The association of psychotic disorders, dopaminergic agents and resting-state EEG/MEG functional connectivity

Psychotic disorders are complex and heterogeneous mental disorders with low recovery rates despite a great amount of research on the topic. Various hypotheses exist as to the etiology of psychotic disorders. Amongst these, the dopamine hypothesis and the dysconnectivity hypothesis have been the most enduring in the last six decades. Little is known on how the dopamine and the dysconnectivity hypothesis are associated. The overarching research question of this thesis is to investigate this knowledge gap.
Resting-state magneto- and electroencephalography (MEG, EEG) were chosen as non-invasive measurement modalities of dysconnectivity at the source and sensor level of the brain in publication 1. Parameters of resting-state EEG microstate classes A-D were used as a global analysis method of functional connectivity at the sensor level of the brain in publications 2 and 3.
The first research question focused on finding systematic evidence on the association of the two hypotheses and was addressed by means of a systematic review (publication 1) of 20 studies published since 2000. Based on the review, no definite conclusion on the association of antipsychotic medication (that mainly acts on the dopamine system) and source- and sensor-level EEG/MEG functional connectivity could be drawn.
The second research question focused on whether differences in parameters of resting-state EEG microstate classes A-D are associated to antipsychotic medication. It was addressed by a study (publication 2) that compared 19-channel clinical EEG recordings of medicated (mFEP, n = 17) and medication-naïve (untreated; uFEP, n = 30) patients with first-episode psychotic disorders (FEP). The study results revealed significant decrease of microstate class A and significant increase of microstate class B to differentiate mFEP from uFEP.
The third research question focused on whether differences in parameters of resting-state EEG microstate classes A-D are associated with psychosis illness progression and transition to psychosis in FEP and ultra-high-risk (UHR) patients. It was addressed by a study (publication 3) that found significantly increased microstate class A to differentiate a combined group of medication-naïve FEP (n = 29) and UHR patients (n = 54) together from healthy controls (HC, n = 25); significantly decreased microstate class B to differentiate FEP from all UHR patients combined; and significantly decreased microstate class D to differentiate UHR-T patients with (n = 20) from UHR-NT patients without (n = 34) later transition to psychotic disorders using 19-channel EEG recordings.
In conclusion across all three publications, an association between the dopamine and the dysconnectivity hypothesis could be demonstrated by means of resting-state EEG microstates assessed in publication 2 and 3. No definite conclusion could be drawn by the systematic review (publication 1). More studies with longitudinal designs are needed to rule-out between-subject differences, track response trajectories, pre-post effects of antipsychotic medication and their association with dysconnectivity. With increased effort, resting-state EEG microstates could contribute to establishing a robust biomarker in a multi- domain approach in order to inform clinicians for the diagnosis, treatment and outcome prediction of psychotic disorders.