Prepulse inhibition of the acoustically evoked startle reflex in patients with an acute schizophrenic psychosis—A longitudinal study

AbstractDeficits in sensorimotor gating as assessed by prepulse inhibition (PPI) of the startle reflex have been reported in schizophrenia. However, the state or trait nature of these deficits and the relationships with clinical features and psychopathological symptoms are not clear. To explore these issues, we performed a longitudinal study with schizophrenia inpatients.We examined 36 medicated schizophrenia inpatients twice in the course of an acute psychotic episode: recently after admission and after psychopathological improvement 2–3 weeks later. In addition, we examined 18 healthy control subjects twice (two weeks apart).Relative to control subjects, patients with schizophrenia had lower PPI only in the acute, but not in the improved clinical state. Larger PPI deficits were associated with more severe formal thought disorder and bizarre behavior.In the present longitudinal study, PPI deficits in schizophrenic patients appeared to be state dependent. Taking into account recent evidence from the literature we propose that reduced PPI may be a mediating vulnerability marker of schizophrenia: Impairments in sensorimotor mechanisms which subserve PPI of the startle reflex may both predispose individuals to develop psychosis, and, in addition, may covary with the presence of acute positive symptoms.

[1]  U. Meincke,et al.  Electromyographical differentiation between the acoustic blink and startle reflex , 2002, European Archives of Psychiatry and Clinical Neuroscience.

[2]  Emil Kraepelin,et al.  Dementia praecox and paraphrenia , 2002 .

[3]  Franz X. Vollenweider,et al.  Stability of the acoustic startle reflex, prepulse inhibition, and habituation in schizophrenia , 2002, Schizophrenia Research.

[4]  R. Simons,et al.  Reflex modification in psychosis-prone young adults. , 1992, Psychophysiology.

[5]  J. Rotrosen,et al.  Effect of treatment status on prepulse inhibition of acoustic startle in schizophrenia , 2003, Psychopharmacology.

[6]  M. Geyer,et al.  Impaired startle prepulse inhibition and habituation in patients with schizotypal personality disorder. , 1993, The American journal of psychiatry.

[7]  A. Mcghie,et al.  Disorders of attention and perception in early schizophrenia. , 1961, The British journal of medical psychology.

[8]  T. Sharma,et al.  Prepulse inhibition of the startle response in risperidone-treated patients: comparison with typical antipsychotics , 2002, Schizophrenia Research.

[9]  L. Gottschalk,et al.  Effect of sensory overload on psychological state. Changes in social alienation-personal disorganization and cognitive-intellectual impairment. , 1972, Archives of general psychiatry.

[10]  T. Sharma,et al.  Prepulse inhibition of the startle response in men with schizophrenia: effects of age of onset of illness, symptoms, and medication. , 2000, Archives of general psychiatry.

[11]  M. Geyer,et al.  Deficits in prepulse inhibition and habituation in never-medicated, first-episode schizophrenia , 2003, Biological Psychiatry.

[12]  N. Swerdlow,et al.  Startle response models of sensorimotor gating and habituation deficits in schizophrenia , 1990, Brain Research Bulletin.

[13]  K H Nuechterlein,et al.  A heuristic vulnerability/stress model of schizophrenic episodes. , 1984, Schizophrenia bulletin.

[14]  N. Swerdlow,et al.  Symptom correlates of prepulse inhibition deficits in male schizophrenic patients. , 1999, The American journal of psychiatry.

[15]  A. Hamm,et al.  Sensorimotor Gating and Attitudes Related to Schizotypal Proneness , 2001, Psychological reports.

[16]  Christian Grillon,et al.  Gating and habituation of the startle reflex in schizophrenic patients. , 1992 .

[17]  K. Nuechterlein,et al.  Attention and schizophrenia: impaired modulation of the startle reflex. , 1993, Journal of abnormal psychology.

[18]  A. Minassian,et al.  Information processing deficits in acutely psychotic schizophrenia patients medicated and unmedicated at the time of admission. , 2002, The American journal of psychiatry.

