These authors summarize current understanding of the pathophysiology of schizophrenia based on dysfunction in dopaminergic and glutamatergic signaling.They suggest several nodes of the basal ganglia-thalamocortical circuit as therapeutic targets for deep brain stimulation (DBS): the hippocampus, the ventral striatum, and the associative striatum. 3 Regarding this dopamine dysregulation-based hypothesis, we believe that there are other targets that could be useful for DBS: the mediodorsal thalamus and the internal globus pallidus. 1,4,5,9 Moreover, in the last few years, findings from voxel-based morphometry, diffusion tensor imaging, and functional MRI suggest structure and functional alterations of the medial prefrontal cortex, specifically the area correlated to the anterior midline node of the default mode network. 6,8This area corresponds to the subcallosal cingulate gyrus, which includes Brodmann area 25.The failure of task-related deactivation in this medial frontal cortex is related to the symptoms of schizophrenia.Actually, a meta-analysis of the whole-brain voxel-based approach revealed that abnormalities in white matter areas in schizophrenia were consistently identified across the studies in only 2 locations, one of them corresponding to this anterior cingulate subgenual area. 2 This region has been stimulated with DBS in other neuropsychiatric disorders, and in our experience in treatment-resistant depression, no associated complications have been observed. 7 We suggest that this could be another possible target for the treatment of resistant schizophrenia.Schizophrenia remains one of the leading causes of disability worldwide, with 30% of patients refractory to treatment.We agree that given the severity of this disease and its high consumption of resources, new treatment strategies are needed.We are conducting a prospective, randomized, double-blind clinical trial (clinical trial no.: NCT02377505, clinicaltrials.gov)aimed at assessing the tolerability and efficacy of DBS in refractory schizophrenia (founding Grant Nos.PI12/00042 [E.A.] and PI12/00686 [S.S.] from the Instituto de Salud Carlos III).We randomized the therapeutic target (nucleus accumbens vs subgenual area), and after the start of stimulation and a period of clinical stability, we made a crossover phase of generator on or off.We are studying treatment response in terms of neuroimaging (MRI, PET) and clinical variables.

Brain stimulation

10.3171/2015.12.jns152874

Cite

Citations (7)

Resting-state functional connectivity alterations in the default network of schizophrenia patients with persistent auditory verbal hallucinations

Schizophrenia Research (2014)

Anna Alonso-Solís Yolanda Vives‐Gilabert Eva Grasa Marı́a J. Portella Mireia Rabella

Hallucinating

Posterior cingulate

Auditory hallucination

Cingulate cortex

Insular cortex

10.1016/j.schres.2014.10.047

Cite

Citations (113)

Influence of clinical and neurocognitive factors in psychosocial functioning after a first episode non-affective psychosis: differences between males and females

Frontiers in Psychiatry (2022)

Maria Serra Sílvia Amoretti Norma Verdolini María Florencia Forte Ana M. Sánchez-Torres

Deficits in psychosocial functioning are present in the early stages of psychosis. Several factors, such as premorbid adjustment, neurocognitive performance, and cognitive reserve (CR), potentially influence functionality. Sex differences are observed in individuals with psychosis in multiple domains. Nonetheless, few studies have explored the predictive factors of poor functioning according to sex in first-episode psychosis (FEP). This study aimed to explore sex differences, examine changes, and identify predictors of functioning according to sex after onset.

Neurocognitive

10.3389/fpsyt.2022.982583

Cite

Citations (2)