authors.affiliation: Psychiatric University Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, Basel, Switzerland.
authors.forename: Undine E
authors.initials: UE
authors.lastname: Lang
authors.affiliation: Psychiatric University Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, Basel, Switzerland.
authors.forename: Anita
authors.initials: A
authors.lastname: Riecher-Rössler
authors.affiliation: Psychiatric University Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, Basel, Switzerland; Medical Image Analysis Center, University Hospital Basel, Switzerland; Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK.
authors.forename: Stefan
authors.initials: S
authors.lastname: Borgwardt
mesh_terms: D000208:Acute Disease; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects / Q000503:physiopathology*; D001931:Brain Mapping; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology; D003702:Delusions / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006212:Hallucinations / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009042:Motivation / Q000187:drug effects / Q000502:physiology*; D009483:Neuropsychological Tests; D011336:Probability; D062706:Prodromal Symptoms; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000188:drug therapy / Q000503:physiopathology*; D012201:Reward; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotic medication; Cingulate cortex; Functional MRI; Insula