[19]  D. Saccuzzo,et al.  Information-processing abnormalities: trait- and state-dependent components. , 1986, Schizophrenia bulletin.

[20]  Kristin S Cadenhead,et al.  Prepulse inhibition and habituation of the startle response are stable neurobiological measures in a normal male population , 1999, Biological Psychiatry.

[21]  D. Bugarski-Kirola,et al.  Prepulse inhibition of acoustic startle in subjects with schizophrenia treated with olanzapine or haloperidol , 2003, Psychiatry Research.

[22]  A. Hamm,et al.  Effective neuroleptic medication removes prepulse inhibition deficits in schizophrenia patients , 2000, Biological Psychiatry.

[23]  T. Sharma,et al.  Normalization of information processing deficits in schizophrenia with clozapine. , 1999, The American journal of psychiatry.

[24]  M S Buchsbaum,et al.  Prefrontal cortex glucose metabolism and startle eyeblink modification abnormalities in unmedicated schizophrenia patients. , 1998, Psychophysiology.

[25]  D L Braff,et al.  Sensorimotor gating and schizophrenia. Human and animal model studies. , 1990, Archives of general psychiatry.

[26]  J. Rotrosen,et al.  Impaired prepulse inhibition of acoustic startle in schizophrenia , 2000, Biological Psychiatry.

[27]  D. Braff,et al.  Clinical and experimental characteristics of "hypothetically psychosis prone" college students. , 1996, Journal of psychiatric research.

[28]  J. Fleiss,et al.  Intraclass correlations: uses in assessing rater reliability. , 1979, Psychological bulletin.

[29]  W. Langewitz,et al.  Midazolam effects on prepulse inhibition of the acoustic blink reflex. , 1999, British journal of clinical pharmacology.

[30]  D L Braff,et al.  Modulation of the startle response and startle laterality in relatives of schizophrenic patients and in subjects with schizotypal personality disorder: evidence of inhibitory deficits. , 2000, The American journal of psychiatry.

[31]  N. Swerdlow,et al.  “Normal” personality correlates of sensorimotor, cognitive, and visuospatial gating , 1995, Biological Psychiatry.

[32]  E. Hazlett,et al.  Attentional modulation of startle in psychosis-prone college students. , 1995, Psychophysiology.

[33]  David L. Braff,et al.  Information-processing deficits and thought disorder in schizophrenia. , 1994 .

[34]  A. Rodríguez-Fornells,et al.  Effects of alprazolam on the acoustic startle response in humans , 1999, Psychopharmacology.

[35]  J. Overall,et al.  The Brief Psychiatric Rating Scale , 1962 .

[36]  R. Kahn,et al.  Effects of Typical and Atypical Antipsychotics on the Prepulse Inhibition of the Startle Reflex in Patients With Schizophrenia , 2002, Journal of clinical psychopharmacology.

[37]  C. A. Morgan,et al.  Preliminary evidence of an association between sensorimotor gating and distractibility in psychosis. , 1996, The Journal of neuropsychiatry and clinical neurosciences.

[38]  D. Braff.  Information processing and attention dysfunctions in schizophrenia. , 1993, Schizophrenia bulletin.

[39]  Torben Mackeprang,et al.  Effects of antipsychotics on prepulse inhibition of the startle response in drug-naïve schizophrenic patients , 2002, Biological Psychiatry.

[40]  M. Geyer,et al.  Prestimulus effects on human startle reflex in normals and schizophrenics. , 1978, Psychophysiology.

[41]  T. Blumenthal,et al.  Normal startle responding in psychosis-prone college students , 1994 .

[42]  D L Braff,et al.  Sensorimotor gating and thought disturbance measured in close temporal proximity in schizophrenic patients. , 1999, Archives of general psychiatry.

[43]  K. Nuechterlein,et al.  Information processing and attentional functioning in the developmental course of schizophrenic disorders. , 1984, Schizophrenia bulletin.

[44]  T. Sharma,et al.  Effects of procyclidine on prepulse inhibition of the acoustic startle response in healthy human volunteers , 2000, Schizophrenia Research.