Pantelis Christos, Velakoulis Dennis, McGorry Patrick D, Wood Stephen J, Suckling John, Phillips Lisa J, Yung Alison R, Bullmore Edward T, Brewer Warrick, Soulsby Bridget, Desmond Patricia, McGuire Philip K
Cognitive Neuropsychiatry Research and Academic Unit, and Melbourne Neuropsychiatry Centre, Mental Health Programme, Department of Psychiatry, University of Melbourne and Sunshine Hospital, Victoria, Melbourne, Australia.
Lancet. 2003 Jan 25;361(9354):281-8. doi: 10.1016/S0140-6736(03)12323-9.
Psychotic disorders, such as schizophrenia, are associated with neuroanatomical abnormalities, but whether these predate the onset of symptoms or develop progressively over the course of illness is unclear. We investigated this issue with MRI to study people with prodromal symptoms who are at ultra high-risk for the development of psychosis.
We did two comparisons, cross-sectional and longitudinal. For the cross-sectional comparison, 75 people with prodromal signs of psychosis were scanned with MRI. After at least 12 months of follow-up, 23 (31%) had developed psychosis and 52 (69%) had not. Baseline MRI data from these two subgroups were compared. For the longitudinal comparison, 21 of the ultra high-risk individuals were scanned again with MRI after at least 12 months. Ten of these had developed psychosis and 11 had not. MRI data from baseline and follow-up were compared within each group of people.
In the cross-sectional comparison, compared with people who did not develop psychosis, those who did develop the disorder had less grey matter in the right medial temporal, lateral temporal, and inferior frontal cortex, and in the cingulate cortex bilaterally. In the longitudinal comparison, when re-scanned, individuals who had developed psychosis showed a reduction in grey matter in the left parahippocampal, fusiform, orbitofrontal and cerebellar cortices, and the cingulate gyri. In those who had not become psychotic, longitudinal changes were restricted to the cerebellum.
Some of the grey-matter abnormalities associated with psychotic disorders predate the onset of frank symptoms, whereas others appear in association with their first expression.
精神分裂症等精神病性障碍与神经解剖学异常有关，但这些异常是在症状出现之前就已存在，还是在疾病过程中逐渐发展，目前尚不清楚。我们通过磁共振成像（MRI）研究前驱症状人群（即处于精神病发展超高风险的人群）来探讨这个问题。
我们进行了横断面和纵向两项比较。在横断面比较中，对75名有精神病前驱症状的人进行了MRI扫描。经过至少12个月的随访，23人（31%）发展为精神病，52人（69%）未发展为精神病。比较了这两个亚组的基线MRI数据。在纵向比较中，对21名超高风险个体在至少12个月后再次进行MRI扫描。其中10人发展为精神病，11人未发展为精神病。比较了每组人群基线和随访时的MRI数据。
在横断面比较中，与未发展为精神病的人相比，发展为精神病的人右侧内侧颞叶、外侧颞叶、额下回以及双侧扣带回皮质的灰质较少。在纵向比较中，再次扫描时，发展为精神病的个体左侧海马旁回、梭状回、眶额皮质和小脑皮质以及扣带回的灰质减少。未发展为精神病的个体，纵向变化仅限于小脑。
与精神病性障碍相关的一些灰质异常在明显症状出现之前就已存在，而其他一些则与症状的首次出现有关。
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