Gogtay Nitin, Sporn Alexandra, Clasen Liv S, Nugent Tom F, Greenstein Deanna, Nicolson Rob, Giedd Jay N, Lenane Marge, Gochman Pete, Evans Alan, Rapoport Judith L
Child Psychiatry Branch, National Institute of Mental Health/NIH, Building 10, Room 3N202, 10 Center Drive, MSC 1600, Bethesda, MD 20892-1600, USA.
Arch Gen Psychiatry. 2004 Jan;61(1):17-22. doi: 10.1001/archpsyc.61.1.17.
Recent anatomical brain magnetic resonance imaging (MRI) studies show a striking postpsychotic progressive loss of cortical gray matter (GM) in patients with childhood-onset schizophrenia (COS), which appears greater than that seen for adult patients. However, the diagnostic specificity and the relationship of these changes to drug treatment and cognitive functioning remain unclear. We performed a comparative prospective brain MRI study in patients with COS and pediatric patients with transient psychosis with behavior problems (psychosis not otherwise specified) provisionally considered multidimensionally impaired (MDI). We hypothesized that cortical GM loss would occur in patients with COS but not in adolescents with atypical psychoses.
Anatomical brain MRI was performed at baseline and follow-up in 19 patients in the MDI group (mean [SD] age of 13.3 [3.1] years); in 23 patients with COS matched for age, sex, IQ score, and drug treatment (mean [SD] age of 13.9 [2.5] years); and 38 healthy control subjects matched for age and sex (mean [SD] age of 13.3 [3.1] years). The mean (SD) follow-up was 2.5 (0.8) years. Volumes of the cerebrum and total and regional GM were obtained by using automated analysis, and percent change in volume across time was calculated. One-way analyses of variance with post hoc Tukey Honestly Significantly Different comparisons were performed to examine group differences in the percent change in GM across follow-up.
The COS group had significantly greater total, frontal, temporal, and parietal GM loss than did the MDI or healthy control groups; analysis of variance post hoc P values ranged from.03 to.001. The MDI and control groups did not differ significantly from each other.
The cortical GM volume loss in COS appears diagnostically specific; it was not seen in children and adolescents with atypical psychosis. Because both patient groups had similar early developmental patterns, cognitive functioning, medications, and hospitalizations, this progressive loss appears to be intrinsic to COS. An ongoing neurodevelopmental process and/or brain response specific to the illness could account for these changes.
近期的大脑解剖磁共振成像（MRI）研究显示，儿童期起病的精神分裂症（COS）患者在精神病发作后出现明显的皮质灰质（GM）进行性丢失，这种丢失似乎比成年患者更为严重。然而，这些变化的诊断特异性以及它们与药物治疗和认知功能的关系仍不明确。我们对COS患者和患有短暂性精神病且有行为问题（未另行指定的精神病）的儿科患者进行了一项比较性前瞻性脑MRI研究，这些儿科患者被临时认为存在多维度损害（MDI）。我们假设皮质GM丢失会发生在COS患者中，而不会发生在非典型精神病的青少年中。
对MDI组的19名患者（平均[标准差]年龄为13.3[3.1]岁）、23名年龄、性别、智商得分和药物治疗相匹配的COS患者（平均[标准差]年龄为13.9[2.5]岁）以及38名年龄和性别相匹配的健康对照者（平均[标准差]年龄为13.3[3.1]岁）在基线和随访时进行大脑解剖MRI检查。平均（标准差）随访时间为2.5（0.8）年。通过自动分析获得大脑、总GM和区域GM的体积，并计算随时间的体积变化百分比。进行单因素方差分析，并采用事后Tukey真实显著差异比较来检验随访期间GM变化百分比的组间差异。
COS组的总GM、额叶、颞叶和顶叶GM丢失显著多于MDI组或健康对照组；方差分析事后P值范围为0.03至0.001。MDI组和对照组之间无显著差异。
COS患者的皮质GM体积丢失似乎具有诊断特异性；在非典型精神病的儿童和青少年中未观察到这种情况。由于两组患者具有相似的早期发育模式、认知功能、药物治疗和住院情况，这种进行性丢失似乎是COS所特有的。持续的神经发育过程和/或特定于该疾病的脑反应可能是这些变化的原因。
