Professor of Adolescent Brain Development and Mental Health, School of Psychology, University of Birmingham, Edgbaston, England.
Can J Psychiatry. 2013 Jan;58(1):13-8. doi: 10.1177/070674371305800104.
The at-risk mental state (ARMS) has been the subject of much interest during the past 15 years. A great deal of effort has been expended to identify neuroimaging markers that can inform our understanding of the risk state and to help predict who will transition to frank psychotic illness. Recently, there has been an explosion of neuroimaging literature from people with an ARMS, which has meant that reviews and meta-analyses lack currency. Here we review papers published in the past 2 years, and contrast their findings with previous reports. While it is clear that people in the ARMS do show brain alterations when compared with healthy control subjects, there is an overall lack of consistency as to which of these alterations predict the development of psychosis. This problem arises because of variations in methodology (in patient recruitment, region of interest, method of analysis, and functional task employed), but there has also been too little effort put into replicating previous research. Nonetheless, there are areas of promise, notably that activation of the stress system and increased striatal dopamine synthesis seem to mark out patients in the ARMS most at risk for later transition. Future studies should focus on these areas, and on network-level analysis, incorporating graph theoretical approaches and intrinsic connectivity networks.
过去 15 年来，风险精神状态 (ARMS) 一直是人们关注的焦点。人们付出了大量努力来确定神经影像学标志物，以帮助我们理解风险状态，并预测哪些人会发展为明显的精神病。最近，有大量的 ARMS 患者的神经影像学文献发表，这意味着综述和荟萃分析已经过时。在这里，我们回顾了过去 2 年发表的论文，并将他们的发现与以前的报告进行了对比。虽然与健康对照组相比，ARMS 患者的大脑确实存在改变，但这些改变中哪一种可以预测精神病的发生，目前还没有明确的一致性结论。这个问题的出现是由于方法学上的差异（在患者招募、感兴趣区域、分析方法和使用的功能任务上），但对于复制以前的研究，投入的努力还远远不够。尽管如此，还是有一些有希望的领域，特别是应激系统的激活和纹状体多巴胺合成的增加似乎可以标记出 ARMS 中最有可能随后发展为精神病的患者。未来的研究应该集中在这些领域，以及网络层面的分析，包括图论方法和内在连通网络。
