Brain Imaging and Behavior

, Volume 13, Issue 2, pp 541–553 | Cite as

Frontal lobe functioning during a simple response conflict task in first-episode psychosis and its relationship to treatment response

  • Keith M. ShafritzEmail author
  • Toshikazu Ikuta
  • Allison Greene
  • Delbert G. Robinson
  • Juan Gallego
  • Todd Lencz
  • Pamela DeRosse
  • Peter B. Kingsley
  • Philip R. Szeszko
Original Research


Prior functional magnetic resonance imaging (fMRI) studies have investigated the neural mechanisms underlying cognitive control in patients with psychosis with findings of both hypo- and hyperfrontality. One factor that may contribute to inconsistent findings is the use of complex and polyfactorial tasks to investigate frontal lobe functioning. In the current study we employed a simple response conflict task during fMRI to examine differences in brain activation between patients experiencing their first-episode of psychosis (n = 33) and age- and sex-matched healthy volunteers (n = 33). We further investigated whether baseline brain activation among patients predicted changes in symptom severity and treatment response following 12 weeks of controlled antipsychotic treatment. During the task subjects were instructed to press a response button on the same side or opposite side of a circle that appeared on either side of a central fixation point. Imaging data revealed that for the contrast of opposite-side vs. same-side, patients showed significantly greater activation compared with healthy volunteers in the anterior cingulate cortex and intraparietal sulcus. Among patients, greater baseline anterior cingulate cortex, temporal-parietal junction, and superior temporal cortex activation predicted greater symptom reduction and therapeutic response following treatment. All findings remained significant after covarying for task performance. Intact performance on this relatively parsimonious task was associated with frontal hyperactivity suggesting the need for patients to utilize greater neural resources to achieve task performance comparable to healthy individuals. Moreover, frontal hyperactivity observed using a simple fMRI task may provide a biomarker for predicting treatment response in first-episode psychosis.


Psychosis Schizophrenia Cognitive control Executive function Functional magnetic resonance imaging Treatment response 



We thank Daniel Bentley for assistance with data analysis.


This work was funded by grants from the National Institute of Mental Health to Dr. Szeszko (R01 MH076995), the NSLIJ Research Institute General Clinical Research Center (M01 RR018535), an Advanced Center for Intervention and Services Research (P30 MH090590) and a Center for Intervention Development and Applied Research (P50 MH080173), and by grants to Dr. Shafritz from Hofstra University.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Keith M. Shafritz
    • 1
    • 2
    Email author
  • Toshikazu Ikuta
    • 3
  • Allison Greene
    • 1
  • Delbert G. Robinson
    • 2
    • 4
    • 5
  • Juan Gallego
    • 6
    • 7
  • Todd Lencz
    • 2
    • 4
    • 5
  • Pamela DeRosse
    • 2
    • 4
    • 5
  • Peter B. Kingsley
    • 8
  • Philip R. Szeszko
    • 9
    • 10
  1. 1.Department of PsychologyHofstra UniversityHempsteadUSA
  2. 2.Center for Psychiatric NeuroscienceThe Feinstein Institute for Medical ResearchManhassetUSA
  3. 3.Department of Communication Sciences and Disorders, School of Applied SciencesUniversity of MississippiOxfordUSA
  4. 4.Division of Psychiatry Research, Northwell Health SystemZucker Hillside HospitalGlen OaksUSA
  5. 5.Departments of Psychiatry and Molecular MedicineHofstra Northwell School of MedicineHempsteadUSA
  6. 6.Weill Cornell Medical CollegeNew YorkUSA
  7. 7.New York-Presbyterian Hospital/Westchester DivisionWhite PlainsUSA
  8. 8.Department of RadiologyNorth Shore University HospitalManhassetUSA
  9. 9.James J. Peters VA Medical Center, Mental Illness Research Education Clinical CenterBronxUSA
  10. 10.Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkUSA

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