Levitt James J, Bobrow Laurel, Lucia Diandra, Srinivasan Padmapriya
Department of Psychiatry, VA Boston Healthcare System, Harvard Medical School, Brockton Campus, 116A4, 940 Belmont Street, Brockton, MA 02301, USA.
Curr Top Behav Neurosci. 2010;4:243-81. doi: 10.1007/7854_2010_53.
Brain imaging studies have long supported that schizophrenia is a disorder of the brain, involving many discrete and widely spread regions. Generally, studies have shown decreases in cortical gray matter (GM) volume. Here, we selectively review recent papers studying GM volume changes in schizophrenia subjects, both first-episode (FE) and chronic, in an attempt to quantify and better understand differences between healthy and patient groups. We focused on the cortical GM of the prefrontal cortex, limbic and paralimbic structures, temporal lobe, and one subcortical structure (the caudate nucleus). We performed a search of the electronic journal database PsycINFO using the keywords "schizophrenia" and "MRI," and selected for papers published between 2001 and 2008. We then screened for only those studies utilizing manual or manually edited tracing methodologies for determining regions of interest (ROIs). Each region of interest was indexed independently; thus, one paper might yield results for numerous brain regions. Our review found that in almost all ROIs, cortical GM volume was decreased in the patient populations. The only exception was the caudate nucleus - most studies reviewed showed no change, while one study showed an increase in volume; this region, however, is particularly sensitive to medication effects. The reductions were seen in both FE and chronic schizophrenia. These results clearly support that schizophrenia is an anatomical disorder of the brain, and specifically that schizophrenia patients tend to have decreased cortical GM in regions involved in higher cognition and emotional processing. That these reductions were found in both FE and chronic subjects supports that brain abnormalities are present at the onset of illness, and are not simply a consequence of chronicity. Additional studies assessing morphometry at different phases of the illness, including prodromal stages, together with longitudinal studies will elucidate further the role of progression in this disorder.
长期以来，脑成像研究一直支持精神分裂症是一种脑部疾病，涉及许多离散且广泛分布的区域。一般来说，研究表明皮质灰质（GM）体积减少。在此，我们有选择地回顾了近期关于精神分裂症患者（首发和慢性患者）GM体积变化的论文，试图量化并更好地理解健康组与患者组之间的差异。我们重点关注前额叶皮质、边缘和边缘旁结构、颞叶的皮质GM以及一个皮质下结构（尾状核）。我们使用关键词“精神分裂症”和“MRI”在电子期刊数据库PsycINFO中进行了检索，并选择了2001年至2008年发表的论文。然后，我们仅筛选那些利用手动或手动编辑的追踪方法来确定感兴趣区域（ROI）的研究。每个感兴趣区域是独立索引的；因此，一篇论文可能会得出多个脑区的结果。我们的综述发现，在几乎所有的ROI中，患者群体的皮质GM体积都减少了。唯一的例外是尾状核——大多数综述研究显示没有变化，而一项研究显示体积增加；然而，该区域对药物作用特别敏感。在首发和慢性精神分裂症中均观察到了这种减少。这些结果清楚地支持精神分裂症是一种脑部解剖学疾病，特别是精神分裂症患者在参与高级认知和情绪处理的区域往往皮质GM减少。在首发和慢性患者中都发现了这些减少，这支持脑部异常在疾病发作时就已存在，而不仅仅是慢性病程的结果。评估疾病不同阶段（包括前驱期）形态学的额外研究以及纵向研究将进一步阐明疾病进展在这种疾病中的作用。
