Auditory/visual hallucinations and perceptual anomalies are one of the core symptoms experienced by patients with schizophrenia. Studies have implicated lateral occipital cortex (LOC) as one of the areas to be aberrantly functioning in schizophrenia, possibly associated with the auditory/visual symptoms of schizophrenia. Here we report of a case of a 29-year-old female diagnosed with treatment resistant schizophrenia on clozapine with persistent auditory verbal hallucinations (AVH) and visual anomalies. Upon targeting the LOC (−40, −66, −8) in this patient, there was a ＞ 25% reduction in AVH, with reduction in the frequency of most visual anomalies and an overall significant response in terms of reduction of symptoms and improvement in functioning. We further discuss the potential of LOC as a novel target for neuromodulation in patients exhibiting perceptual abnormalities especially in auditory and visual senses.

Auditory/visual hallucinations and perceptual anomalies are one of the core symptoms experienced by patients with schizophrenia. Studies have implicated lateral occipital cortex (LOC) as one of the areas to be aberrantly functioning in schizophrenia, possibly associated with the auditory/visual symptoms of schizophrenia. Here we report of a case of a 29-year-old female diagnosed with treatment resistant schizophrenia on clozapine with persistent auditory verbal hallucinations (AVH) and visual anomalies. Upon targeting the LOC (−40, −66, −8) in this patient, there was a ＞ 25% reduction in AVH, with reduction in the frequency of most visual anomalies and an overall significant response in terms of reduction of symptoms and improvement in functioning. We further discuss the potential of LOC as a novel target for neuromodulation in patients exhibiting perceptual abnormalities especially in auditory and visual senses.

Auditory/visual hallucinations and perceptual anomalies are one of the core symptoms experienced by patients with schizophrenia. Studies have implicated lateral occipital cortex (LOC) as one of the areas to be aberrantly functioning in schizophrenia, possibly associated with the auditory/visual symptoms of schizophrenia. Here we report of a case of a 29-year-old female diagnosed with treatment resistant schizophrenia on clozapine with persistent auditory verbal hallucinations (AVH) and visual anomalies. Upon targeting the LOC (−40, −66, −8) in this patient, there was a ＞ 25% reduction in AVH, with reduction in the frequency of most visual anomalies and an overall significant response in terms of reduction of symptoms and improvement in functioning. We further discuss the potential of LOC as a novel target for neuromodulation in patients exhibiting perceptual abnormalities especially in auditory and visual senses.

Auditory/visual hallucinations and perceptual anomalies are one of the core symptoms experienced by patients with schizophrenia. Studies have implicated lateral occipital cortex (LOC) as one of the areas to be aberrantly functioning in schizophrenia, possibly associated with the auditory/visual symptoms of schizophrenia. Here we report of a case of a 29-year-old female diagnosed with treatment resistant schizophrenia on clozapine with persistent auditory verbal hallucinations (AVH) and visual anomalies. Upon targeting the LOC (−40, −66, −8) in this patient, there was a ＞ 25% reduction in AVH, with reduction in the frequency of most visual anomalies and an overall significant response in terms of reduction of symptoms and improvement in functioning. We further discuss the potential of LOC as a novel target for neuromodulation in patients exhibiting perceptual abnormalities especially in auditory and visual senses.

Objective: Exacerbated inflammatory pathway has emerged as a predominant etiological construct of major depressive disorder (MDD). Innate immune molecules like complement proteins induce inflammatory responses and also regulate key neurobiological processes. However, there is a dearth of literature on the impact of critical complement proteins in MDD. Herein, plasma profiling of seven complement proteins was carried out to obtain a better insight into the role of the complement pathway in MDD. Methods: Plasma levels of C1q, C3, C3b/iC3b, C4, Factor B, Factor H, and properdin were assayed in 22 patients with MDD and 27 healthy controls by multiplex suspension assay. The patients with MDD were diagnosed as per DSM IV-TR. Hamilton Depression Rating Scale (HAM-D), Montgomery Depression Rating Scale and Clinical Global Improvement were used for clinical assessments of the patients. The plasma levels of these complement proteins were also correlated with various clinical scores and phenotypes of MDD. Results: The patients with MDD and healthy controls did not differ in terms of age and gender (p ＞ 0.1). The patients with MDD had a mean duration of illness of around 3 years, with average number of depressive episodes being 6 and the mean HAM-D score was 19. Of the seven complement components, the plasma levels of C1q, Factor B, and Factor H (p ≤ 0.05) were significantly elevated in MDD patients compared to healthy controls. However, the plasma levels of these complement proteins were not found to correlate with the clinical profile of MDD patients. Conclusion Both Factor B and Factor H are crucial in the induction and regulation of the alternative pathway of complement activation. The alternative pathway also plays a critical role in inflammation. These findings suggest an important role of the alternative complement pathway in immuno-inflammation in MDD.

Interoception is the perception of signals from inside the body. It plays a significant role in the nervous, cardiovascular, respiratory, gastrointestinal, genitourinary, and endocrine systems. It is also closely related to the autonomic nervous system and inflammatory pathways and plays a significant role in our optimal functioning. Recently, interoception has gained more attention in neuropsychiatric research. Anatomical and physiological aspects of interoception like relevant brain areas, the role of the vagus nerve, and the autonomic nervous system are gradually being understood. Different facets of interoception like interoceptive attention, detection, magnitude, discrimination, accuracy, awareness, and appraisal have been proposed and their assessments and importance are being evaluated. Further, interoception is often dysregulated or abnormal in psychiatric disorders. It has been implicated in the psychopathology, etiopathogenesis, clinical features and treatment of mood, anxiety, psychotic, personality and addiction-related disorders. This narrative review attempts to provide a nuanced understanding of the pathway(s), components, functions, assessments, and problems of interoception and will help us to detect its disturbances and evaluate its impact on psychiatric disorders, leading to a better perspective and management. This will also advance interoception-related research.

