Article

A Diagnostic Model Incorporating P50 Sensory Gating and Neuropsychological Tests for Schizophrenia

Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan
PLoS ONE (Impact Factor: 3.53). 02/2013; 8(2):e57197. DOI: 10.1371/journal.pone.0057197
Source: PubMed

ABSTRACT Endophenotypes in schizophrenia research is a contemporary approach to studying this heterogeneous mental illness, and several candidate neurophysiological markers (e.g. P50 sensory gating) and neuropsychological tests (e.g. Continuous Performance Test (CPT) and Wisconsin Card Sorting Test (WCST)) have been proposed. However, the clinical utility of a single marker appears to be limited. In the present study, we aimed to construct a diagnostic model incorporating P50 sensory gating with other neuropsychological tests in order to improve the clinical utility.
We recruited clinically stable outpatients meeting DSM-IV criteria of schizophrenia and age- and gender-matched healthy controls. Participants underwent P50 sensory gating experimental sessions and batteries of neuropsychological tests, including CPT, WCST and Wechsler Adult Intelligence Scale Third Edition (WAIS-III).
A total of 106 schizophrenia patients and 74 healthy controls were enrolled. Compared with healthy controls, the patient group had significantly a larger S2 amplitude, and thus poorer P50 gating ratio (gating ratio = S2/S1). In addition, schizophrenia patients had a poorer performance on neuropsychological tests. We then developed a diagnostic model by using multivariable logistic regression analysis to differentiate patients from healthy controls. The final model included the following covariates: abnormal P50 gating (defined as P50 gating ratio >0.4), three subscales derived from the WAIS-III (Arithmetic, Block Design, and Performance IQ), sensitivity index from CPT and smoking status. This model had an adequate accuracy (concordant percentage = 90.4%; -statistic = 0.904; Hosmer-Lemeshow Goodness-of-Fit Test, = 0.64>0.05).
To the best of our knowledge, this is the largest study to date using P50 sensory gating in subjects of Chinese ethnicity and the first to use P50 sensory gating along with other neuropsychological tests to develop a diagnostic model for schizophrenia. Further research to validate the predictive accuracy of this model by applying it on other samples is warranted.

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    • "In contrast, the HS group showed a significant P50 attenuation effect, where the S 2 elicited a response similar to the S 1 leading to an almost null suppression effect. These effects have consistently been observed in schizophrenia, where patients show considerable reductions in P50 suppression (Shan et al., 2013 "
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    ABSTRACT: Sensory gating is the ability to filter out irrelevant stimuli from the environment. Individuals with schizophrenia consistently demonstrate deficits in this ability leading to sensory overload and cognitive fragmentation. This dysfunction has also been found in schizotypy, which is defined as a manifestation of nonclinical symptoms qualitatively similar to those found in schizophrenia. In the present study, auditory sensory gating was assessed in healthy individuals by testing the attenuation of the P50 event-related potential. The degree of suppression was then correlated with schizotypy by using the O-LIFE questionnaire. Relative to the low-scoring individuals, P50 suppression was significantly reduced in those with high levels of schizotypy. Furthermore, the degree of deficit in P50 gating correlated with both cognitive disorganisation and impulsive nonconformity dimensions of schizotypy. These results suggest that schizotypal individuals may have early sensory gating deficits similar to schizophrenia patients, especially if they display a disorganised or impulsive profile. As they do not exhibit overt psychotic symptoms, it is likely that such deficits represent an underlying core cognitive dysfunction within the schizophrenia spectrum.
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    • "In contrast, the HS group showed a significant P50 attenuation effect, where the S 2 elicited a response similar to the S 1 leading to an almost null suppression effect. These effects have consistently been observed in schizophrenia, where patients show considerable reductions in P50 suppression (Shan et al., 2013 "
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