Compton Michael T, Walker Elaine F
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 49 Jesse Hill Jr Drive, SE, Room No. 333, Atlanta, GA 30303, USA.
Schizophr Bull. 2009 Mar;35(2):425-36. doi: 10.1093/schbul/sbn151. Epub 2008 Nov 5.
The well-documented excess of minor physical anomalies (MPAs) among individuals with schizophrenia generally supports the neurodevelopmental model, which posits that both genetic and environmental factors contribute to structural and functional brain changes in the intrauterine and perinatal periods that predispose one to developing schizophrenia. This review synthesizes select areas of research findings on MPAs to address the question, Are MPAs part of the syndrome of schizophrenia? Although MPAs are not specific to schizophrenia, their presence in some patients indicates that aberrations in the development of the nervous system contribute to risk for the disorder. The broadly defined, heterogeneous MPA construct may be of limited value in further elucidating the specific pathophysiology of schizophrenia, though particular anomalies, such as those pertaining to nasal volumes, palatal abnormalities, or craniofacial morphology, may be informative. Given the availability of more sophisticated microarray technologies, and in light of recent findings on spontaneous mutations in patients with schizophrenia, it is possible that MPAs will prove to be useful in identifying etiologic subtypes and/or the loci of genetic risk factors. It remains to be determined whether MPAs-which, of course, are fixed markers present throughout childhood and adolescence well before the onset of the prodrome and psychosis-may have utility in terms of risk stratification for future preventive efforts. Taken together, research findings on MPAs indicate that these minor anomalies are indeed part of some schizophrenia syndromes, representing a stable systemic or physical set of manifestations of the underlying neurodevelopmental processes that lead to the illness.
精神分裂症患者中存在大量有充分记录的轻微身体异常(MPA),这普遍支持了神经发育模型。该模型假定,遗传和环境因素均会导致子宫内和围产期大脑结构和功能发生变化,使人易患精神分裂症。本综述综合了MPA研究结果的某些领域,以回答“MPA是否属于精神分裂症综合征的一部分?”这一问题。虽然MPA并非精神分裂症所特有,但在一些患者中出现表明神经系统发育异常会增加患该疾病的风险。宽泛定义的、异质性的MPA结构在进一步阐明精神分裂症的具体病理生理学方面可能价值有限,不过特定的异常情况,如与鼻腔容积、腭部异常或颅面形态有关的异常,可能会提供有用信息。鉴于更先进的微阵列技术的可用性,以及近期关于精神分裂症患者自发突变的研究结果,MPA有可能被证明在识别病因亚型和/或遗传风险因素位点方面有用。MPA作为在整个童年和青春期都存在的固定标志物,远在前驱症状和精神病发作之前就已出现,其在未来预防工作的风险分层方面是否有用仍有待确定。综合来看,关于MPA的研究结果表明,这些轻微异常确实是某些精神分裂症综合征的一部分,代表了导致该疾病的潜在神经发育过程稳定的系统性或身体表现。