title: Lower prefrontal activation during emotion regulation in subjects at ultrahigh risk for psychosis: an fMRI-study.
abstract: BACKGROUND
  Previous research has shown that patients with schizophrenia experience difficulties with emotion regulation and activate prefrontal regions to a lesser extent during reappraisal of emotional information. It has been suggested that problems in emotion regulation might precede the onset of psychosis. Therefore, it could be hypothesized that also individuals at ultrahigh risk (UHR) for developing psychosis experience difficulties with emotion regulation.
  
  
  OBJECTIVE
  The aim of the current study was to investigate whether individuals at UHR for developing psychosis show abnormal brain activation during reappraisal of negative pictures.
  
  
  METHODS
  Using functional magnetic resonance imaging (fMRI), we scanned 15 UHR participants and 16 matched healthy controls while performing an emotion regulation task. During this task, participants had to reappraise their negative emotion elicited by International Affective Picture System pictures. Furthermore, the reported use of reappraisal was examined with the emotion regulation questionnaire (ERQ).
  
  
  RESULTS
  Individuals at UHR for psychosis showed less activation in the left ventrolateral prefrontal cortex during reappraisal compared with healthy controls. Furthermore, they reported less use of reappraisal in daily life (P=0.01; 95% CI (0.24-1.63)).
  
  
  CONCLUSIONS
  These findings indicate that dysfunctional emotion regulation may already occur in individuals at risk for psychosis. These regulation difficulties are underpinned by less ventrolateral prefrontal cortex activation, and may result in high negative affect, lower social functioning, and high rates of psychotic symptoms.
authors.affiliation: Neuroimaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Academy for social studies, Hanze University of Applied Sciences, Groningen, The Netherlands.
authors.forename: Jorien
authors.initials: J
authors.lastname: van der Velde
authors.affiliation: Neuroimaging Center, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.
authors.forename: Esther M
authors.initials: EM
authors.lastname: Opmeer
authors.affiliation: Neuroimaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Rob Giel Research Center, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Edith J
authors.initials: EJ
authors.lastname: Liemburg
authors.affiliation: Rob Giel Research Center, University Medical Center Groningen , Groningen, The Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: Bruggeman
authors.affiliation: Department of Psychosis studies, Mental Health Care Friesland , Leeuwarden, The Netherlands.
authors.forename: Roeline
authors.initials: R
authors.lastname: Nieboer
authors.affiliation: Department of Psychosis studies, Mental Health Care Friesland , Leeuwarden, The Netherlands.
authors.forename: Lex
authors.initials: L
authors.lastname: Wunderink
authors.affiliation: Neuroimaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Psychology, University of Groningen, Groningen, The Netherlands.
authors.forename: André
authors.initials: A
authors.lastname: Aleman