Marenco S, Weinberger D R
Clinical Brain Disorders Branch, IRP, NIMH, NIH, Bethesda, MD 20892, USA.
Dev Psychopathol. 2000 Summer;12(3):501-27. doi: 10.1017/s0954579400003138.
This is a critical review of the literature related to the neurodevelopmental hypothesis of schizophrenia which posits that the illness is related to abnormal brain development. The review focuses on data deriving from clinical studies, and it is organized according to the life phase from which the data were collected: conception and birth, infancy and childhood up to the onset of the illness, after illness onset, and postmortem. The neurodevelopmental hypothesis is supported by several pieces of evidence, including increased frequency of obstetric complications in patients with schizophrenia: the presence of minor physical anomalies; the presence of neurological, cognitive, and behavioral dysfunction long before illness onset; a course and outcome of the illness itself that is incompatible in most cases with a degenerative illness; the stability of brain structural measures over time; and the absence of postmortem evidence of neurodegeneration. A historical perspective on how this research accumulated and a section addressing important areas of future investigation are also provided. We conclude that schizophrenia is certainly not a degenerative brain disorder, and that it is likely that a brain insult in utero or at birth plays a role in its expression. Current evidence cannot completely exclude the role of environmental variables after birth. In addition, it is possible that other psychiatric disorders may also have a neurodevelopmental component.
这是一篇对与精神分裂症神经发育假说相关文献的批判性综述，该假说认为该疾病与大脑发育异常有关。综述聚焦于来自临床研究的数据，并根据收集数据的生命阶段进行组织：受孕与出生、疾病发作前的婴儿期和童年期、疾病发作后以及死后。神经发育假说得到了多项证据的支持，包括精神分裂症患者产科并发症的发生率增加；轻微身体异常的存在；在疾病发作前很久就存在神经、认知和行为功能障碍；在大多数情况下，疾病本身的病程和转归与退行性疾病不相符；脑结构测量随时间的稳定性；以及死后不存在神经退行性变的证据。还提供了关于这项研究如何积累的历史视角以及一个涉及未来重要研究领域的章节。我们得出结论，精神分裂症肯定不是一种退行性脑疾病，并且子宫内或出生时的脑损伤很可能在其表现中起作用。目前的证据不能完全排除出生后环境变量的作用。此外，其他精神障碍也可能具有神经发育成分。
