Department of Psychosis Studies, King's College London, King's Health Partners, Institute of Psychiatry, UK.
J Psychiatr Res. 2011 Feb;45(2):190-8. doi: 10.1016/j.jpsychires.2010.05.012. Epub 2010 Jun 30.
Several studies have indicated that people with prodromal signs of psychosis show alterations in the structure and function of the brain when they first present to clinical services. However, the longitudinal course of these abnormalities, and how they relate to subsequent clinical and functional outcome is relatively unclear.
A cohort of subjects at ultra high risk of psychosis were studied using functional magnetic resonance imaging (fMRI) in conjunction with the N-Back task, and volumetric MRI at first clinical presentation and again after one year. Levels of psychopathology and global functioning were assessed at the same time points using the CAARMS, PANSS, and the GAF scale.
At baseline, the high risk group showed reduced activation during the task in the left middle frontal gyrus, supramarginal gyrus and inferior parietal lobule, and reduced gray matter volume in the left middle and medial frontal gyri, left insula and the right anterior cingulate gyrus. Within the high-risk group, there was a positive correlation between the magnitude of the functional and structural alterations in the left middle frontal gyrus. Between presentation and follow up, the severity of perceptual disorder and thought disorder (rated by the CAARMS), and of general psychopathology (rated by the PANSS general score) decreased, and the level of global functioning improved. This clinical and functional improvement was associated with a longitudinal increase in activation in the anterior cingulate and right parahippocampal gyrus. The change in anterior cingulate response was directly correlated with the improvement in the GAF score.
In subjects presenting with prodromal signs of psychosis, reduced prefrontal activation during a working memory task is associated with a reduction in gray matter volume in the same area. Changes in anterior cingulate activation were correlated with functional improvement in this group, consistent with the role of this region in multiple cognitive and social processes.
多项研究表明，出现精神病前驱症状的人在首次就诊于临床服务时，其大脑结构和功能会发生改变。然而，这些异常的纵向过程以及它们与随后的临床和功能结果的关系尚不清楚。
本研究使用功能磁共振成像（fMRI）结合 N-Back 任务，对处于精神病超高风险的受试者队列进行了研究，并在首次临床就诊时和一年后再次进行了容积 MRI 检查。同时使用 CAARMS、PANSS 和 GAF 量表评估了精神病病理水平和整体功能。
在基线时，高风险组在任务期间左额中回、缘上回和下顶叶的激活减少，左额中回、额内侧回、左岛叶和右前扣带回的灰质体积减少。在高风险组内，左额中回的功能和结构改变之间存在正相关。在出现和随访之间，知觉障碍和思维障碍（CAARMS 评定）的严重程度、一般精神病学（PANSS 一般评分评定）的严重程度降低，整体功能水平提高。这种临床和功能的改善与前扣带和右海马旁回的激活纵向增加有关。前扣带反应的变化与 GAF 评分的改善直接相关。
在出现精神病前驱症状的受试者中，工作记忆任务期间前额叶的激活减少与同一区域的灰质体积减少有关。前扣带激活的变化与该组的功能改善相关，这与该区域在多个认知和社会过程中的作用一致。
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