Transcranial alternating current stimulation (tACS) may modulate neuronal oscillations by applying sinusoidal alternating current, thereby alleviating associated symptoms in schizophrenia. Considering its possible utility in schizophrenia, we reviewed the literature for tACS protocols administered in schizophrenia and their findings. A scoping review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline in databases and clinical trial registers. The search resulted in 59 publications. After excluding review articles unrelated to tACS, trials without published results or not involving patients with schizophrenia, 14 studies were included. Among the included studies/case reports only 5 were randomized controlled therapeutic trials. The studies investigated the utility of tACS for clinical and neurobiological outcomes. All studies reported good tolerability with only transient mild side effects. It was administered mostly during the working memory task (such as computerized n-back task, dual back task, and computerized digit symbol substitution task) for schizophrenia patients with cognitive deficits and during resting state while targeting positive symptoms. A possible reduction in hallucinations and delusions using alpha tACS, and improvement in negative and cognitive deficits with theta and gamma tACS were reported. Nevertheless, one of the randomized controlled trials targeting hallucinations was negative and rigorous large-sample studies are lacking for other domains. The current evidence for tACS in schizophrenia is preliminary though promising. In future, more sham controlled randomized trials assessing the effect of tACS on various domains are needed to substantiate these early findings.

Objective: Schizophrenia is a disorder of language and self, with first-rank symptoms (FRS) as one of the predominant features in a subset of patients. Abnormal language lateralization is hypothesized to underlie the neurobiology of FRS in schizophrenia. The role of Broca’s area with its right-hemispheric counterpart, consisting of pars triangularis (PTr) and pars opercularis (POp) of the inferior frontal gyrus in FRS is undetermined. We compared the volumes and asymmetries of PTr & POp in anti-psychotic-naive schizophrenia patients with FRS (FRS[＋]) with those without FRS (FRS[−]) and healthy-controls (HC) using three dimensional, interactive, semi-automated volumetric morphometry. Methods: Antipsychotic naïve FRS(＋) (n = 27), FRS(−) (n = 24) and HC (n = 51) were carefully assessed with structured and semi-structured clinical tools. T1-weighted images were acquired in a 3T scanner. Volumes of regions of interest were measured independently for both sides using slicer-3D software, and asymmetry indices were calculated. Results: FRS(＋) but not FRS(−) had a significant volume deficit in right PTr after controlling for the potential confounding effects of age, sex, and intracranial volume (p = 0.029). There was a significant leftward asymmetry of PTr in patients with FRS (i.e., leftward asymmetry in patients) (p = 0.026). No significant volume/asymmetry abnormalities were observed in POp. Conclusion Study findings suggest reduced right PTr volume with leftward asymmetry to be associated with FRS in schizophrenia. This is consistent with the loss of Yakovlevian torque in schizophrenia. Role of PTr in the neurobiology of schizophrenia as a disorder of self, speech, and social cognition needs further systematic evaluation in future research.

Objective: Schizophrenia is a disorder of language and self, with first-rank symptoms (FRS) as one of the predominant features in a subset of patients. Abnormal language lateralization is hypothesized to underlie the neurobiology of FRS in schizophrenia. The role of Broca’s area with its right-hemispheric counterpart, consisting of pars triangularis (PTr) and pars opercularis (POp) of the inferior frontal gyrus in FRS is undetermined. We compared the volumes and asymmetries of PTr & POp in anti-psychotic-naive schizophrenia patients with FRS (FRS[＋]) with those without FRS (FRS[−]) and healthy-controls (HC) using three dimensional, interactive, semi-automated volumetric morphometry. Methods: Antipsychotic naïve FRS(＋) (n = 27), FRS(−) (n = 24) and HC (n = 51) were carefully assessed with structured and semi-structured clinical tools. T1-weighted images were acquired in a 3T scanner. Volumes of regions of interest were measured independently for both sides using slicer-3D software, and asymmetry indices were calculated. Results: FRS(＋) but not FRS(−) had a significant volume deficit in right PTr after controlling for the potential confounding effects of age, sex, and intracranial volume (p = 0.029). There was a significant leftward asymmetry of PTr in patients with FRS (i.e., leftward asymmetry in patients) (p = 0.026). No significant volume/asymmetry abnormalities were observed in POp. Conclusion Study findings suggest reduced right PTr volume with leftward asymmetry to be associated with FRS in schizophrenia. This is consistent with the loss of Yakovlevian torque in schizophrenia. Role of PTr in the neurobiology of schizophrenia as a disorder of self, speech, and social cognition needs further systematic evaluation in future research.

Transcranial direct current stimulation (tDCS) is a novel brain stimulation technique which has kindled hope in alleviating motor, language as well as cognitive deficits in neuronal injury. Current case report describes application of tDCS in two phases using two different protocols in a patient with hypoxic injury. In the first phase anodal stimulation of dorsolateral prefrontal cortex improved the language fluency. Subsequently, after 6 months second phase application of anodal stimulation over posterior parietal region targeted arithmetic and working memory deficits. Individualising the treatment protocols of brain stimulation, based on the lesion and the functional deficits, for neuro-rehabilitation is emphasised.
Brain ; Clinical Protocols ; Cognition Disorders ; Dyscalculia ; Hope ; Humans ; Hypoxia-Ischemia, Brain ; Memory, Short-Term ; Neurons ; Parietal Lobe ; Prefrontal Cortex ; Rehabilitation ; Transcranial Direct Current Stimulation