Roiz-Santiáñez R, Ayesa-Arriola R, Tordesillas-Gutiérrez D, Ortiz-García de la Foz V, Pérez-Iglesias R, Pazos A, Sánchez E, Crespo-Facorro B
Marqués de Valdecilla University Hospital, IFIMAV, Santander, Spain.
Department of Neuroradiology, Marqués de Valdecilla University Hospital, Santander, Spain.
Psychol Med. 2014 Jun;44(8):1591-604. doi: 10.1017/S0033291713002365. Epub 2013 Sep 26.
Schizophrenia is a chronic brain disorder associated with structural brain abnormalities already present at the onset of the illness. Whether these brain abnormalities might progress over time is still under debate.
The aim of this study was to investigate likely progressive brain volume changes in schizophrenia during the first 3 years after initiating antipsychotic treatment. The study included 109 patients with a schizophrenia spectrum disorder and a control group of 76 healthy subjects. Subjects received detailed clinical and cognitive assessment and structural magnetic resonance imaging (MRI) at regular time points during a 3-year follow-up period. The effects of brain changes on cognitive and clinical variables were examined along with the impact of potential confounding factors.
Overall, patients and healthy controls exhibited a similar pattern of brain volume changes. However, patients showed a significant lower progressive decrease in the volume of the caudate nucleus than control subjects (F 1,307.2 = 2.12, p = 0.035), with healthy subjects showing a greater reduction than patients during the follow-up period. Clinical and cognitive outcomes were not associated with progressive brain volume changes during the early years of the illness.
Brain volume abnormalities that have been consistently observed at the onset of non-affective psychosis may not inevitably progress, at least over the first years of the illness. Taking together with clinical and cognitive longitudinal data, our findings, showing a lack of brain deterioration in a substantial number of individuals, suggest a less pessimistic and more reassuring perception of the illness.
精神分裂症是一种慢性脑部疾病，在疾病发作时就已存在与大脑结构异常相关的情况。这些大脑异常是否会随着时间推移而进展仍存在争议。
本研究的目的是调查在开始抗精神病药物治疗后的头3年里，精神分裂症患者大脑体积可能的进展性变化。该研究纳入了109例精神分裂症谱系障碍患者和一个由76名健康受试者组成的对照组。在3年的随访期间，受试者在定期时间点接受详细的临床和认知评估以及结构磁共振成像（MRI）检查。研究了大脑变化对认知和临床变量的影响以及潜在混杂因素的影响。
总体而言，患者和健康对照组表现出相似的大脑体积变化模式。然而，患者尾状核体积的进展性减小明显低于对照组（F 1,307.2 = 2.12，p = 0.035），在随访期间，健康受试者的减小幅度大于患者。在疾病早期，临床和认知结果与大脑体积的进展性变化无关。
在非情感性精神病发作时一直观察到的大脑体积异常可能并非不可避免地进展，至少在疾病的头几年是这样。结合临床和认知纵向数据，我们的研究结果表明，相当一部分个体不存在大脑恶化情况，这提示对该疾病的看法应少一些悲观，多一些安心。
