Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
Neuropsychobiology. 2012;66(1):44-9. doi: 10.1159/000338547. Epub 2012 Jul 13.
Schizophrenia is often assumed to comprise a group of biologically distinct disorders, yet it has been difficult to dissect subgroups using biological markers. We review recent brain imaging morphometry studies addressing the issue of heterogeneity within the diagnostic category of schizophrenia. Studies of subgroups of schizophrenia patients have mostly used either symptom structure or clinical course for the delineation of potentially meaningful subgroups. Studies defining subgroups according to outcome, i.e. good versus poor outcome (or 'non-Kraepelinian' vs. 'Kraepelinian', respectively) have shown that while these two subgroups might overlap in the extent (and possibly also strength) of prefrontal deficits, they differ in temporal and occipital areas, where poor-outcome patients show stronger deficits. More recent studies have investigated subgroups of schizophrenia based on factor analysis of psychopathology. They have demonstrated a complex pattern of regional changes, where the typical three subgroups might overlap in prefrontal changes, but show divergence in structural deficits in other areas such as the thalamus, hippocampus, or cerebellum. Altogether, these studies demonstrate that brain structure per se is not a uniform endophenotype, but rather a combination of regional deficits highly heterogeneous in both meeting endophenotype criteria as well as in their distribution within the disease category.
精神分裂症通常被认为包含一组生物学上不同的疾病，但使用生物学标志物来剖析亚组一直很困难。我们回顾了最近的脑影像学形态计量学研究，这些研究探讨了精神分裂症诊断类别内异质性的问题。精神分裂症患者亚组的研究大多使用症状结构或临床病程来划定有意义的亚组。根据结局（即预后良好与预后不良（或分别为“非克拉佩林”与“克拉佩林”）定义亚组的研究表明，尽管这两个亚组在前额叶缺陷的程度（可能还有强度）上可能重叠，但它们在颞叶和枕叶区域存在差异，预后不良的患者在这些区域显示出更强的缺陷。最近的研究基于精神病理学的因子分析研究了精神分裂症的亚组。他们展示了一种复杂的区域变化模式，其中典型的三个亚组在前额叶变化上可能重叠，但在其他区域（如丘脑、海马体或小脑）的结构缺陷上存在分歧。总的来说，这些研究表明，大脑结构本身并不是一个统一的内表型，而是一组区域缺陷的组合，在满足内表型标准以及在疾病类别中的分布方面都具有高度异质性。
