{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T05:10:32Z","timestamp":1778476232377,"version":"3.51.4"},"reference-count":60,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":31,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wellcome Trust Clinical Research Career Development Fellowship","award":["224625\/Z\/21\/Z"],"award-info":[{"award-number":["224625\/Z\/21\/Z"]}]},{"name":"NIHR Oxford Health Biomedical Research Centre","award":["NIHR203316"],"award-info":[{"award-number":["NIHR203316"]}]},{"name":"NIHR or the Department of Health and Social Care"},{"name":"UKRI MRC Clinical Research Training Fellowship"},{"name":"NIHR Academic Clinical Fellowship","award":["ACF-2022-17-009"],"award-info":[{"award-number":["ACF-2022-17-009"]}]},{"name":"NIHR Maudsley Biomedical Centre Predoctoral Fellowship"},{"name":"NIHR Academic Clinical Fellowship","award":["ACF-2023-13-016"],"award-info":[{"award-number":["ACF-2023-13-016"]}]},{"name":"NIHR Academic Clinical Fellowship","award":["ACF-2023-17-017"],"award-info":[{"award-number":["ACF-2023-17-017"]}]},{"name":"SNSF Post-Doctoral Mobility Fellowship","award":["P500PM_217669"],"award-info":[{"award-number":["P500PM_217669"]}]},{"DOI":"10.13039\/501100000272","name":"UK National Institute for Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100012176","name":"Maudsley Charity","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012176","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000874","name":"Brain and Behaviour Research Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000874","id-type":"DOI","asserted-by":"crossref"}]},{"name":"UK Academy of Medical Sciences"},{"name":"NIHR and the Rosetrees trust"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Hypothesis<\/jats:title>\n                    <jats:p>Animal, post-mortem, and pharmacological studies suggest altered choline levels in psychosis. Proton magnetic resonance spectroscopy (1H-MRS) may allow in vivo investigation of the cholinergic system. This meta-analysis examined the magnitude and variability of 1H-MRS choline across the psychosis spectrum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Following a pre-registered protocol (CRD42023403879), we searched MEDLINE, EMBASE, and PsycINFO for studies reporting 1H-MRS choline levels in individuals with psychosis, clinical high risk (CHR) states, and healthy controls. Standardized mean differences (SMDs) and log coefficient of variation ratios were pooled using random-effects meta-analysis, stratified by brain region and clinical subgroup. Meta-regression examined associations with imaging and clinical parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Results<\/jats:title>\n                    <jats:p>We included 165 studies comprising 5178 patients and 4269 controls. Choline levels were elevated in people with psychosis in the anterior cingulate cortex (ACC: SMD\u2009=\u20090.23, CI 0.12\u20130.33), medial prefrontal cortex (mPFC: SMD\u2009=\u20090.12, CI 0.01-0.23), and dorsolateral prefrontal cortex (dlPFC: SMD\u2009=\u20090.15, CI 0.01-0.28). Elevations were also seen in CHR cohorts (ACC: SMD 0.19, CI 0.03-0.36; mPFC: SMD 0.36, CI 0.16-0.57), with the largest effects in treatment-resistant schizophrenia (ACC: SMD 0.65, CI 0.38-0.91; dlPFC: SMD 1.13, CI 0.65-1.60). Increased choline variability was observed in the dlPFC in psychosis cohorts and the mPFC and temporal lobe in CHR groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This is the largest meta-analysis of 1H-MRS choline in psychosis to date. Increased variability in psychosis and greater differences in treatment-resistant cohorts suggest increased choline levels might identify a subgroup who do not respond to dopamine antagonist treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/schbul\/sbag069","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T11:29:19Z","timestamp":1776166159000},"source":"Crossref","is-referenced-by-count":0,"title":["Variability and Magnitude of Choline Levels Across the Psychosis Spectrum: A Meta-analysis"],"prefix":"10.1093","volume":"52","author":[{"given":"Jack B","family":"Fanshawe","sequence":"first","affiliation":[{"name":"Department of Psychiatry, University of Oxford , Oxford OX3 7JX ,","place":["United Kingdom"]},{"name":"TUNE-UP service, Oxford Health NHS Foundation Trust , Oxford OX3 7JX ,","place":["United 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